Advertisement - Hide this advert





Author Topic: AMIC Patella - Any experiences?? (+ femoral derotation)  (Read 389 times)

0 Members and 1 Guest are viewing this topic.

Offline sbugs

  • MICROgeek (<20 posts)
  • *
  • Posts: 10
  • Liked: 0
AMIC Patella - Any experiences?? (+ femoral derotation)
« on: November 10, 2018, 04:05:14 PM »
Hi all.

Quite some time passed since my last post. I have seen more than 10 specialists, done lots of physio, tried to make up my mind. Short story:

Anterior knee pain both knees since ~12 years old
Quite sportive though, especially lots of mountaineering/climbing
2015 patella sublux (?)
2015 patella debridement, chondral flake removal intended but not found  -> very long recovery, never fully recovered
2016 MPFL reconstruction -> made everything worse, daily pain (sometimes quite ok, sometimes really bad)
on good days able to hike a bit (did a max of 700hm up/down and 15km on one day this year -> was ok but kneecap locked up the weeks after, also had more pain the weeks after), bike, swim painful
bad days: difficulties walking stairs, patella locking/getting stuck, quite painful

New information:
femoral torsion of 40, tibial torsion 29
excessive bone growth patella
4 of 8 surgeons thinking MPFL overtight (including the one who did the surgery)

Plan of new surgeon:
femoral derotation
patella osteochondroplasty -> remove overgrowing bone, do microfracture, put tissue on top (AMIC)

I know that cartilage procedures are not that successful under the patella. I didn't find a surgeon who was willing to do a MACI on me. I was suggested AMIC by two surgeons. Did not find so much long-term literature on it, but seems to have not that bad results at least for 2 years (but decline in knee scores > 48 months) see
https://www.researchgate.net/profile/Peter_Behrens/publication/237148201_Mid-term_results_of_autologous_matrix_induced_chondrogenesis_amic_in_cartilage_knee_surgery/links/00b7d5284ffd409d0a000000/Mid-term-results-of-autologous-matrix-induced-chondrogenesis-amic-in-cartilage-knee-surgery.pdf

But the person inventing AMIC (Behrens) is a co-author thus has some financial interest (I am quite sceptical at this point). And the declining results after 3 years really worry me -> I want a solution for longer.

DID ANYONE HERE HAVE SUCCESSFUL AMIC UNDERNEATH THE KNEECAP?

I am at a point where the femoral derotation does not scare me that much. Aligning my legs properly makes a lot of sense to me. But the Osteochondroplasty/AMIC scares me off. My surgeon answered a lot of questions concerning the derotation, also said that MACI doesn't give the best results and doesn't want to do it on me. He believes that the AMIC would give me pain relief, but it also seemed to me that this was more an 'I don't have a better option for you right now' than something he really believes in. All in all iIhave a good feeling with him (he seems competent and honest, works in a public hospital so less financial interests in doing the surgery).

There are days where I just want to get another surgery because I am used to live a sportive life and have trouble in daily activities (especially walking down stairs, squatting, doing work on the floor/kneeling).
But there are also days that I think: hey I can ride a bike, I can take walks, I can swim (with pain but bearable) - why should I take all those troubles to probably waste this?

Can anybody give advice? Did anybody improve or get worse after AMIC on the kneecap? Am I wanting too much if I want to be able to do more sports (also I need to do fieldwork in my job, currently not possible to full extent). Thank you!

Best
Stef
born 1987
since 2000 bilat patellofemoral issues, pain/swelling
very sportive: seemed to improve
03/2015 LK:  MRI revealed loose body 7mm
06/2015 LK: arthroscopy to remove loose body -> chondropathy gr II-III; feeling of instability
10/2016 LK: MPFL recon: pain, mechanical issues since then

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 407
  • Liked: 44
Re: AMIC Patella - Any experiences?? (+ femoral derotation)
« Reply #1 on: November 11, 2018, 09:56:39 AM »
Hi Stef,

Just a few thoughts. Do you have an isolated focal patella cartilage lesion? Or more generalized patella cartilage damage? Isolated focal lesions always have much better chance for successful repair. Have you read closer on the outcomes of the study you mention when it comes to patella vs. other areas? Typically, there is always better results at the other cartilage areas compared to the patella. This could give you an idea of the odds of the procedure. Regarding this type of cartilage repair, it sounds quite similar to what for example @reflex_nl underwent on his patella in the UK. You could look up and read his posts.

Lastly, if you can ride your bike, walk and function normally without pain in your daily life, I believe you should be much more hesitant going forward with any surgery, then if you for example is in constant pain. This type of surgery has no guarantees and can always make things worse. So, you must carefully weigh all factors (repairability of your specific defect, importance for you to get back to sports/more activity, quality of life right now etc.) before making a decision. I understand it is not an easy choice. Maybe someone else with first hand experience of patella cartilage repair could chip in? 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline reflex_nl

  • Regular Poster
  • ***
  • Posts: 137
  • Liked: 13
Re: AMIC Patella - Any experiences?? (+ femoral derotation)
« Reply #2 on: March 06, 2019, 05:50:51 PM »
Hi Stef,

Seems you are more or less in the same boat as I, I do a MCIC procedure by dr. shetty in the UK to restore the cartilage (+MPFL reefing+LR) but, no luck. Just tons on bone growth on the patella. I'm still in pain every day, I can do more or less the same things like you mentioned.

I have no idea what to do next ACI / MACI /etc... all mediocre success rates on the patella. I have not heard about AMIC yet, nor got it recommended.

What are your next ideas/steps?

Reflex



RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline sbugs

  • MICROgeek (<20 posts)
  • *
  • Posts: 10
  • Liked: 0
Re: AMIC Patella - Any experiences?? (+ femoral derotation)
« Reply #3 on: July 28, 2019, 11:53:57 AM »
Hi Reflex and Brandon,

sorry for the late reply - it also had to do with the fact my knee just took a too big part of my life. So many of my thoughts were just circling around the question on how to proceed with it until I decided that I will just take a break and not decide anything for a few months. Also I tried just to accept the status quo, make the best of it, try not to think about it too much and decide just after 09/2019.
My current thoughts (yes somehow today I had the idea that I haven't been on knee guru for more than 6 months) are not to do any surgery soon.
My knee still improved (I didn't suspect this after almost 3 years after the last surgery and so much physio). I am happy with what I can do (I am actually super thankful that I can walk down stairs without pain now most of the days). I am back on mountains (still smaller ones..). Not to the extent that I used to and surely not without pain but still - I could not imagine this 10 months ago. 

So to all hopeless knee patients out there. Improvements are still possible - even if you are close to giving up, and even with very bad prospects when looking at X-Rays, MRIs etc.

I hope this phase will continue for me and I wish that many of you will experience this too.

Cheers
Stef
born 1987
since 2000 bilat patellofemoral issues, pain/swelling
very sportive: seemed to improve
03/2015 LK:  MRI revealed loose body 7mm
06/2015 LK: arthroscopy to remove loose body -> chondropathy gr II-III; feeling of instability
10/2016 LK: MPFL recon: pain, mechanical issues since then

Offline Brandon123

  • Forum Faithful
  • ****
  • Posts: 407
  • Liked: 44
Re: AMIC Patella - Any experiences?? (+ femoral derotation)
« Reply #4 on: July 30, 2019, 09:37:36 AM »
Thanks for the update, Stef! Great to hear that you are slowly improving, despite a negative initial outlook. It gives us all some hope :)
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment















support