Does BUPA cover MACI/ACI surgery

[AlexAb]

Hello everybody,

I hope all is well.
I am having an international coverage from BUPA and I am wondering if they are covering MACI/ACI (Autologous Chondrocytes Implantation) knee surgery. At the moment they are claiming that the procedure is experimental and, hence, they cannot cover the procedure. My treating doctor disputed that by sending them research reports confirming the efficiency of the procedure and at the moment I am waiting for response.

Please, share if somebody had experience dealing with BUPA.

Best,
Alex

[Vickster]

Assume you mean the UK? I believe not but all policies vary. There are no trials ongoing which will lessen your chances (I finally got approval from another company around 9 years ago, not that I actually went through with the main op). The NICE guidance from a year or two back won’t be helping either as the insurance companies tend to follow the NHS stance. Is a couple years old, due for review next year

https://www.nice.org.uk/guidance/ta477

What surgeon/ what hospital as I think there are a handful still doing on NHS.
What’s the history with your knee?

There have been other posts on the subject if you use the search function
Eg https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=59580.msg576002#msg576002

Good luck

[AlexAb]

Thanks!
Actually this is not UK. I am having international gold coverage from Bupa and was planning to undertake the surgery in Germany.
I have a cartilage defect on the femur in patello-femoral joint with the size approximately 25x15mm which was previously treated by Microfracture. However, after 7 years it is still hurting while I am doing sports.
My doctor sent NHS report to BUPA that provides evidence of efficiency of ACI compared to MF. I hope this would help.

Thanks,
Alex

[Vickster]

The NICE guidance actually recommends against ACI if a previous repair has failed. The success rate is also rather lower on the patella. Have you researched all the other options like OATS? The rehab for ACI is tough, one if not two years to get back to anything close to normal. Also is your joint aligned? If not you may need an osteotomy or repair success is even less unlikely

NICE:

Autologous chondrocyte implantation (ACI) is recommended as an option for treating symptomatic articular cartilage defects of the knee, only if:

the person has not had previous surgery to repair articular cartilage defects

there is minimal osteoarthritic damage to the knee (as assessed by clinicians experienced in investigating knee cartilage damage using a validated measure for knee osteoarthritis)

the defect is over 2 cm2 and

the procedure is done at a tertiary referral centre.

[AlexAb]

As I understand there are different generations of ACI that help to overcome the previous failure of microfracture. As for OATs unfortunately my deffect is too large for this procedure.
I think that my joints are perfectly aligned.
Still waiting for response from Bupa :-(

[Vickster]

There’s ACI and MACI as far as I know?
Both involve harvesting cells to attempt to have them form a type of clot in the hole. In MACI, the cells are seeded onto a matrix to help this process

Info here With lots of useful links to click through to

http://www.kneeclinic.info/problems_articular_cartilage.php

http://www.kneeclinic.info/download/CKC_Articular_Cartilage_Repair_Info.pdf

ACI rehab guidelines

http://www.kneeclinic.info/download/CKCGHCFTCCIRehabGuide040612.pdf

OATS actually uses cartilage with a bone plug. Either from own knee (non weight bearing bit) or a cadaver. I don’t think 1.5x2 too big for latter

I doubt BUPA will respond that quickly unfortunately

[AlexAb]

Thanks for that. Just to provide an update.

Bupa approved and I have already undergone the first procedure and the healthy cartilage cells were harvested and I expect the second surgery in two weeks. :-)

[Vickster]

Thanks for that. Just to provide an update.

Bupa approved and I have already undergone the first procedure and the healthy cartilage cells were harvested and I expect the second surgery in two weeks. :-)

Good stuff. Hope it goes well and the rehab is smooth

[Celina1989]

Hi Alex,

Happy for you to hear it all went so fast (and I am also a bit jealous).
I am going to have ACI surgery as well.

Your second surgery will be very soon now so wishing you all strenght and a good recovery! At what hospital will you have the surgery?

I am also curious if you have any advice or information for me. I met some people who have had the surgery many years ago but nobody who had it recently. What recovery time did they say for normal daily life activities?

Best of luck,

Celina