Notes from Dr. Borkosky

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 …

Unfortunately, my lesions were too large to have that option. 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.

Of note, he is to be TOUCHDOWN WEIGHTBEARING for the next 6 weeks.

That’s when I will have the second surgery.

Is a 2.5 cm central full-thickness patella defect considered small enough for OATS?

It’s nice to hear about your confidence in your doctor. Once the cells have matured they are placed within a membrane for transfer, and are glued into place. But I guess it’s also better to have a surgeon that is the best in the country for cartilage restoration procedures.

anterior aspect of lateral femoral chondyle and posterolateral tibial plateau

Joint preservation provides alternative treatments to keep you moving. OATS: OATS stands for 'osteochondral autograft transfer system,' and the technique is very similar to mosaicplasty. If that’s the case I might just give up & call it quits.

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. See COVID-19 testing information. 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).

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How many weeks post-MACI are you? I seriously don’t think I can make it to October!

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). My MACI graft has not completely filled in or hardened yet. This will result in pain relief and for the damaged tissue to heal. 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. A failed MACI would be my concern after such a long and intense rehab.

What type of tissue is formed by the activation of marrow mesenchymal cells following subchondral drilling of an 8x7 mm osteochondral defect? 5-10% of people > 40 years old have high grade chondral lesions; location. A 24-year-old female has moderate arthrosis of the medial facet of the patella and the medial femoral condyle. 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? MACI is a two step surgery. My doctor told me we will re-evaluate things at the 12 month mark.

chronic ACL tear. Are you able to share his name?

Both procedures provide the benefit of using your own tissue and cells, so there is a smaller risk of rejection. MACI was superior to microfracture (KOOS response rates 97% vs. 77%), while a positive trend was seen for the individual components of the co- primary efficacy parameter for both pain and function. That must be disheartening to hear that the MACI graft has not filled in or hardened yet.

incidence. Hang in there! My surgeon will cut the matrix to fit my defects and glue it in. ( Log Out /  MACI stands for matrix-induced autologous chondrocyte implantation. 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.

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 mixture of type I and II collagen. In the case of osteoplasty, excess bone that causes painful impingement inside the hip is removed through an arthroscopic incision.

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. Tissues that have healthy cells, or chondrocytes, are sent off to the lab to grow.

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. Ideal candidates for these procedures are typically less than 50 years of age with some cartilage damage, but still have healthy tissue remaining. 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. Because of this, it does not take on the mosaic appearance, but the principle is the same. (OBQ13.99) Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.

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.

This was most likely due to the trauma from my initial knee injury along with the chronic instability I had from my PCL.

But at my age, a replacement really isn’t an option. Was the MACI successful in developing into strong solid cartilage?

A 25-year-old patient undergoes the procedure seen in Figure A. Please take a look at the rest of my blog to see my recovery from this surgery. In my opinion not the best option because there will be areas between the small plugs of no cartilage. Once joint pain sets in, these small tasks can become a challenge. ( Log Out /  Your doctor stated it would be difficult to get the right contour but yet he suggesting it now as an option. Technique B is a single-stage procedure. Biopsy shows type II collagen.

See our COVID-19 FAQ for visitor guidelines and more. Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft? I’m doing ok. Slightly frustrated with the recovery since my symptoms haven’t improved at all. He is to use for at least 2 hours a day for 200 flexion, extension cycles, whichever comes first. 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) Our knee preservation service offers the OATS and MACI procedures.

Thank you and wishing you a full recovery ! Copyright © 2020 Lineage Medical, Inc. All rights reserved. Basically I have three large areas of grade IV articular cartilage damage which means the cartilage has worn down to the bone.

Biopsy shows type I collagen. performed a randomized study to compare the outcomes of MACI vs microfracture for treatment of symptomatic cartilage defects of the knee. It’s so hard to be patient when I’m in pain on a daily basis & it’s affecting my sleep. I will not be able to walk on my leg for the first 6 weeks because we need the bone to heal from the TTO and the OCA graft to heal.

Tested Concept, (OBQ11.1)

A photograph from a recent diagnostic arthroscopy shows the defect (Figure A), which measured 25 x 25mm after debridement. 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.

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Tested Concept. Everything is looking as good as can be expected with my knee right now. In Technique B, healing is initiated by allogeneic chondrocytes reimplanted beneath a periosteal patch. Joint preservation techniques are used on patients who have cartilage wear and tear.

I will be using a continuous passive motion (CPM) machine for the first 6 weeks. 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. TTO stands for tibial tubercle osteotomy. But usually patients notice improvement in symptoms by 6 months.

At this point I wish I would have done OCA for all 3 lesions because my medial femoral condyle OCA is doing fantastic.

I think he will be a little more selective in choosing a donor to make sure the size patella & trochlea matches with my knee. These cells are cultured and increased in number over a three to five week period.

With OCA, can your own cartilage be used from a non-weightbearing joint? What surgical treatment would you recommend?

The OATS procedure, or Osteochondral Autograft Transfer System, is often referred to as a mosaicplasty. I just had a MACI/TTO a week ago. • MACI vs MFX at 5 years • 128 of 140 patients • Continued Superior KOOS Pain Scores and Function Scores for MACI Group ... Long Term OATS vs MFX • Randomized Controlled Trial • 20 OATS, 20 MFX • Lysholm: 1yr, 5yr, 10yr, 15yr • Both groups improved at all time points The transplanted chondrocytes are nonviable and articular cartilage is gradually replaced by fibrocartilage. (OBQ13.152) The transplanted chondrocytes are viable and articular cartilage heals. A review illustrated by a case report. I tried looking but couldn’t find it.

Change ), https://www.facebook.com/groups/130981344407971/?ref=share. 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.

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''. Grrrrr . I’m also going to make tons of freezer meals for easy cooking. (OBQ13.203)

In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone.

They sent that biopsy off to a lab. 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.

For other care needs, call 317-621-2727 to be directed. He said it takes up to 18 months for the grafts to completely fill in and harden. However, in the group with smaller lesions (< 4 cm 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. I hope you are recovering well!

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