OATS -MACI Options for cartilage defect repair

[NE_Runner]

Hi all, I'm new here and hoping to get some advice from people that have gone through similar experiences.

I was recently diagnosed with a 1.5 cm full thickness cartilage defect in the medial femoral condyle with flap formation in my right knee. I'm 46 years old, male, long distance runner, competitive for my age (sub 3h marathoner). I was training for a Spring marathon when I started feeling some pain after some of my runs and the sports doctor seeing me got the diagnosis via MRI. She actually let me finish my training and run the marathon because she thinks the cartilage defect is there for a while and does not actually hurt when running. After the marathon she put me on a 6-week break from running with cross training (biking or swimming only) to lower the swelling in the knee, which I did and took care of it. Now I'm back to running again and training for a Fall marathon and she's OK with that. She referred me to a cartilage repair surgeon who I'm seeing in 5 weeks and said I should stop my training if it starts hurting or my knee gets swollen again. In addition she said the surgeon may ask me to stop running when he sees me in 5 weeks and recommend cartilage repair surgery and I should be mentally prepared for that :(

Everything I read about OATS and microfracture surgeries to fix this problem tells me I should delay it as much as I can because the recovery is brutally long but maybe someone here can share better stories. Also I wonder if anyone here has been able to keep running or doing some other high impact sports with this type of cartilage defect. Many thanks in advance!

 

[Jamie]

Hi, and welcome to BoneSmart. Sorry to hear about your knee damage. You can read about other members who have had the OATS procedure by clicking on the OATS - MACI prefix in your thread title from the index thread listing in either the knee pre-op or recovery forums. This will give you a list of all the threads with that prefix in each of the forums.

If your area of damage is 1.5 cm, you would seem to be a good candidate for the OATS procedure. You would want to be careful if you decide to delay the procedure, though, as you could incur additional damage and make it less likely that the cartilage implants would work well. I would be surprised if you would find anyone who would tell you it's fine to continue marathon running while you are healing from either of these procedures. The recovery is frequently long and can be painful. You will probably just have to resign yourself to the fact that you'll be taking a break from the running for quite a while. But if it is successful and you recover well, you should be able to go back to marathon training.

 

[NE_Runner]

Thanks Jamie, I'll check out other threads for more info. I found a couple of runners who have done OATS on a popular running forum and it often took them 2-3 years to return to running, and some had more pain in the few months after the surgery compared to before, so that really scares me.

My appointment with the surgeon is not until Mid-August. I'm a little concerned of doing more damage by keeping running (I usually run every day) until my appointment but the sports doctor said I should be fine as long as I use pain as guide and it's not hurting. I don't know what to do.

 

[Peter Mac]

I am recovering from MACI right now.
It hasn't been fun, but then I read the stories about those recovering from TKR and realize it isn't so bad.

The problem with microfracture is that it grows fibrocartilage (scar tissue). MACI grows your own cartilage.

There are many biologic choices out there and I wish more of them could be discussed on this forum.
I'm personally against microfracture.

There are several ortho-biologic options available:
1. MACI by Vericel. A small piece of your own cartilage is taken and they grow millions of cartilage cells in a lab to implant back into your knee. It can take a year for full regrowth of new cartilage--now that sucks.
2. Denovo juvenile minced cartilage. Cartilage is taken from young donors under 13 so you get more chondrocytes.
3. Novocart 3d--not available yet in the USA, but substantively not much different than MACI in my view.
4. Biocartilage: similar to Denovo in that its an allograft, but it requires a microfracture, which I'm not fond of.
If your getting donor graft, why not get a juveline donor graft instead?

BioCartilage: Background and Operative Technique

Damage to articular cartilage is prevalent and causes significant morbidity. A common initial treatment for focal, full-thickness articular cartilage …

www.sciencedirect.com

5. Dr. Stone in San Francisco uses a cartilage paste (similar to Biocartilage idea but with your own cartilage). He performs a super microfracture and microfractures have a tendency to create some fibrocartilage even if you get some hyaline cartilage

I went to Dr. Dunn in Florida for IAGH many years ago, but I think it's a total scam.

As a patient, I've learned you have to research technology on your own. I've never met a doctor who will educate you on orthobiologics. The problem is many orthobiologics only work on small to medium defects.

MACI can cost $70,000 (yes, you read that right!) Better make sure your insurance will cover it first. My insurance paid for it 100%.

BTW, I'm 48 and MACI was only FDA tested for those under 55. If I were over 70 I would have leaned strongly towards Denovo, but then again at 70 maybe my entire knee would have deteriorated.

 

[NE_Runner]

Thanks @Peter Mac for sharing your experience and knowledge. That's very interesting. I'm seeing the cartilage repair expert in 10 days and can't wait to hear what intervention plan he's going to recommend. I have no idea how many of these different procedures he has done in his career but he has several years of experience in the medical team of professional sport teams in Boston. He's currently part of the Red Sox medical team, teach at Harvard medical school, and was highly recommended by the sports doctor who first found my femoral cartilage defect.

What's intriguing about my injury is that I'm running 45-50 miles per week without any pain. I get the occasional temporary discomfort during a run but more often just walking around or doings chores but does not bother me much. I know it's probably not going to be like that forever but it's hard for me right now to grasp the concept of getting a surgery and spending months or even years recovering and possibly not being able to run after all that.

All the recovery stories I've been reading about all these procedures, including MACI, and their outcome returning to high impact sports, really scares me. I'm a competitive recreational runner (meaning top 5% in my age group) and running is like part of my life, my daily routine. My wife is also a runner and some of my best friends are part of my running community. My number 1 priority is to get whatever treatment that will give me the best chance to keep me running in the long term.

 

[Peter Mac]

MACI is a commitment where you are sacrificing a year to benefit the rest of your life. I'm five weeks MACI post op. It takes a year for enough regrowth to be able to run again.

 

[Jamie]

@NE_Runner you’re doing the right thing by taking things slow and doing research into what’s available. There is no medical option that can guarantee success. I understand your desire to return to competitive running. Our members who are really into sports feel the same, as it’s such a big part of their lives. Honest conversations with the surgeons you see will help you in making your choice. You are wise to address this cartilage defect now before it worsens. Please let us know how your appointment goes.