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Author Topic: cartilage damage: cartiform vs maci vs allograft  (Read 196 times)

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Offline patrick2020

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cartilage damage: cartiform vs maci vs allograft
« on: August 18, 2020, 10:38:37 PM »

hey fellow knee patients,

i might not be using the right lingo always as not a native speaker and not a med professional - thanks for your patience. about 18 months ago the cartilage under my patella tore, leaving a pretty big damage including a flake that irritated the whole area/my joint. i live in germany, so i started researching and a friend made me aware that in the us you can get a cartilage transplant from a donor, which apparently is not possible in germany/europe (?). so i flew to the us and after seeing three doctors decided to first go with a simple cleaning of the damaged cartilage (i think this is called chondroplasty) at hss in nyc. i had a good 15 months without further surgery afterwards but as expected the pain is starting to kick in again. the question is now what technique to apply. for a donor cartilage (i think called allograft) my doctor in the us says my damage does not have a good form as it is rectangular and not circular (which seems to make this option difficult). he recommends cartiform instead. my doctor in germany suggests to transplant my own cartilage which he will take out in one procedure, grow it in a lab and then reinsert, i think this is called maci, which is the standard procedure in germany as cartiform, allografts etc are not approved i believe. i have heard very mixed things about this approach.

what do you guys think? any experience/view on cartiform? any view on maci?

i read through several posts and the language being used seems much more advnaced - i am only starting to read up on all of this, so thanks for any advise or thoughts

patrick

Offline Celina1989

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Re: cartilage damage: cartiform vs maci vs allograft
« Reply #1 on: August 19, 2020, 06:59:05 AM »
Hi Patrick, I had my ACI (autolougous chondrocyte implantation) in march this year. It was Spherox by the German company Co.don. I think its the only company in Europe that is allowed. I would say this surgery is a good option if you have plenty of time for recovery and don't need to be active fast. At Spherox they put little pearls of your own cartilage back (after they are artriscopicly removed during first surgery). Its the newest generation ACI. You still need to be very careful and start with no weight bearing to full weight bearing at weeks 6 (from week 7 I never used my crutches). Jumping, running and twisting might tore down the cartilage that takes a year to fully mature. My ortopedic surgeon says it is nearly as strong as normal cartilage. My location was not the patella so recovery might be a bit different, but if you have any questions feel free to ask :) my OS also said that the osteochondrol allograft is the option if the ACI would fail, so it should also be done in Europe.

Offline Vickster

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Re: cartilage damage: cartiform vs maci vs allograft
« Reply #2 on: August 19, 2020, 11:10:28 AM »
You can find a list of some cartilage repair specialists here as a starting point
https://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-articular-cartilage-repair

I believe allograft is available in the UK, although only a small handful of surgeons, for example Tim Spalding
(There’s a diary from one of his patients here, who had an allograft and meniscus transplant)
https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=70076.0
« Last Edit: August 19, 2020, 11:12:18 AM 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 kaylachrist

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Re: cartilage damage: cartiform vs maci vs allograft
« Reply #3 on: August 21, 2020, 04:01:45 AM »
Hi Patrick,

I have a very similar injury to yours, a patella cartilage tear that I got in 2018 that was "cleaned up" but still left as a pothole. I'm not ready for more surgery yet but I know it's coming someday, so I try to keep up to date on what's happening in the cartilage world and particularly what works for patella issues like yours and mine.

I've heard of good outcomes in the patella for all of the options you mentioned. If I were you I'd lean towards Cartiform or MACI because they don't involve the bone, and if either of these fails you still have the option of getting an allograft afterwards.

You also might be interested in the new product Cartimax, a putty-like allograft that would work well for filling a large irregular hole like you have. It's not widely known yet, but I see you have been to the U.S. for surgery before so this might be worth looking into if you're willing to travel here again. You will probably need to call around or contact the company directly (Conmed) to find a surgeon who uses it. Cartimax is definitely an option I'm going to look into when it's my time for future surgery.

Here's a presentation on Cartimax that is very encouraging. This was made back when only 13 patients had it. Last I heard in December of 2019 there were around 25 patients now, still mostly patella ones with very good results: https://youtu.be/_b93Mf6MjLI

Best of luck to you.
Jan '18- Injured RK, age 30
June '18- RK arthroscopy, smoothed out patella cartilage damage
Diagnosed with post-traumatic cartilage lesion and osteonecrosis of lateral femoral condyle