Because my defects are on my patella and trochlea, I will be limited in how far I can bend my knee.
My three areas of damage (circled in red above) are: 2.5 cm x 2.2 cm defect on the lateral femoral trochlea (slightly larger than the size of a quarter), 2 cm x 2 cm on the medial femoral condyle (slightly smaller than the size of a quarter), and 1.5 cm x 1.5 cm defect on my patella (knee cap).
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 develop into hardened cartilage. Through small incisions, your surgeon will place a camera inside the hip joint and use small instruments to repair and/or removed problematic tissue. Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft? Overtime the bone and cartilage will grow into the damaged area to resolve joint pain. I’m going to have a cooler at my bedside to stock up on stuff each day. The healthy cartilage is first removed from a non-weight bearing location.
Once my cells have grown to an appropriate size (enough for both my trochlea and patella defects) they will be ready to be implanted back into my knee. OCA stands for osteochondral allograft transplant surgery. Change ), https://www.facebook.com/groups/130981344407971/?ref=share. This machine does the straightening & bending for me to help with range of motion. The MACI was/is my best chance of having a full recovery to be as painfree as possible, so it was the best first choice surgery. See COVID-19 testing information. Unfortunately, my lesions were too large to have that option. Change ), You are commenting using your Facebook 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.
Which of the following procedures is contraindicated?
An arthroscopic picture taken during diagnostic arthroscopy is shown in Figure A.
But I agree with you that it is nice to have a graft that is already formed and hard rather than waiting 18 months for it to grow. - 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!
( Log Out / Our knee preservation service offers the OATS and MACI procedures. The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage.
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He said the OCA revision surgery would be a salvage procedure to buy me a few more years until I’m a little older for a replacement. These areas of exposed bone are extremely painful. In the case of osteoplasty, excess bone that causes painful impingement inside the hip is removed through an arthroscopic incision. Please take a look at the rest of my blog to see my recovery from this surgery.
That is a pretty large lesion. But at my age, a replacement really isn’t an option. Tissues that have healthy cells, or chondrocytes, are sent off to the lab to grow.
Yes, they can use your own cartilage that is called an Osteochondral autograft transplant surgery (OATS), but it can only be used for smaller lesions. Change ), You are commenting using your Twitter account. I had anther follow-up appointment today with my favorite orthopedic surgeon, oh how I wish he could be the one doing this next surgery. And have as many non-perishable snacks as I can handle to make it easy. These cells are cultured and increased in number over a three to five week period.
When is fill-in expected to occur? 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. I’m 7.5 months post-op (lost track of weeks by now). 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? Technique B is a single-stage procedure. Which of the following statement is true with respect to Technique B and C? Create a free website or blog at WordPress.com. Once joint pain sets in, these small tasks can become a challenge. Because of this, it does not take on the mosaic appearance, but the principle is the same. 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.
With the patella not being very thick, and the shape of the patella, it makes it more difficult to get the transplant graft in there and getting a nice smooth surface with no clefts or divots. 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. How many weeks post-MACI are you? In the OATS procedure, the plugs are usually larger, and therefore only one or two plugs are needed to fill the area of cartilage damage.
A 25-year-old patient undergoes the procedure seen in Figure A. What type of tissue is formed by the activation of marrow mesenchymal cells following subchondral drilling of an 8x7 mm osteochondral defect?
Our knee preservation service offers the OATS and MACI procedures. Alone these surgeries are difficult and long recoveries, all three combined will definitely take its toll on me.
OATS is one technique of several used to treat this problem; the type of procedure is called a mosaicplasty. https://www.facebook.com/groups/130981344407971/?ref=share.
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. Walking, gardening and bending down to pick up your kids are activities we take for granted until they’re no longer second nature. Which of the following statements best describes the incorporation of the graft and biopsy results of the graft at one year?
My surgeon is Dr. Brian Cole in Chicago. The first step was done in May where my doctor performed a knee scope and took a small biopsy of my articular cartilage. Are you able to share his name? Grrrrr . I have had to give up all forms of exercise (biking & swimming even cause me pain) & it has been difficult to do household chores.
I just need to be patient as I wait for the next surgery.
Initially after surgery I will be in another long knee brace and not able to bend my knee on my own. A failed MACI would be my concern after such a long and intense rehab. Hip arthroscopy is a less invasive method to address orthopedic problems that occur inside the hip joint, such as a torn labrum, damaged cartilage, or excessive bone growth.
A biopsy of the repair site at 3 months will reveal more Type I collagen in Technique B than in Technique C. Technique C is a 2-stage procedure. Hang in there! Good for you to do research and consider all of your options before jumping into it without knowing all the details.
I share the good, the bad, and the ugly that doctors won’t tell you about. But usually patients notice improvement in symptoms by 6 months. My goal in sharing my journey is to be able to help someone going through this uncommon surgery. He is also to start a continuous passive motion machine from 30-70 degrees and advance 10 degrees for goal 0-120 degrees. Could you provide the name of the FB support group? ( Log Out / With OCA, can your own cartilage be used from a non-weightbearing joint?
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