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Author Topic: CMI, Implants and Meniscus Allograft Transplant  (Read 3223 times)

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Offline exception

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CMI, Implants and Meniscus Allograft Transplant
« on: January 30, 2017, 03:34:37 PM »
Hi,

I have been to several doctors over the last year and I have been to some who I consider to be good surgeons. I developed quite a sceptical view on meniscus surgeries.
Two surgeons, who I trust, told me they implanted > 20 CMIs each in the past, and >50% of them had to be revised. They explained me, that the tissue growing into such scaffolds (doesnt matter which ones) is not the same like the original meniscus tissue. One of them explained something like cartilage fibers are streched over from inside to outside of the meniscus, and are alligned over the meniscus in this half-circle-like shape. And the tissue growing into such scaffolds is some scar tissue, that can even harm the cartilage which is left inside the joint, as it is harder and can rub off cartilage. There is absolutely no protective function for the cartilage.

The reason I am writing this is because I searched over months in internet for experiences and informations regarding CMI and Actifit and Nusurface and several other stuff in hope to get my medial meniscus fixed and not think about any future PKR or TKR so much, and I think a lot of others do exactly that. And I want to share the info to others, who are searching for these infos, and are desperate and in hope for these techniques.
I found some good experience topics here which I read completely (robbiepapenfus and others) but also bad experiences where implants failed. But personally I believe, the chance is high to have no cartilage protecting tissue out of scaffold implant procedures and instead have even high chance of damaged cartilage caused by the low quality tissue that grows in.

So for me personally, I know now that CMI,Actifit,etc. is NO option for me and way too risky. Rather I face the facts. For me these companies currently are making money out of the fears and hopes of people. Though, I hope that in future there will be good development and evidence of chondroprotective implants (nusurface, which i expect 2019) or other stuff. Until then, just cope with it.

The surgeons also said that they have very good results with meniscus transplants, which is not an option for me yet, since i still have intact partial meniscus. They told me the indication for it would be if the partial meniscus is gone, or protruded. Then the best method they offer is meniscus allograft transplantation with a bone plug.
Personally I think for this kind of procedure I would search for a very good surgeon with good experience with this procedure and ask around for people who had this done, before deciding to do it.

If anyone has some better information regarding these topics, and newer experiences, please answer. I am very interested in new developments of cartilage and meniscus repair.
I think there are a lot of people out there searching for answers, and we can help each other with only writing, which costs us nothing. And sorry for my engish, its not my first language

Offline Getov95

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #1 on: January 30, 2017, 06:48:46 PM »
I have Actifit implant fitted by prof. Verdonk on my left knee -medial side .Now 17 weeks after surgery i'm fine and i can jump on my operated leg .19 weeks left to full recovery and i belive ,that my condition will be like before .I don't know whether actifit will protect my cartilage for a long time ,but i was required to try ,because i'm 21 old ,whitout medial meniscus and future problems were secure .

Offline exception

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #2 on: January 31, 2017, 08:10:51 AM »
Hi Getov, I read all your posts and happy that you are fine and building up strength. I hope everything will work out for you. I am 29 years old, and my future problems are already secure. I guess all of us who injure the joints will have problems at some point.
How does your knee feel now, do you have pain on load, or weather changes? i hope you keep up writing how your success is with Actifit and if cartilage remains intact after some years

Offline Getov95

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #3 on: January 31, 2017, 05:38:48 PM »
I feel almost like before, now i can make standing long jump around 110cm with my operated leg .And generally my plyometrics improves every week ,and i expect to be in top shape after 9th month .After 6th month i'll start swimming ,and that will be fine for my knees .I don't feel any kind of pain(but my cartilage was fine before the surgery) .Sometimes i hear some popping sound from my knee ,when i folding and unfolding my leg-nothing serious and i hope ,that will stop after my recovery .I really want to be like before my knee problems ,and i give all of my energy and dedication in rehabilitation.Btw i know for one guy from my country ,who started skiing one year after actifit surgery -that's good motivation .

Offline Bardlas

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #4 on: March 09, 2017, 05:23:45 PM »
Hi exception,

I was curious if you got anywhere with NuSurface or any other solutions ? I was accepted for that study in nyc and going to see the specialist in the end of March. I am also looking at Actifit as an option. My problem that these procedures require (or strongly suggest) HTO, which I am not willing to consider.
I can send an update here after I see a NuSurface doc.

Thanks,

Offline Catherine88

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #5 on: March 10, 2017, 06:43:51 PM »
Helo bardias, could you please ask,  if nusurface will be available for lateral compartement in the future? Do they have such a plan? To my knowledge they only do it for medial so far..

Offline Bardlas

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #6 on: March 10, 2017, 07:44:23 PM »
Hi Catherine,

Will sure ask them and post the information here.


Offline exception

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #7 on: March 11, 2017, 01:10:41 PM »
Hi Bardlas,

I have not applied for the study, it is in an too early state currently, in my opinion. But I am looking every week into official news regarding NuSurface, they post on twitter occationally https://twitter.com/hashtag/nusurface

And I am really curious about the first results of the studies.

As for now I have read a lot about actifit failing after 1-2 years in patients, leaving some yellow plastic like fragments in the joint. This is too risky for me personally. And as I wrote in the top, I spoke to a few specialist knee surgeons, who I trust, and they told me they used CMI in some patients in the last years (one of them told me its because surgeons sometimes have to try out promising stuff since studies take so long) and it is by far not recommendable they told me. The scar tissue that is built up, if any, can even harm the joint. They had over 50% revision rate.

If you have news regarding nusurface, PLEASE write here...  Write about your experiences and what they tell you and surgery if you have it

Regarding the HTO, i have read and heard from doctors, that in severe cases, where the leg axis is really significantly out of a straight line it makes sense to do the HTO. The Problem that i can imagine (and i tested unloader one brace) is that you put a lot of load to the other compartment, which is not used to this load and gives in after time. Fortunately my legs are perfectly straight, but i read, that joints can change over the years and it can become bowed.

Thanks
« Last Edit: March 11, 2017, 01:19:52 PM by exception »

Offline Bardlas

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #8 on: March 27, 2017, 09:56:16 PM »
Hi All ,

I just wanted to share some information re my appointment with NuSurface study. Let me start by replying to Catherine88 re the lateral side. Unfortunately, the doctor told me there is no plans to work in that direction because of some complications with fixation and the mechanics of that compartment. Based on doctor's reaction and sort of excitement(including all the required input and my condition) it appeared that I am a good candidate. He told me that my case will be reviewed further in order to approve me for the procedure. I got excluded from the study today based on the following explanation:

"The issue was that you had areas of arthritis that would come into direct contact with the implant, should you be placed into the surgical group. This is obviously a concern for us, since we do not want anything to interfere with the implant and its placement."

Here is some information that I will be happy to share. Unfortunately not much new I believe.
They are testing version 2.0 of the implant. The initial version was not robust enough and failed in a number of cases. This is probably what was mentioned by exception earlier. The doctor showed me one successful case that he did less then a year ago, but , obviously I was not allowed to see the name and get in touch with this person. The
person is doing well so far. I understood that this doctor had a number of surgeries done, I don't know an exact number and some people are doing well. I am not sureif he referred to the overall number (version 1 and 2), but I gathered that the version 1 was a failure in general and they had to improve the material etc. No public data is available. Even some successful cases in Europe from 2008 are not on the website anymore. According to him the information was there earlier. Please ask me any questions, I if can recollect more information.

Now, as far as my personal feeling about NuSurface.... My biggest concern is that the implant is not fixated in any way. He also told me that part of the experiment is to test if it does not break the horn, which is supposed to hold it in place. And obviously one's activities should be modified with no impact sport , jumping etc. That poses a problem personally for me as I play recreational(I would even say competitive) volleyball and this kind of procedure won't go well with NuSurface even if I was a good candidate.
Also on a personal note, I started looking more seriously into Actfit , but saw some not very encouraging information from exception's post :).

Also, regarding the prerequisites as far as one's legs varus. If it is greater than 5 it would eliminate one from the study. In my case it is 5 which is considered mild or may be borderline.
And personally for me it would be HTO (this doctor against it) if I want to continue  playing volleyball or keep it as is with my unloader until I am at the point when I am ready for Makoplasty. According to the stories of Dr Kevin Stone patient's they are involved in a bit more intense sport activities after MAKO than what is defined as low impact :).

Thanks!
 








Offline exception

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #9 on: March 27, 2017, 10:20:23 PM »
Thanks for the very useful infos Bardlas. Seems that this product NuSurface is not good enough yet. I think it will take some time, but already does not sound promising.

Getov and others report very good results in the beginning and mid term with actifit. However there are also very scary posts that i found, even one where a guy shows in photos the yellowish fragment, which blocked his joint and they had to take it out. If i find the links again i will reference here.
Same for other infos.

Thanks

Offline dal_knee

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #10 on: March 28, 2017, 02:31:01 AM »
Thanks very much for posting the information on your consultation for NuSurface here!

Thought it was strange that there is nothing published whatsoever from its use in Europe in the past 8 years or so, yet there is clinical trial availability in the U.S.  Not even case studies from European patients.  Wish there were greater transparency in the experimental outcomes.

Wishing you luck and warm wishes in the search for a better, more functional knee  8)
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 Bardlas

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #11 on: March 28, 2017, 02:48:41 PM »
Thank you all,

It would be great if people would continue sharing their digs on that topic. Wanted to add also that the same doctor(NuSurface) was quite negative about CMI and told me for my case (I am 47) it is not even an option to look at.

Thanks to dal_knee for that reference:

https://www.hss.edu/playbook/meniscus-treatment-using-3d-printing/#.WNpk2W_ytph

but these guys are still far away according to the NuSurface doc I saw.

Also wanted to verify with exception what exactly this procedure about: meniscus "allograft transplantation with a bone plug". I know exception is not US-based , but is not it that procedure that offered by Dr Kevin Stone in CA and Dr Broyles from Baton Rouge, LA.

It would be interesting to hear if jmfronsee had some new ideas.  He had mention on the other thread some options like:

"Fibrofix, another scaffold - using silk worm spun replacement, I think...

Tissue Regenix OrthoPure XM.   

Atlas Knee System"

I read not very positive experiences about Atlas Knee System here on kneeguru. This is another study that is accepting candidates in nyc in April. I was asked by another doctor I saw prior to NuSurface , but was reluctant to give any definitive answer.

Can people comment on Actifit what kind of sport activity it assumes provided it is successfully "implanted".

Thanks!













Offline exception

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #12 on: March 28, 2017, 11:23:18 PM »
Bardlas, the allograft transplant wasn't discussed in detail with the surgeons that i trust, since they both said that I don't need it (yet).

But basically I understood it like this: they explained they take out a boneplug from your leg with exactly the size of an allograft boneplug attached to the dead meniscus and then put this transplant bone-meniscus inside the hole where they took the bone plug out. Obviously a better fixation technique since its bone to bone healing.
Both surgeons assured me they had good results with their patients using that technique, and would do that rather than any experimental scaffold implants.

I found some text with indications/contraindications and fixation techniques described: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438274/

I saw somewhere another technique with sutures for fixation, but probably this is not as good as bone to bone healing and fixation.

I am based in Austria, but I also have contacted Dr. Stone in SF for his opinions. I think he is a good doctor, but probably more expensive than others, which, I believe, can be very good surgeons too.

Thanks

Offline dal_knee

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #13 on: March 29, 2017, 12:37:06 AM »
In order to achieve success with an allograft of bone+meniscus, which would need to be tibia + meniscus, then the overlying femur also needs to achieve near perfect congruence to the shape (at all functional angles) of the donor meniscus, so how likely is that to happen?   I think this type of (Frankenstein) surgery is mostly kept on the "downlow" so-to-speak, probably not likely to be highly successful, and still in the experimental stages.  Their failures are probably gross, get in contact with those patients who are more than 3 years out or so, to ask about their outcomes.
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 exception

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Re: CMI, Implants and Meniscus Allograft Transplant
« Reply #14 on: March 29, 2017, 09:08:33 AM »
Dal_knee, thanks for the info, sounds not very encouraging such a frankenstein surgery :)

I will ask my surgeon about the congruence of femur to the MT and his opinion in 6-8 weeks when i will go to control and update.















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