OATS - MACI My right knee MACI procedure

[Peter Mac]

On June 30, 2022 I had a MACI procedure on my right knee in the trochlear groove.
I've been resting in bed most of the time.

The MACI book says I can start CPM 24 hours after surgery, but my surgeon doesn't want me to use a CPM machine.

I have a feeling my doctor is extra cautious about protecting the MACI graft.

This is my first post to this forum.
I joined this forum to get feedback and support from anyone who has gone through a MACI procedure.

I've had two previous failed attempts to fix my loss of cartilage in my trochlear grooves. I was promised a microfracture could fix my knee the first time. Due to an OR mixup the surgeon did the wrong procedure. I feel I was scammed in the second procedure so I'll save that discussion for another day. I realized I needed to find technologies that could actually regrow cartilage on my own and then find surgeons trained for them and that's how I found MACI.

 

[Jockette]

Hi and Welcome!

You can use the search feature to find other members and the MACI procedure.

I will leave you our Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest​

elevate​

ice​

take your pain meds by prescription schedule (not when pain starts!)​

don't overwork.​

3. Do what you want to do BUT

​

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​

b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

​

the BoneSmart view on exercise​

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for TKRs​

6. Access to these pages on the website

​

Oral And Intravenous Pain Medications​

Wound Closure​

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in the majority of BoneSmart’s forums, we ask that each member have only One Recovery Thread. This policy makes it easier to go back and review the member’s history before providing advice, so please post any updates or questions you have right here in this thread.

 

[Jockette]

Here is a list of some members with MACI:

Knee Surgery Recovery Area

For post-operative knee patients, on the "other side"

bonesmart.org

 

[Peter Mac]

How tough is the MACI graft? Vericel wants me in a brace for 6 weeks. I have a feeling with the MACI physical therapy guide there is a lot of worry about protecting the graft, but how long is the graft really vulnerable to being dislodged?

 

[Jaycey]

how long is the graft really vulnerable to being dislodged

A question for your surgeon I am afraid. Only they know the technicalities of that graft - size, location and condition of your knee before the procedure was done.

 

[Peter Mac]

Thank you for responding. Are there general MACI guidelines? For example, does it typically take 6 weeks for the average graft to be mostly absorbed by my knee?

I thought my knee was arthritic all over, but luckily it was only the trochlear groove that needed a MACI patch. Most of my knee was healthy.

 

[Peter Mac]

Has anyone had a fall after recovering from MACI? My crutches got caught in some netting today on the floor and I took a tumble. I'm not in any pain. My brace was locked in place so maybe that saved me.

 

[Jockette]

I’m sorry you fell! We don’t have many members with MACI, but several of our TKR members have fallen in the early weeks of recovery. Most often it was soft tissue soreness, and no harm to the implant. Hopefully that’s the case for you! Take it easy for a while, you may be more sore tomorrow, that's often the case with a fall.

Are there general MACI guidelines?

The TKR Recovery Guidelines are as close as we have.

Most of my knee was healthy.

This is really good news!

 

[Peter Mac]

It seems like the vast majority of members here get total knee replacements. Why aren't there more biologic surgeries performed like MACI, Arthrex Auto Cart, Denovo, Novocart 3D, etc?

 

[sistersinhim]

Why aren't there more biologic surgeries performed like MACI, Arthrex Auto Cart, Denovo, Novocart 3D, etc?

Only a surgeon can determine what surgery a patient needs. We have no way of knowing what is best for someone. That's their and their doctor's decision.

 

[Jamie]

It seems like the vast majority of members here get total knee replacements. Why aren't there more biologic surgeries performed like MACI, Arthrex Auto Cart, Denovo, Novocart 3D, etc?

You don’t see more people on BoneSmart with cartilage repair procedures because the majority of our members are dealing with arthritis damage and not a cartilage defect or injury. These procedures are not usually appropriate for a patient with arthritis and in some cases can even cause or worsen arthritis. They do appear to be good options for a select group of people under age 55 with specific types of cartilage damage. As sistersinhim suggested, it is important to talk with one or more surgeons as many of these expensive treatments are not covered by insurance.

 

[BSN50]

I am recovering from a triple MACI graft from January 2022. I am still unable to go up and down stairs or walk normally. I would encourage you to download the MyMACI app on your phone. It is full of knowledge about the procedure but it’s been my experience to truly listen to your body regarding recovery.

 

[Peter Mac]

I am recovering from a triple MACI graft from January 2022. I am still unable to go up and down stairs or walk normally. I would encourage you to download the MyMACI app on your phone. It is full of knowledge about the procedure but it’s been my experience to truly listen to your body regarding recovery.

I responded to your thread. I think if I had a triple graft I'd hope I'd be eligible for 3 weeks of skilled nursing coverage post surgery. That sounds brutal to recover from.

 

[Samsrf]

@Peter Mac I was actually approved for a MACI when it was still experimental back in 1998. To repair a degenerating cartlidge from an injury in 1995. But at the time I was told it was a 1 year recovery … and I couldn’t even swim for 6months. I was just 20 years old and on my own. My surgeon was the only one in the state (HI) who performed these, and he hadn’t done many. By the time the graft was grown and was ready to be implanted I chickened out decided I had to work (retail) and wasn’t prepared for the long recovery so I just sucked it up and waited until I couldn’t walk which resulted in a TKR @43 years old‍. Hindsight is always 20/20, but the good news is technology is always getting better and I got a solid 15 years out of the knee until it failed. I truly wish you all the best and hope the MACI keeps you from a future TKR! Best of luck.

 

[Peter Mac]

@Peter Mac I was actually approved for a MACI when it was still experimental back in 1998. To repair a degenerating cartlidge from an injury in 1995. But at the time I was told it was a 1 year recovery … and I couldn’t even swim for 6months. I was just 20 years old and on my own. My surgeon was the only one in the state (HI) who performed these, and he hadn’t done many. By the time the graft was grown and was ready to be implanted I chickened out decided I had to work (retail) and wasn’t prepared for the long recovery so I just sucked it up and waited until I couldn’t walk which resulted in a TKR @43 years old‍. Hindsight is always 20/20, but the good news is technology is always getting better and I got a solid 15 years out of the knee until it failed. I truly wish you all the best and hope the MACI keeps you from a future TKR! Best of luck.

MACI was probably Carticel back then and I've read the outcomes were poor because the doctor had to sew the graft in. MACI is a relatively easy procedure because the graft is glued in with a biological glue. The difference between Carticel and MACI seems to be night and day even though they are based on the same technology.

Recovering from any surgery for me has been such a miserable experience every time.

 

[Peter Mac]

@ChrisF Are you icing regularly throughout the day? 45-60 minutes per session?

Every time I've been to physical therapy for any knee injury, I've been told to only ice 20 minutes per session. This forum is the first place I've ever heard to ice 45-60 minutes at a time. Why do you recommend such lengthy icing sessions? I've always been told over 20 minutes per session is harmful.

 

[Jockette]

Why do you recommend such lengthy icing sessions?

Ice (Cryotherapy) to control pain and swelling

Updated 22 November 2020 Please note that though this article primarily talks about knees and hips, the information applies equally to shoulders and other joints as well. Using ice (cryotherapy) is an excellent means of controlling pain and swelling after joint replacement surgery and it...

bonesmart.org

 

[Jaycey]

Why do you recommend such lengthy icing sessions? I've always been told over 20 minutes per session is harmful.

The 20 minute sessions are recommended for injuries such as sprains. Twenty minutes does nothing for someone recovering from surgery. And as long as you have a cloth between the skin and the ice source, there is no danger in icing for 45-60 minutes. Most of our members are using this method and have seen very good results.

 

[Peter Mac]

The 20 minute sessions are recommended for injuries such as sprains. Twenty minutes does nothing for someone recovering from surgery. And as long as you have a cloth between the skin and the ice source, there is no danger in icing for 45-60 minutes. Most of our members are using this method and have seen very good results.

Well, that goes against everything I've been told my entire life. Interesting.

 

[WFD]

Another thing to keep in mind is that many or most of us are using icing machines, often with frozen soda bottles of water instead of ice.

Between the bottles and the long hose going to the pad, the pad is not as cold as say a plastic bag of crushed ice placed directly on the knee.

Because of this, you can and should ice longer with a machine than a bag of crushed ice.

Note also that some of the ice pads that you put in the freezer to re-use can be colder than 32 F. At one point I made some, one using isopropyl+water and the other using salt water. They were both colder than 32 F, especially the one containing alcohol. Using these I only iced for a half hour or my knee got too cold. Using the machine I often ice for two hours without any issues because it is not quite as cold.