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Author Topic: Patellar cartilage tear, considering ACI/Denovo ?  (Read 13019 times)

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Offline jjackish

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Patellar cartilage tear, considering ACI/Denovo ?
« on: September 18, 2015, 10:24:32 AM »
Hi there, i play ice hockey and took a hard fall to the ice a few years ago and tore a piece of cartilage 12 x 5mm  or so on the medial portion of knee.  It is still in place but torn. 

I have pain when doing running for longer periods (for instance greater than a few miles can get fairly stiff afterwards).  Jumping is difficult.  Deep bends especially (squats, etc) are the worst.  I used to love leg workouts and any deep bending particularly with weights will get pain and stiffness later.

I also have some mild medial quad VMO weakness that has been hard to eradicate as it's a little difficult to fully strengthen.

Am considering arthroscopy, and then assuming that likely won't work.  ACI with autograft or Denovo.  Denovo would be covered bc it would be part of a study.  That would be in Minnesota.  The autograft ACI I could do with Dr. Cole at Rush-Chicago.  He could get that covered through insurance reportedly.  He seemed nice but also seemed a little rushed sometimes.  I was leaning towards MN Denovo guy.  Dr. Cole mentioned he may consider a micro fracture on arthroscopy depending on how it looked inside my knee.

Anyhow, looking for anyone's thoughts on this surgery.  My defect is not huge, but I am 39 and like to be quite active and this is a bummer.  Played 2 college sports so it's a big part of my life.  Any help is appreciated!!  Be well.

JJ
« Last Edit: September 18, 2015, 11:39:49 AM by jjackish »

Offline dal_knee

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #1 on: September 18, 2015, 03:55:55 PM »

I would suggest asking your physicians how close is the generated cartilage (histologically) to normal hyaline cartilage.   Real cartilage is critical to outcome.   

Don't accept microfracture, it's unethical due to the subchondral bone damage it creates.

I have heard (ortho assistant) that with DeNovo they were seeing overgrowth as a common complication.  So ask your physician about that.   

Also since you are looking at ACI & DeNovo, you might want to consider Cartiform.   User willrunagain just had his procedure, you may want to take a look at his posts.  I'm seeing 85-90% matching to hyaline for Cartiform.

Another option would be Dr Saw in Malaysia or Dr Broyles in Baton Rouge, if affordable.    Dr Saw claims 95% matching to hyaline.
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #2 on: September 22, 2015, 03:55:51 PM »
Thanks for your advice.  I actually work at a hospital and surprisingly one of the authors of a Denovo patellar article is right at my institution so I talked with him.  He thinks it is maybe the best procedure for the patella based on the contours and other matters.  However, he did not feel that it was totally normal cartilage.  I don't know that there is anything that is.  I have not heard much about Carticel. 

Given everything will go for arthroscopy and then DeNovo likely if that does not work. 

He also agreed that micro fracture is not a good idea. 

Thanks again, JJ
« Last Edit: September 22, 2015, 04:01:05 PM by jjackish »

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #3 on: September 23, 2015, 09:11:11 PM »
jjackish,

Check out this video starting at 4:59.  They directly compare the Cartiform repair tissue to Denovo repair tissue.   The study was done by an independent pathologist.  The science has made it pretty clear. Tissue morphology rating when compared to healthy cartilage is 91/100 for cartiform and a dismal 25/100 for Denovo.

http://www.arthrex.com/resources/presentation/BY488mDq0U2FywFLmQZS0g/cartiform-cartilage-restoration-using-a-novel-cryopreserved-viable-chondral-graft

Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #4 on: September 30, 2015, 07:05:09 AM »
Thanks guys for your replies.  Carticel, while appearing encouraging in that it has good apparent hyaline cartilage matching, doesn't seem to have much of a track record.  I looked through some older posts and there were other mentions of overgrowth and failure, but I don't know if the procedure had been well perfected back then.  I may go see this Dr. Farr and get an opinion.  I don't have trouble with ADL's really so would hate to mess it up with a procedure that went the wrong way.  I will look forward to seeing your progress willrunagain!

Offline dal_knee

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #5 on: September 30, 2015, 03:51:48 PM »

jackish,

I think you are confusing Carticel and Cartiform.   Carticel is same as ACI and is prone to failure.  One problem I'm aware of is that the cartilage that's regenerated doesn't have the needed bony component, and is prone to non-adherence to the underlying bone.    With that being said, I'm certainly not pushing Cartiform.  Just wanted to clarify for everyone's benefit.
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #6 on: September 30, 2015, 11:32:24 PM »
You sir are correct. I didn't realize I was conflating the two. Cartiform!

It'a odd that a search for Cartiform here reveals nothing but crickets.  I actually called Osiris pharmaceuticals to see if they had any follow up studies on their product.  The cartilage restoration market would be huge so I'm surprised there aren't more studies on this?  It just makes me slightly leery that it is as good as advertised. If they thought it was that good I would imagine that they would be doing larger-scale studies to demonstrate its effectiveness?
« Last Edit: October 01, 2015, 01:34:57 AM by jjackish »

Offline dal_knee

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #7 on: October 01, 2015, 03:02:59 AM »

And you should be leery, these cartilage restoration products tend to come and go, after 2 to 5 to 7 year data becomes available.  First, orthopedists will perform the procedure and then follow up analysis begins, all the while having been approved for general market use, somehow.   I'm not an expert in the way these things get released without controlled trials.  Look at microfracture, for example.   How did this technique ever get widely publicized and then implemented as a cartilage restoration procedure?   What about OATS?  My doc says it's only good for 2 years and the 5 year outcomes are not acceptable. 

When you asked Osiris for their latest data, what was the result of that?  According to Dr Farr in video referenced above, approx 200 Cartiforms have been implanted but I cannot find the publicized data on it. 
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #8 on: October 01, 2015, 03:11:41 PM »
The cartiform search results in crickets because with FDA regulations and other obstacles it is very difficult in the USA to come out with new innovative products that can be used on humans.  Let alone market them.  In Europe and Asia, the cartilage repair market offers much more innovative products.  In the US, we still have to use first generation ACI, while in Europe they are onto 4th/5th generation ACI.  If you look back at posts from 2007-2010 most everybody on kneeguru was getting ACI, even though Denovo had been out for 3 years by 2010.  My point is it takes cartilage products quite a bit of time for a new product to gain market share because they require long term studies of up to 5 years for patients to feel comfortable going through such a major surgery.

You can remain skeptical of Cartiform, but remember the procedure is only 2 years old now.  It is the first of its kind where they have figured out how to get mature hyaline cartilage alone to heal to the bone.  Arthrex the leading distributor of orthopedic products signed on only 18 months ago with Osiris to help market Cartiform.  It usually takes up to 5 years for a good cartilage product to make its way into the mainstream market.  And if you look at Arthrex's track record, they are not a company to sign on a product if they don't believe it has potential.

Although there aren't long term studies, every cartilage specialist agrees that the more closely the repair tissue resembles hyaline cartilage the better the outcome.  And cartiform is true hyaline cartilage. There is no denying that.

Offline LauraB12

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #9 on: October 02, 2015, 01:45:28 PM »
(forget it)
« Last Edit: October 02, 2015, 01:50:02 PM by LauraB12 »

Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #10 on: October 03, 2015, 08:46:16 PM »
Great discussion.

Willrunagain, you may be absolutely correct, I don't know.  It's hard to judge at this stage because there doesn't seem to be a tremendous amount of data.  I sent my query to an Orthopedist I know who authored an article on outcomes of DeNovo juvenile allograft.  He does not work for pharmaceuticals however or get paid by them to my knowledge.

Here's what he said:
"If it really can achieve the results that Osiris, or Arthrex, claims, that would be fantastic.  The problem at this point is that none of those claims have been validated with any independent study.  Certainly in the case of Arthrex (who sells the product), they are a great company, but also happy to put exciting products out there without good data...that always is a red flag for me.  So, my opinion at this point is that it is an interesting idea with no data to support it; perhaps there will be, perhaps there won't be.  I have not really looked into using it at this point because of lack of info.  One of my partners has used it, but I don't think he has enough patients nor are they far enough out for him to really know what to think of it.  Jack Farr is a great surgeon, but also very happy to try new things without data.  Since he (or someone like Brian Cole) is the end of the road for many patients, he has some liberty in being able to try new things."
« Last Edit: October 03, 2015, 08:49:19 PM by jjackish »

Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #11 on: October 03, 2015, 08:48:10 PM »
I called Osiris, have not heard back from them.  They didn't seem to indicate they had an ongoing study or a registry of how these patients are doing though from what I could tell.  I am not sure though, will have to wait to see if they get back to me.

I will try to get more information on it, because if it can produce more hyaline like cartilage and with no more downsides, I'm all for it.  I just want to see more numbers, more studies. 

Thanks everyone. 
« Last Edit: October 03, 2015, 08:49:55 PM by jjackish »

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #12 on: October 04, 2015, 01:14:30 AM »
Well I don't know how you're going to find the studies you're looking for on cartiform when the registry only has 600 patients so far. An independent pathologist with no monetary affiliations to arthrex or Osiris graded the repair tissue of cartiform. I still think anyone going with Denovo over cartiform is making a serious mistake. Zimmer makes Denovo and there are far more surgeons in bed with zimmer than there are Osiris. Not to mention zimmer makes the majority of knee replacement parts while Osiris is strictly a biotech company. When it comes to cartilage repair patients are sort of at the mercy of the market and the surgeon, but if you do your research you don't have to be.

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #13 on: October 04, 2015, 01:48:05 AM »
There have been in vivo goat studies and a clinical human case. Both studies graded the cartilage at over 85% true hyaline cartilage. That was enough for me to make an educated decision. I wasn't going to wait around in knee pain for 5 years to see long term studies. If someone wants to wait for long term studies that's great, but I feel the few studies out there are enough to prove it's a lot better than Denovo.

Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #14 on: October 10, 2015, 05:20:06 AM »
Yeah, I heard back from Osiris but the person who contacted me via email had no further information other than to direct me to their website.  Bottom line is they don't have any large studies and they don't seem to be monitoring it in any specific way which makes me a bit leery.  It may be a great product, but if so, they would probably want to do bigger studies.  If it showed efficacy they'd be selling this stuff like crazy. 

Here is the link
http://www.arthrex.com/orthobiologics/cartiform

I may schedule some time with Osiris' biologic sales manager to see if I can get more information. 

Best!

Willrunagain, wish you the best on a full recovery.  Let us know how you are doing!!
« Last Edit: October 10, 2015, 05:23:04 AM by jjackish »

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #15 on: October 12, 2015, 10:09:35 PM »
Thanks for looking into this jjackish.  Let me know when/if you are able to get in touch with an Osiris sales manager. 

I too wish there was an independent study of at least 30 patients or so.  I was only Dr. Farr's 10th or 11th patient when it came to cartiform, but he is seeing good results in his subset of patients.  I sought many opinions before meeting with Dr. Farr.  They all suggested Denovo.  The decision to see Dr. Farr was easy because my insurance wouldn't even approve Denovo.  Since Cartiform qualifies as an osteochondral allograft, there is already an established insurance billing code (27415).

You are right to be worrisome in that Osiris is not publishing much.  I think it has more to do with the fact they are not an orthopedic oriented company rather than it being a poor product.  Zimmer being such a long standing powerhouse in Orthopedics is a big reason Denovo is still so popular.  The mere size of Zimmer is a big entry barrier for Osiris's Cartiform product.

Apparently there have now been over 600 cases to date from what I inferred from Dr. Farr.  That number includes other joints though and not just the knee.  I just recently emailed Dr. Phil Davidson who has supposedly done nearly 30 cartiform procedures.  I have not heard back from him yet, but he put together a powerpoint presentation on Cartiform.  One of the final slides mentioned he is putting together a registry of his patients.  He's done a few second looks and has stated that it resembles hyaline cartilage in firmness and appearance.  I will post if I hear back from Dr. Davidson.


Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #16 on: October 14, 2015, 03:11:11 AM »
Cool good stuff willrunagain, you've done your research so kudos.  Sounds promising! 

I'll meet with an Osiris rep this Friday and let you know.


Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #17 on: October 14, 2015, 10:08:42 PM »
Dang... nice work jjackish.  I have to hand it to you for pulling off a meeting with an Osiris rep!  Please post what you can find out from this person in regards to Cartiform patient results!


Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #18 on: October 27, 2015, 02:59:54 AM »
Yeah, I talked with someone who said a representative would be available this Friday.  I told them when I could meet and never heard back.

Offline poohray32

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #19 on: November 13, 2015, 01:36:00 AM »
Please, keep updating your findings and this thread.   :D

Ive been battling severe knee pain since April 2014.  My O/S took an extremely conservative approach and was completely honest from the get go and said there may be a lot of scenarios we have to pass first. 

At the time of my first MRI I don't think he realized the multiple things wrong with my knee and its surrounding areas.  I had a stress fracture of my tibia close to my knee.  So he treated that first.. Took off 4 months to heal, tried working out and was still in excruciating pain.  Went back and he mentioned how fissured and tore up my cartilage was from my MRI back in April 2014. 

Took a cortisone shot and Naxproxen Rx, nothing helped..

Did a Microfracture on my patella Nov 24 2014.  After a looooooong rehab tried exercising again, still in excrutiating pain going up and down stairs, squatting and still can't even jog to chase my 3 year old..  Did another MRI this past July 2015 said the micro fracture filled the defect in nicely and healed.. but that my pain is due to all the shredded/fissured cartilage under my patella.. 

Asked me to go on a special medical diet to lose 50 lbs I did!  He thought the extra weight I was carrying from post baby was making my knee hurt.. STILL IN THE SAME PAIN..

I have a SCOPE scheduled for Nov 15th to determine if I am a candidate for ACI.  He is afraid I am not because my micro fracture defect is a kissing legion he won't know for sure until he puts a scope in there.  If I am not a candidate for the ACI than he will do to the deNovo tissue graft at that time instead.  Either way I am getting cut WIDE OPEN over my knee.

If I am a candidate for ACI (which he says is better, and has a better success rate 80%) than he will take some healthy cartilage during the scope and send it to the labs.  I will then have my stage 2 surgery on Dec. 30th.   :-\ :-[   

Background; 34 female, athletic, prior D1 field hockey player.  Medial Meniscus tear when I was 17 that was repaired..  played multiple sports year round with ZERO resting.. BIG MISTAKE!!
Left knee Scope - Medial Mensicus, plica removal --12/98
Left knee Microfracture  Trochella Groove 12/14
Left knee Cartiform 11/15
(and scope to harvest healthy cartilage for possible ACI if needed later.)

Offline dal_knee

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #20 on: November 13, 2015, 02:04:38 AM »

Poohray
How did doc treat tibial stress fracture?  These are nearly impossible to treat. I'm assuming it was a weight bearing area.

I would immediately seek second and third opinions as ACI after micro fracture is recipe for failure. Are you not aware that the harvested chondrocytes do not include the necessary bony component that secures the new cartilage to underlying bone?  Is your ORTHO aware ?  Please ask.

As for Denovo. That is also another risky one at least for patellar defects.  The histological composition of it is subpar. You will find a lot of supporting info on this forum. 

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline hopalong2

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #21 on: November 14, 2015, 04:21:45 PM »
Fascinating discussion.  I just wanted to chime in about something upthread.  OATs (allograft) is well-studied, and the 10-year success rate is roughly 82%.  (As someone who had that procedure, I got nervous when I saw the comment that they don't last for more than two years!)  Here is one of several reports that I found:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528935/

Offline jjackish

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #22 on: December 26, 2015, 12:35:36 PM »
poohray, let us know how you are doing.  Good luck!

hopalong, you had OATS and it went pretty well??

I am a physician too, FWIW, although not orthopedic so I don't know that I have much special knowledge apart from anybody here.  I will see if I can meet with Osiris rep again.  They gave me the cold shoulder after initially agreeing to meet.  As for myself, I haven't made any decisions yet.  I have no impairment with ADL's so there's no rush for me. 

Offline hopalong2

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #23 on: December 29, 2015, 11:14:17 PM »
Yes, I had an osteochondral allograft in July 2014 and am pleased with the outcome.  To be clear, however, I am not back to where I was before my injury.  My repaired knee is still noticeably weaker, sometimes stiff and sore, and certain ways of moving, including descending stairs normally, remain challenging.  But overall I feel strong and healthy, and I can walk, hike, and cycle for hours at a time.  Feel free to message me if you have any more specific questions.

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #24 on: December 30, 2015, 04:47:51 AM »
I just wanted to add my 2 cents to this board.  I am 16 weeks post op from cartiform to the patella.  Some of you may be already following me in the post op diary section. 

I had an MRI at 14 weeks and the cartiform was already of equal thickness compared to the rest of my patella cartilage.  It is also well integrated to my subchondral bone which is perhaps the most important thing.

Although I am still in the early stages of recovery, I am very happy with the results thus far.  I just biked over 80 miles last week and wasn't even reminded of my knee problem.  I even cheated a little bit and jogged through a crosswalk last week pain free.

I've been saying this since I've been on this website and I'll say it again. Cartiform is one of the best treatments out there for focal defects.  Denovo and ACI are 3rd class treatments at best.  They do not have the required bony component to ensure good integration to your subchondral bone.  Not to mention the repair tissue does not maintain the normal 3 layered architecture of hyaline cartilage like cartiform does.

Offline psny

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #25 on: December 30, 2015, 07:01:04 PM »
I just wanted to add my 2 cents to this board.  I am 16 weeks post op from cartiform to the patella.  Some of you may be already following me in the post op diary section. 

I had an MRI at 14 weeks and the cartiform was already of equal thickness compared to the rest of my patella cartilage.  It is also well integrated to my subchondral bone which is perhaps the most important thing.

Although I am still in the early stages of recovery, I am very happy with the results thus far.  I just biked over 80 miles last week and wasn't even reminded of my knee problem.  I even cheated a little bit and jogged through a crosswalk last week pain free.

I've been saying this since I've been on this website and I'll say it again. Cartiform is one of the best treatments out there for focal defects.  Denovo and ACI are 3rd class treatments at best.  They do not have the required bony component to ensure good integration to your subchondral bone.  Not to mention the repair tissue does not maintain the normal 3 layered architecture of hyaline cartilage like cartiform does.

It is indeed a wonderful treatment and seems to be the best option right now. The only other competing treatment would be the modified microfracture plus weekly BMAC + PRP + HA injections that known on this forum as the Dr.Saw / Dr.Broyles protocol. It would be really nice if Cartiform was done arthorscopically. It is indeed done arthorscipically for the ankle, not sure why it is not done this way for the knee. I guess it would be difficult to get under the patella.

Offline ArmstrongK

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #26 on: February 01, 2016, 01:36:09 AM »
I wonder if you could get Cartiform if you don't have a full thickness defect.  I have a grade 3 patella cartilage defect so I'm kind of in no man's land. 

Offline dal_knee

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #27 on: February 01, 2016, 02:47:40 AM »
These are purely my own thoughts, but would think the decision making tree would go something like this:  If grade III defect has intact hyaline cartilage, go with Cartiform only.  But if the grade III cartilage is found to be fibrocartilage ( as a response to normal, yet sub-par, healing due to prior injury), than it's ok to rip out that fibrous tissue, apply subchondral drilling (improved version of microfracture) + Cartiform implant.   I think that the Cartiform needs a normally hyaline & intact scaffold to adhere to.
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline canyonking

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #28 on: February 02, 2016, 09:29:13 PM »
I'm with willrunagain on this debate. I had cartiform almost two years ago (in March) and I have loved it. I have no pain in my patella where I used to. I had it scoped about 4 months ago and in the pictures you can see where there is definitely cartilage where there didn't used to be any before. I took a risk getting the surgery done as I was maybe Dr. Davidson's 5th patient at that time for cartiform. I have liked it so much I planned to get it done on my left knee. The problem was I had damage in the trochlear groove and the cartiform would probably have gotten torn up. Insurance wouldn't authorize both cartiform and ftg arthrosurface inlay at the same time so the plan is to get the inlay now, then have the option of getting cartiform in the patella down the road. Although going through two major surgeries on one knee would positively suck. And that's only if my new insurance company will even cover cartiform.

Offline psny

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #29 on: February 03, 2016, 02:30:19 AM »
I'm with willrunagain on this debate. I had cartiform almost two years ago (in March) and I have loved it. I have no pain in my patella where I used to. I had it scoped about 4 months ago and in the pictures you can see where there is definitely cartilage where there didn't used to be any before. I took a risk getting the surgery done as I was maybe Dr. Davidson's 5th patient at that time for cartiform. I have liked it so much I planned to get it done on my left knee. The problem was I had damage in the trochlear groove and the cartiform would probably have gotten torn up. Insurance wouldn't authorize both cartiform and ftg arthrosurface inlay at the same time so the plan is to get the inlay now, then have the option of getting cartiform in the patella down the road. Although going through two major surgeries on one knee would positively suck. And that's only if my new insurance company will even cover cartiform.

How good is it? Can you do sports? Can you lift weights? Or does it only allow basic human activities such as walking, etc.

Offline poohray32

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #30 on: February 09, 2016, 04:13:38 AM »
Sorry all, I never knew my thread from November went thru..

So, it appears I'm the 3rd person on here that has had Cartiform surgery!!  I'm at 12 weeks recovery now.  My OS/Pt are extremely conservative and I appreciate that.. 

I'm finally starting to do more challenging exercises now.  The first phases of recovery are crazy limited because of the weight bearing issues and protecting the graft from forces and impact.

I'm now doing the elliptical everyday, 1 leg down presses on the biodex machine, seated squats and some balancing on one leg while throwing a tiny small med ball at the trampoline (these are my favorite!). PT had me try lunges but that hurt like hell ad put me back a week.

They've given me a portable tens unit/ivf machine for pain relief bc there are days where I still feel like crap.  That's too be expected bc this surgery was pretty invasive.  My knee still swells up considerably and is still warm to the touch but I'm SLOWLY getting better :)
Left knee Scope - Medial Mensicus, plica removal --12/98
Left knee Microfracture  Trochella Groove 12/14
Left knee Cartiform 11/15
(and scope to harvest healthy cartilage for possible ACI if needed later.)

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #31 on: February 09, 2016, 06:36:16 PM »
Poohray - It is strange that your PT already had you doing lunges at only 12 weeks.  I had my cartiform surgery done by Dr. Farr and his rehab guidelines say NO SQUATS or LUNGES until 6 months in bold print.  He said I can bike as much as I want, but was adamant about me avoiding loading my knee too much before 6 months.

Offline ArmstrongK

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #32 on: February 11, 2016, 06:04:37 PM »
CanyonKing:  Did you have grade 4 patella cartilage lesion/defect?  Can you jog? 

And, what is ftg arthrosurface inlay? 

Offline poohray32

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #33 on: February 18, 2016, 02:48:39 AM »
Willrunagain - Yes, I agree I thought they were crazy. I haven't tried them since, even though they were modified and I barely descended they hurt like a m*$&!  I would love a copy of your rehab guideline sheet that would be so awesome. I can't find one anywhere online.  My doctor uses the same guidelines as the CARTICEL REHAB and gave me those handouts after surgery.

I can say that I am only going to PT once a week now, but I am in constant pain all day long now.  Probably from overworking it..
Left knee Scope - Medial Mensicus, plica removal --12/98
Left knee Microfracture  Trochella Groove 12/14
Left knee Cartiform 11/15
(and scope to harvest healthy cartilage for possible ACI if needed later.)

Offline poohray32

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #34 on: February 18, 2016, 02:56:37 AM »
ALSO Willrunagain and CanyonKing - do either one of you ever wear a knee brace or specific unloader brace???  At the end of SOME of my days I am in so much pain I start to limp ;(
Left knee Scope - Medial Mensicus, plica removal --12/98
Left knee Microfracture  Trochella Groove 12/14
Left knee Cartiform 11/15
(and scope to harvest healthy cartilage for possible ACI if needed later.)

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #35 on: February 18, 2016, 03:50:40 PM »
Sorry all. I was about to post my rehab protocol and realized it is copyrighted.  I thought it was strange to have a copyright on a rehab protocol!?
« Last Edit: February 19, 2016, 08:17:22 PM by willrunagain »

Offline poohray32

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #36 on: February 20, 2016, 04:24:24 PM »
Willrunagain.  Its been 13 weeks since my Cartiform surgery.  Taking 2 weeks off of PT to rest my irritated knee per my therapist.  ---- surely due to LUNGES😡  I will still do some light exercises at home.  As for the bracing I had found a good bit of relief with the Donjoy Reaction Web bracing (after my mfx surgery on my trochlea and prior to the Cartiform surgery on my patella.)

How long did you go to physical therapy at an office?
Left knee Scope - Medial Mensicus, plica removal --12/98
Left knee Microfracture  Trochella Groove 12/14
Left knee Cartiform 11/15
(and scope to harvest healthy cartilage for possible ACI if needed later.)

Offline willrunagain

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #37 on: February 22, 2016, 03:06:50 PM »
Poohray - I only did physical therapy at a clinic for the first 3 months post surgery.  Now I go to the gym and do my PT exercises on my own.  I just don't feel like paying the $30 copay for every PT session when all my therapist does is give me one new exercise a week.  My sister has a doctorate of Physical Therapy, so I've just been having her guide me through my rehab protocol for free   :D

I may look into that knee brace.  Thanks for the suggestion.

Offline taylob

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #38 on: July 22, 2016, 09:44:12 PM »
Poohray32: Been a while since you've posted and I wanted to know how things are progressing regarding your Cartiform. I'm new, only just over 2 weeks, but eager to learn more. I did get that lunges aren't going to work at 3 months out, so that's good to know.

Anyway, wishing you the best!

Offline nkaufman

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #39 on: September 14, 2016, 05:27:47 PM »
...
Don't accept microfracture, it's unethical due to the subchondral bone damage it creates.

Another option would be Dr Saw in Malaysia or Dr Broyles in Baton Rouge, if affordable.    Dr Saw claims 95% matching to hyaline.

I thought Dr Broyles did micro-drilling. Is this different from micro-fracture?

Thanks,

Offline dal_knee

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #40 on: September 14, 2016, 06:05:13 PM »
It's similar to microfracture but uses holes that are spaced much closer and are deep enough to access the bone marrow space to generate a lot of bone bleeding. Can't believe it's taken this long for orthos to make an improvement to the microfracture technique. It's like they have no knowledge of the scientific method
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline nkaufman

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Re: Patellar cartilage tear, considering ACI/Denovo ?
« Reply #41 on: September 16, 2016, 01:00:28 PM »
It's similar to microfracture but uses holes that are spaced much closer and are deep enough to access the bone marrow space to generate a lot of bone bleeding. Can't believe it's taken this long for orthos to make an improvement to the microfracture technique. It's like they have no knowledge of the scientific method

The reason I ask is:

From Dr. Broyles website - "The Augmented Marrow Simulation procedure involves an outpatient microdrilling surgery"

From Arthrex/Cartiform - https://www.arthrex.com/resources/patient-education-brochure/0i_0rZOz8UWKGgFPYCmmTA/a-patients-guide-to-cartiform-treatment-options -
"A microfracture procedure, also known as a marrow stimulation technique, consists of removing the damaged cartilage until a border of healthy cartilage is found."

Hence was thinking that perhaps people use the terms interchangeably. Both the above talk about Marrow Simulation.

Thanks,