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Author Topic: MACI for worn-out Cartilage ?  (Read 1494 times)

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Offline HarryInOZ

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MACI for worn-out Cartilage ?
« on: April 17, 2004, 01:54:58 PM »
Hello Knee Geeks.

I am beginning to really suffer from a 15 year old injury, where I injured meniscus, Articular cartilage, and ruptured my ACL (Right Medial). I had an arthroscopy and clean-up at the time, and have got on with a mildly active life since then - Regular Gym Aerobics + occasional Bushwalking / Mountain Climbing. Mimimal Knee pain.

I did another meniscal tear  late 2002, and had an arthroscopy early 2003. The OS diagnosed me as having "Not a happy Knee" - Significan Bony spurs forming on both sides of the knee, and hardly any remaining articular cartilage on the medial side.

Since then, I have started to get increased pain, and have recently stopped Gym aerobics, and started riding a pushbike to keep up some excercise. I can still do stairs with minimal pain, but walking 2 km starts to hurt. 1 hour of aerobics hurts for about 2 days.

Talking again to OS this year, He says I am bone-on-bone or nearly so, and suggested I have a look at my  options - ACI  / Meniscal Repair

I think I'm on the brink of a downward slide, with a significant increase in my knee pain, and I'm hoping I can still avoid TKR for the next 20 or so years (I'm 38 now).

After reading what I could and following the pointers from my OS, I think that my best course of action is to have ACL repaired, and Meniscus repaired with Collagen Meniscal Implant. Finally, to have MACI procedure on the worn / thinned section of articular cartilage.

My problem is that I read that both Collagen Meniscal Implants and MACI are not recommended for sufferers of Osteoarthritis. My OS has never used the word, but I understand that is exactly what I am suffering.

So, does anyone have experience with MACI on knees suffering significant reduction of the joint space, any explanation of why it's not recommended, any other thoughts on a course of action?

Thanks for your intereset, and a great web site.

Cheers, Harry
First injury 1987, Arthroscopy/Meniscectomy/ loose body 1988. New pain 2002, Diagnosed ACL deficient, Meniscal tear, Advanced articular degeneration / Joint space narrowing 2003.

Offline Beauzer

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Re: MACI for worn-out Cartilage ?
« Reply #1 on: April 17, 2004, 04:16:00 PM »
Hi Harry,

I have very similar injuries (ACL recon, multiple menisectomies, several articular cartilage tears).  Bone on bone equals arthritis (whether or not your OS uses that terminology).  Because of that, it's my understanding too that meniscus transplant and ACI aren't helpful.  The arthritis is the endpoint of mensicus damage, and the reason they don't do meniscus transplants in arthritic knees is it doesn't solve the major problem.  I guess if your cartilage damage is limited to a small area, ACI with meniscus transplant might work.  From everything I've read, though, you can't ACI an entire compartment.  I'd be a little wary of undergoing a big procedure like that (really long recovery time, not too certain results) without getting at least a second opinion, preferably from someone who's actually done both together and had a reproduceable good result.

You're lucky in that you're still able to do some activities without too much pain, considering the amount of cartilage loss.  It's hard sometimes.  I've reached the point where I have pain just getting around the house, and often when I'm not doing anything at all.  My OS doesn't even think I'd be a UKR candidate (partial lateral menisectomy, lateral compartment arthritis too) and I'm only 29.  So believe me, I know what a pickle you're in currently.  If you find out any new info on these, let me know.

Good luck,
Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline HarryInOZ

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Re: MACI for worn-out Cartilage ?
« Reply #2 on: April 20, 2004, 01:23:32 PM »
Thanks for your help Danielle.

I'm still living in hope, but I think I may have to accept that I wont be able to do all the things I'd hoped to do. I still haven't got a decisive answer about MACI, but everything I read says I'm already too far gone. Can only hope for a new miracle cure - There's certainly lots of work being done in the area.

I'm sorry that you're in so much pain, At the moment, I only get a mild aching when I do nothing, and still bearable when I overdo things.

All the best with your own Knee,

Harry.
First injury 1987, Arthroscopy/Meniscectomy/ loose body 1988. New pain 2002, Diagnosed ACL deficient, Meniscal tear, Advanced articular degeneration / Joint space narrowing 2003.

Offline Heather M.

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Re: MACI for worn-out Cartilage ?
« Reply #3 on: April 21, 2004, 12:09:46 AM »
I'm not sure about the contraindications, but perhaps microfracture would be helpful and even buy you a few years?  Also, if the damage is limited to one compartment, you may be a candidate for osteotomy (TTT or Fulkerson procedure, probably) to unload that compartment.  A way to see if that might be helpful is to be fitted for an unloader brace.  This will help shift your body weight from the damaged area to the other side (damaged medial means shift to lateral and vice-versa).  Again, these options are only appropriate if you have damage in one compartment.

Assuming you have read the pages on kneeguru about your options, here are some further links:

http://www.steadman-hawkins.com/meniscus/overview.asp
about meniscus injuries and what the options are for treatment

http://www.steadman-hawkins.com/knee_chondral/overview.asp
more on articular cartilage defects

http://www.steadman-hawkins.com/knee_microfracture/overview.asp
info on microfracture from one of the pioneers

http://www.patellapain.com  for an overview of the types of surgeries out there for patello-femoral problems.  Very technical, but good info.  The author of this web page also wrote the book "What your doctor may not tell you about knee surgery" and is very knowledgable.  You may want to get that book through the web page here.

Good luck with your journey.  I feel like knees sometimes are like tires, and they just have a certain number of miles in them.  Mine gave out early--at 31--and that really leaves me very few options.

Heather
« Last Edit: April 21, 2004, 12:10:17 AM by hmaxwell »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline HarryInOZ

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Re: MACI for worn-out Cartilage ?
« Reply #4 on: April 21, 2004, 04:31:41 PM »
Hi Heather,
Thanks for the info and the pointers. I haven't seen the steadman-hawkins pages, so I'll follow them up.
My OS thinks HTO is the way to go, but I'd rather keep this option for later, as I don't want the lateral side to go too soon. I've seen quite a bit about unloader braces, my OS didn't mention this option, but it might be a good temporary solution. I'm hoping that ACI or MACI will be possible - My OS says I'm marginal for it but he doesn't seem to know a lot about it - I know this has a major recovery time, but it should be a good fix, and if it fails I'll still have microfracture / HTO as backups. (plus I'm still dreaming about a miracle cure).

Thanks again. Harry.
First injury 1987, Arthroscopy/Meniscectomy/ loose body 1988. New pain 2002, Diagnosed ACL deficient, Meniscal tear, Advanced articular degeneration / Joint space narrowing 2003.

Offline Beauzer

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Re: MACI for worn-out Cartilage ?
« Reply #5 on: April 21, 2004, 05:41:48 PM »
I have an unloader brace.  It's somewhat uncomfortable and took some getting used to.  But it helps more than anything else.  It might be worth asking your OS about.  (Plus, folks that get relief from an unloader tend to get relief from a HTO, so it's kind of a test drive, without having surgery).

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05