I am one of those folks who is lucky enough to have a combination of bad knee genes, an active life style and junk for knee cartilage. A BIG part of the problem started in the early to mid 1990’s when I had a number of scopes on both of my knees where the doctor removed a fair amount of Meniscal cartilage . It turns out that when they remove Meniscal cartilage basically the next day you start to develop Osteoarthritis, and then the remaining cartilage starts to destroy itself. At this point you are on borrowed time and eventually you destroy most of the remaining cartilage and you have a bone on bone condition, which is just a bit uncomfortable (ok, it is very uncomfortable). Now you have a couple of options:
- Do nothing - (a real but sub-optimal option)
- Get a partial or total knee replacement (TKR)
- Get a Autologous Chondrocyte Implantation (ACI) – AKA Cartilage transplant - with supporting procedures
- A variety of other options exist that offer everything from short term relief to absolutely no relief
In 2000 I had to make a decision for my right knee. Being an engineer, I naturally did a lot of research using resources at the NIH Library sometimes referred to as PUBMED, the National Library of Medicine, and the Internet. My conclusion was that doing nothing was not going to work, that I was too active and too young for the knee replacement options, I looked at the group of non-ACI options and decided that there were none that I felt were acceptable – and in fact there seemed to be some folks selling ‘snake oil’ types of solution. I chose the ACI option. A little more research uncovered Dr. Tom Minas and his staff at the Cartilage Replacement Center here in Boston. Dr. Minas is one of the pioneers in this process of Cartilage Repair so he was my first choice.
In making this choice I did not realize that I just decided to make the 6 months to a year after the procedure uncomfortable and a lot of work. For me, the long term rewards made the effort well worth it. I got to continue using my real knees and the chronic pain is mostly gone. I went to Brigham And Women's Hospital in Boston, Mass and had an ACI along with three Osteotomies performed. The Osteotomies were to change the lines of force through my knee, which was accomplished by canting my leg 14 degrees out. All in all this was a very good choice since my right knee went from being chronically painful, to relatively pain free.
The damage in my right knee was described as the following:
"Preoperative Diagnosis:Varus malalignment, right knee, with full thickness condyle defect, medial femoral condyle.
Primary procedure:Autologous chondrocyte implantation grafting, right knee, medial femoral condyle 54 mm long, 28 mm wide using two vials carticel with tibial periosteum, right knee.
Secondary procedure:High tibial valgus osteotomy, closing of wedge 14 degrees with tibial tubercle osteotomy, patellar lateral release, mid shaft fibula osteotomy."
Fast forward to 2008 and now I go in for the same basic procedure on my left knee, except that there will be no Osteotomies this time, but there will be a Meniscal Allograft (described here, and here)
The damage in my left knee was described as the following:
Left knee chondral defects accompanied by meniscal deficiency.
Left knee autologous chondrocyte implantation grafting to lateral femoral condyle 40x20 mm, lateral tibial plateau 30x20 mm, trough technique for lateral meniscal allograft 35 mm wide x 14 mm long, ACI to the trochlea 15x15 mm, using Bio-Gide membrane, four vials of autologous cultured chondrocytes (Carticel), capsular patellar lateral release."
For the not so squemesh: a condensed video of the basic ACI procedure
Please note that this video along with all other pictures of my surgeries were provided by Dr. Tom Minas, Tim Bryant R.N. and the amazing staff at the Cartilage Repair Center to whom I am grateful for the opportunity to continue using my real knees!