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Author Topic: MACI / OATS, etc.  (Read 279 times)

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Offline MTLover

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MACI / OATS, etc.
« on: May 10, 2019, 05:42:06 PM »
I've been recently diagnosed with a 1.2cm osteochondral "abnormality" on the medial condyle of my tibia.  The doctor has said that the cartilage basically has a hole in it.  It is quite painful to walk, etc. so I have been on crutches since this flared up about a month ago.

I was wondering if anyone knows if there is an age limit in the US to have a procedure like OATS or MACI done?  It seems from what I read, 55 is pretty much the cutoff.

I'm older than that, but the doctor said that the joint space is good and I do not need a knee replacement.

So, he said to pretty much suck it up and deal with the pain.  He said I would continue to get these "flare-ups" for the rest of time...

I would love to hear if anyone over 55 has had any type of cartilage restoration done and what the results have been.  I really don't want to go through life with this type of pain.

Oh, and if anyone knows a surgeon who does this on the "over 55" crowd in the US, could you please let me know?

Thanks!

Offline Vickster

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Re: MACI / OATS, etc.
« Reply #1 on: May 10, 2019, 05:53:20 PM »
There's a list of cartilage repair surgeons here, you could try dropping some emails to get their views

https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-articular-cartilage-repair

You could look on the ICRS site as well

The older MACI and OATS repairs as well as microfracture are fairly hit and miss in terms of efficacy as they produce , the new ones which combine in stem cells with microfracture seem to produce better quality cover / something closer to hyaline cartilage (I think a Dr Cole in the US is using the technique)

Do you have any cover at all over the defect on the MRI?  Is there other wear around the joint?

Resurfacing or a PKR might be better if there's more wear around the defect

Just to note that the femur has a condyle not the tibia (which is flat and has a plateau), so perhaps check which and whether it's on the weight bearing surface. You could also look at unloader braces to open up the joint and relieve pressure (how's the joint space?)

Good luck :)
« Last Edit: May 10, 2019, 05:55:16 PM by Vickster »
Came off bike onto concrete 9/9/09
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Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
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Offline The KNEEguru

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Re: MACI / OATS, etc.
« Reply #2 on: May 11, 2019, 06:56:32 AM »
The summary in this paper may help - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389429/ - three of the authors are from USA. Note that it is Jack Farr with two 'r's (there is a spelling mistake on the paper).
« Last Edit: May 11, 2019, 06:59:05 AM by The KNEEguru »
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Offline MTLover

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Re: MACI / OATS, etc.
« Reply #3 on: May 12, 2019, 10:10:16 PM »
This is what was listed on the MRI report:

Grade III to IV chondromalacia of the medial compartment with osteochondral abnormalities of the medial tibial condyle

Approximately 1.2 cm apparent osteochondral abnormalities of the anterior medial medial tibial condyle with bowing of the cortex in this region..

 Cartilage thinning of the medial and patellofemoral compartments especially over the weightbearing anterior to mid tibial condyle and the lateral facet of patella.

The doctor said my joint space was good and that I didn't need a knee replacement.  In fact, he said that I may never need a knee replacement.

So, unless I find someone that will help people over 55 years old, the current doctor said I will just have to deal with the pain for the rest of my life....

Vickster - I was confused as to the condyle.  The doctor mentioned the femur, but the MRI report states tibia...

Because the joint space is OK - and from the x-ray and MRI looks pretty even, so I'm not sure if even that would help. 

Offline NeePain

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Re: MACI / OATS, etc.
« Reply #4 on: June 18, 2019, 01:27:54 AM »
Instead of MACI,  have you considered Hyalofast stem cell scaffold? I had it done in the US almost 2 years ago as part of a clinical trial.  I was 52 at the time.  The advantage is that it is a single stage procedure. It can
be done either in an open or arthroscopic surgery.  The recovery protocol is similar to MACI.  The only issue I had is that it overfilled and they had to go back in to trim it down (recovery was quick).  The swelling and pain have gone away and may have taken Advil once or twice since the surgery.  I'm back to playing sports although I do have a little difficulty jogging (sprinting I can do- go figure), I'm hoping that I'm just a slow healer.

Hyalofast is legal in Europe and I recommend you look into it. It has good results with people our age.  I just came across 2 other stem cell treatments that seem interesting as well- RECLAIM from the Mayo Clinic, and Impact. Lastly, Last November when they went back in my Doctor took a piece of cartilage to send to the MACI
lab just in case my knee doesn't hold up- I go back in July for my next appointment. I would be over 55 at the
 time if they do another procedure (hope not), but my doctor thinks that I shouldn't have too much difficulty getting approved. 

Best of luck to you.















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