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Author Topic: Which ACI product is available in Europe?  (Read 103 times)

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Offline Celina1989

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Which ACI product is available in Europe?
« on: October 13, 2019, 01:39:49 PM »
My surgeon adviced me to do ACI on my grade 4 OCD defect in the mfc of which previous mfx (1,5 year ago) failed. He sad there is some legal issue with the surgery atm. I googled a bit and found that MACI is suspended because they are no longer produced in Europe and some other products were already suspended "because of commercial issues". I am wondering if anyone in Europe recently had ACI and what product has been used?

I am now also wondering if I can call my specialist a specialist in ACI if he hasn't done the therapy in years (I read the issue started 5 years ago).


Offline Vickster

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Re: Which ACI product is available in Europe?
« Reply #1 on: October 13, 2019, 06:18:03 PM »
OATS allograft seems to be taking over in the U.K. at least among a small proportion of specialist surgeons. Also, there has been some adoption of the microfracture + stemcell modalities (at least in the private sector)
This specialist centre in the U.K. Is doing an ACI plus stem cell trial
https://www.rjah.nhs.uk/Research/ASCOT-Trial.aspx


In the U.K., the regulatory / funding authorities determined that there wasn't enough benefit to ACI/MACI and the private insurers stopped funding

Success of ACI/MACI seems to be pretty hit and miss with a long arduous rehab which might also explain the unwillingness to fund and thus do

The big ACTIVE trial finished a number of years ago and that will also be limiting at the main centres with the cessation of manufacturer funding

Other options such as resurfacing for unicompartmental arthritis also exists as another option that doesn't rely of filling a defect with something liquid and hoping it hardens properly!
« Last Edit: October 13, 2019, 08:04:33 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Celina1989

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Re: Which ACI product is available in Europe?
« Reply #2 on: October 13, 2019, 08:06:25 PM »
Thank you for all the information once again Vickster.

I was almost convinced they would choose OATS for me but they explained that ACI is better for me now and leave OATS as a back up option as the other way around is (nearly) impossible. so I believe my surgeon (after some research I did) but now I am very worried it takes to long to get the surgery as I need to be recovered to start my university master in September (that I posponed for a year). ACI is cvered in the Dutch healthcare if you meet certain criteria.

Offline Vickster

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Re: Which ACI product is available in Europe?
« Reply #3 on: October 13, 2019, 08:19:48 PM »
When I consulted about MACI in 2010, I was told to expect a 2 year recovery to see benefit (weight bearing lateral condyle 1.5cm2 approx back then) (about a year to be back to where I was which actually was good function with moderate pain). Being mildly knock kneed with kissing defect (mild degeneration opposite on tibia) I was given a 25% chance of seeing worthwhile benefit.
 Clearly you need to be realistic about the rehab, will your studies involve being on your feet a lot, travelling, physical activity or essentially desk based. Will you be able to access the specialist physio you'll need etc. These are all things to consider

OATS has a quicker recovery I believe as they basically transplant ready made bone and cartilage rather than liquid!

These are quite investing resources around cartilage repair
http://www.kneeclinic.info/problems_articular_cartilage.php
http://www.kneeclinic.info/download/CKC_Articular_Cartilage_Repair_Info.pdf

Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Celina1989

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Re: Which ACI product is available in Europe?
« Reply #4 on: October 14, 2019, 06:15:12 AM »
My study will start in Septembre, so I got 10 months still. It is a master health science at the university so it is at a desk and sometimes presentation, but not very demanding. I would normally cycle from my room to uni but if it is not possible I could drive so I think after more then 1/2 year after surgery I should be able to. Only heavier thing is needing to do groceries but could always fund a solution.

I got a lot of pro's for this surgery as I am young, I got perfect alligned legs, i got one isolated defect. Only con's are there is a bigger chance on failing cause I had previous mfx and cause it is some long going issue (2 y in Novembre).

I did ask if I should be able to start my study and the nurse practitioner said yes. I also read an average of 87% survival rate after 10 y. So I am positive to the result just it will indeed take forever and if it can't happen soon it might be too late.

Offline Celina1989

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Re: Which ACI product is available in Europe?
« Reply #5 on: October 14, 2019, 10:07:29 AM »
This morning I had some time to read your articles / links. Interesting that in the UK ACI is not allowed as a second cartilage repair treatment while in the Netherlands and USA it is mostly used as a second repair technique (most often after failed microfracture). I got about 7 months for the recovery till I start uni. And should either switch PT to that location or be able to continue but at a lower pace. If I read different recovery protocols in 3 to 6 months you should be able to return to daily activity.

I really value your opinion Vickster and am now doubting if I should go ahead with this ACI or ask for OATS. But if I do OATS I use my back up option and don't know what is possible if that fails. 

Offline Vickster

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Re: Which ACI product is available in Europe?
« Reply #6 on: October 14, 2019, 01:01:15 PM »
You should follow your Dr's advice.
Cost is likely a large part of the UK resistance to do ACI, 2 surgeries, costly processing of the 'raw material' all the follow up and rehab
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up















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