This will result in pain relief and for the damaged tissue to heal. How many weeks post-MACI are you? Joint Preservation: An Alternative to Joint Replacement, How to Talk to Your Doctor About Joint Pain, Combating Shoulder Pain in Contact Sports. See COVID-19 testing information. To register for MyChart, our patient communication and information system, please choose from the following options: If you have an activation code from your enrollment letter/provider: Need Care? TTO stands for tibial tubercle osteotomy.
Which of the following procedures is contraindicated? Sites are re-opening to serve patients with respiratory vs. non-respiratory symptoms; see location/service updates. Which of the following statement is true with respect to Technique B and C? A patient with a symptomatic chondral defect undergoes the arthroscopic procedure seen in Figure A. Change ), You are commenting using your Google account. The autograft transplant might be an option depending on your surgeon. Our hip preservation service offers arthroscopic hip labral repair and hip osteoplasty. He said it takes up to 18 months for the grafts to completely fill in and harden. Once the cells have matured they are placed within a membrane for transfer, and are glued into place. Hang in there! Your doctor stated it would be difficult to get the right contour but yet he suggesting it now as an option.
Although, the administrative assistant told me it will be ANOTHER 3 months from now, & I’m not having that so I’ll be calling the insurance company to get thing prior authed.
MACI seems unpredictable, idk, thus I’m more inclined to go with transplanting cartilage that is already formed and hard rather than waiting months for the transplanted cartilage cells to … anterior aspect of lateral femoral chondyle and posterolateral tibial plateau
This surgery has only been FDA approved since December 2016. They sent that biopsy off to a lab. chronic ACL tear. But usually patients notice improvement in symptoms by 6 months. A 32-year-old female is referred to you for definitive treatment of a symptomatic focal chondral defect on her medial femoral condyle. My doctor is fixing them two different ways. The second part of the surgery is called MACI. Thank you and wishing you a full recovery ! He is also to start a continuous passive motion machine from 30-70 degrees and advance 10 degrees for goal 0-120 degrees. They grow the cells in a matrix, like a very thin sponge, as seen below. Biopsy shows type II collagen. Both procedures provide the benefit of using your own tissue and cells, so there is a smaller risk of rejection. A 24-year-old female has moderate arthrosis of the medial facet of the patella and the medial femoral condyle. It definitely makes me nervous knowing the OCA surgery is going to be very difficult, so I’m really hoping we don’t need to go there. That’s when I will have the second surgery.
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OATS: OATS stands for 'osteochondral autograft transfer system,' and the technique is very similar to mosaicplasty. I think he will be a little more selective in choosing a donor to make sure the size patella & trochlea matches with my knee. In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone.
I just had a MACI/TTO a week ago. These areas of exposed bone are extremely painful. The first step was done in May where my doctor performed a knee scope and took a small biopsy of my articular cartilage. That means I will be on crutches until week 10. Everything is looking as good as can be expected with my knee right now. Many believe that when it comes to joint pain you have only one solution: joint replacement. Of note, he is to be TOUCHDOWN WEIGHTBEARING for the next 6 weeks. I will have yet another dead person in me (my PCL is also a cadaver). Change ), https://www.facebook.com/groups/130981344407971/?ref=share. Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft? Is a 2.5 cm central full-thickness patella defect considered small enough for OATS? Alone these surgeries are difficult and long recoveries, all three combined will definitely take its toll on me. Duif C(1), Koutah MA(1), Ackermann O(2), Spyrou G(1), von Engelhardt LV(3), Kaya D(1), Willburger RE(1), Lahner M(1). Through small incisions, your surgeon will place a camera inside the hip joint and use small instruments to repair and/or removed problematic tissue. How are you doing? Tested Concept. My MACI graft has not completely filled in or hardened yet. Tested Concept, Anterior (Maquet) tibial tubercle osteotomy, Anteromedial (Fulkerson) tibial tubercle osteotomy, Medial opening wedge high tibial osteotomy, Lateral closing wedge high tibial osteotomy, (OBQ10.257) If you are interested in learning more about joint preservation techniques, call 317-621-2727 to schedule an appointment with one of our orthopedic specialists, or sign up for our Online Hip and Knee Pain Seminar for next steps. Overtime the bone and cartilage will grow into the damaged area to resolve joint pain. Community Virtual Care visits available 24/7. My doc will cut off a small piece of my tibia (shin bone) where the patellar tendon attaches, move it forward, and place screws to keep it in place.
My goal in sharing my journey is to be able to help someone going through this uncommon surgery. OATS - MOSAICPLASTY No disease transmission Good chondrocyte survival Reliable bony union Limited donor size Graft size ... MACI vs MFX 137 pts with FU @ 2years KOOS scales MACI was clinically and statistically better for treating symptomatic cartilage defects than MFX
Joint preservation provides alternative treatments to keep you moving. I’m also going to make tons of freezer meals for easy cooking. See if this link works? See our COVID-19 FAQ for visitor guidelines and more. I’m still hoping the surgery will be a success, but I will be heartbroken if I go through all of this and still need another surgery. This was most likely due to the trauma from my initial knee injury along with the chronic instability I had from my PCL.
Initially after surgery I will be in another long knee brace and not able to bend my knee on my own. My doctor told me we will re-evaluate things at the 12 month mark. MACI, or Matrix-Induced Chondrocyte Implantation, is a two-step procedure where new cartilage cells are grown and implanted within the existing damaged cartilage. Biopsy shows type I collagen. But I’m so thankful for tissue donors to give people like me another chance to live life pain free and better than what it was before. OCA stands for osteochondral allograft transplant surgery. These next few months will definitely be an adventure & one that I’m sure I will never want to do again. Amputate my leg and be done with it all together. When this procedure is performed, plugs of cartilage and bone are taken from a healthy, non-weight bearing area of the joint and moved to replace a damaged area.
The literature search was performed using the terms: ``mosaicplasty'' or ``osteochondral transplantation'' or ``OATS'' and ``autologous chondrocyte implantation'' or ``autologous chondrocyte transplantation'' or ``ACI'' or ``matrix-associated autologous chondrocyte implantation'' or``MACI'' and ``combination''. The Facebook group is called MACI support group. MACI is a two step surgery. I tried looking but couldn’t find it. I actually had an appt yesterday with my doctor and he said if I fail MACI then my next option is OCA. Unfortunately, my lesions were too large to have that option. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Thank you for sharing your journey. Although the procedure still remains a 2-stage procedure, the use of the matrix reduces operative time and morbidity and theoretically allows for more even chondrocyte distribution within the defect. However, in the group with smaller lesions (< 4 cm But I guess it’s also better to have a surgeon that is the best in the country for cartilage restoration procedures. For other care needs, call 317-621-2727 to be directed. My doc has been one of the leading surgeons on this new technique. When this procedure is performed, plugs of cartilage and bone are taken from a healthy, non-weight bearing area of the joint and moved to replace a damaged area. (OBQ13.152) The transplanted chondrocytes are viable and articular cartilage heals. - Kris J. Alden, MD, PhD (OSET 2018), Pro: The Autologous Cartilage Tissue Implant - Thomas M. DeBerdino, MD (OSET 2018), Mini-Panel: I Didn’t Realize The Cartilage Lesion Was >2cm But <5cm - Solving The Problem! 5-10% of people > 40 years old have high grade chondral lesions, anterior aspect of lateral femoral chondyle and posterolateral tibial plateau, 70% of lesions found in posterolateral aspect of medial femoral condyle, acute trauma or chronic repetitive overload, impaction resulting in cartilage softening; fissuring; flap tears; or delamination, ICRS (International Cartilage Repair Society) Grading System, Abnormal (lesions extend < 50% of cartilage depth), Severely abnormal (>50% of cartilage depth), Severely abnormal (through the subchondral bone), commonly present with history of precipitating trauma, may complain of effusion, motion deficits, mechanical symptoms (e.g., catching, instability), look for background factors that predispose to the formation of articular defects, assess range of motion, ligamentous stability, gait, used to rule out arthritis, bony defects, and check alignment, most sensitive for early joint space narrowing, used to measure TT-TG when evaluating the patello-femoral joint, most sensitive for evaluating focal defects, Fat-suppressed T2, proton density, T2 fast spin-echo (FSE) offer improved sensitivity and specificity over standard sequences, dGEMRIC (delayed gadolinium-enhanced MRI for cartilage) and T2-mapping are evolving techniques to evaluate cartilage defects and repair, may be used to rule out inflammatory disease, first line of treatment when symptoms are mild, viscosupplementatoin, corticosteroid injections, unloader brace, may provide symptomatic relief but healing of defect is unlikely, acute osteochondral fractures resulting in full-thickness loss of cartilage, treatment is individualized, there is no one best technique for all defects, decision-making algorithm is based on several factors, ability to tolerate extended rehabilitation, presence or absence of subchondral bone involvement, correct malaligment, ligament instability, meniscal deficiency, steochondral autograft transfer (pallative if older/low demand, > 4 cm2 = osteochondral allograft transplantation or autologous chondrocyte impla, address patellofemoral maltracking and malalignment, < 4 cm2 = microfracture or osteochondral autograft transfer, > 4 cm2 = autologous chondrocyte implantation (microfracture if older/low demand), goal is to debride loose flaps of cartilage, include simple arthroscopic procedure, faster rehabilitation, problem is exposed subchondral bone or layers of injured cartilage, unknown natural history of progression after treatment, need osteochondral fragment with adequate subchondral bone, consider drilling subchondral bone or adding local bone graft, fix with absorbable or nonabsorbable screws or devices, best results for unstable osteochondritis dissecans (OCD) fragments in patients with open physis, lower healing rates in skeletally mature patients, nonabsorbable fixation (headless screws) should be removed at 3-6 months, goal is to allow access of marrow elements into defect to stimulate the formation of reparative tissue, includes microfracture, abrasion chondroplasty, osteochondral drilling, defect is prepared with stable vertical walls and the calcified cartilage layer is removed, awls are used to make multiple perforations through the subchondral bone 3 - 4 mm apart, protected weight bearing and continuous passive motion (CPM) are used while, mesenchymal stem cells mature into mainly fibrocartilage, include cost-effectiveness, single-stage, arthroscopic, best results for acute, contained cartilage lesions less than 2 cm x 2cm, poor results for larger defects >2 cm x 2cm, requires limitation of weight bearing for 6 - 8 weeks, goal is to replace a cartilage defect in a high weight bearing area with normal autologous cartilage and bone plug(s) from a lower weight bearing area.
They have all said the first week or two you won’t want to leave your bed because the pain is so bad. Once joint pain sets in, these small tasks can become a challenge. Technique B is a single-stage procedure.
Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. I’m confident in my doctor that if I do have to go through with the OCA revision he is one of the best in the country to do it. In my opinion not the best option because there will be areas between the small plugs of no cartilage. Copyright © 2020 Lineage Medical, Inc. All rights reserved. In the case of osteoplasty, excess bone that causes painful impingement inside the hip is removed through an arthroscopic incision. When is fill-in expected to occur? You're Not Alone.
That was the size of my trochlea defect which is slightly larger than a quarter. At this point I wish I would have done OCA for all 3 lesions because my medial femoral condyle OCA is doing fantastic. OATS is one technique of several used to treat this problem; the type of procedure is called a mosaicplasty.
Since the medial femoral condyle already had microfracture done (little holes poked into the bone) in August 2017 he has to do a procedure called OCA transplant. My surgeon will cut the matrix to fit my defects and glue it in. A photograph from a recent diagnostic arthroscopy shows the defect (Figure A), which measured 25 x 25mm after debridement. My knee gets swollen if I do too much activity, gets stiff in the morning & late at night, causes pain if I walk/stand too much or if I sit in one position too long, so basically it is a huge inconvenience in my life. The transplanted chondrocytes are nonviable and cartilage is used as a scaffold for growth of new articular cartilage. The healthy cartilage is first removed from a non-weight bearing location. Your welcome. I have a very specific rehab protocol that won’t allow me to ride a bike until 10 weeks post-op. I joined a Facebook support group so I can talk with people who are also going through MACI/TTO surgery. I thought I would give a more detailed description of what my next knee surgery will be. These cells are cultured and increased in number over a three to five week period. The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage.
It was definitely a difficult decision for me to make, but in the end I trusted my surgeon and his past experience with patients and that he saw better outcomes using MACI for patella & trochlea vs OCA.
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