OATS Procedure Recovery

[Beauzer]

Hi Sammy,

Overall my knee feels pretty good.  Most days it doesn't hurt at all.  Sometimes my patella catches and pops where they harvested the grafts, but that pain is minimal compared to what it was before surgery.  I do have some trouble on stairs and sloping surfaces.  And I still can't wear hard-soled dress shoes.

I can stand all day.  As long as I get occasional breaks I can go for 12 or more hours.  It's a lot harder if I don't get to rest, though.  On a good day I have no pain at all.  On a bad day I may need to take a few Advil, but that's it!

I actually had a microfracture in 1999 (after 3 chondroplasties to the same area).  My microfracture lasted a few years, but by 2003 I was starting to have a lot of pain again.  It was about a year after that that I developed AVN.  We think the trauma (maybe even from the microfracture) probably caused it.

My OS did the procedure open.  I had two 9mm plugs harvested from the lateral trochlear groove and put into the MFC (medial femoral condyle).  The procedure is difficult to do with the scope unless the lesion is very small.  If your OS is thinking of doing it through the scope, make sure that they've had a lot of experience doing it that way.

OATS is a good procedure, but only in the right candidates.  It tends to work better in younger folks.  The biggest thing is you have to be absolutely committed to the rehab and restrictions or it won't work!  I was NWB for 6 weeks postop and PWB for 2 more.  I was in a CPM machine for 20 hours a day for 3 weeks postop.  I was on the exercise bike at 2 weeks postop and in the pool at 4 weeks postop.  I rehabbed extensively.  I still do.

The knee really has to be babied for 2 years.  I was back standing long hours too early and this may have contributed to my recurrent AVN and stress fracture postop.  I'm really only supposed to stationary bike or swim and that restriction is forever!  I have been doing a little walking lately with the dog, but the knee doesn't tolerate very much.

Good luck,
Danielle

[thkaa]

Hi Danielle,

Thx very much for your sharing. I suppose to go for the oats surgery. I also think that open knee surgery will give a better result. I work in a bank and need some walking. Do you think 6 months recovery is enough for me to go back to work? Was the post-op feeling different from microfacture? Sorry to ask too much questions. I really hope to get rid of the limping.

Sammy

[Beauzer]

Sammy,

Six months should be more than enough to go back to work.  I was NWB for 6 weeks, PWB for 2 weeks and back standing in the OR (not quite full-time) at 10 weeks.  I was only off work for 3 weeks though.  I came back and did some administrative stuff.  I just couldn't get any more time off work!  The post-op feeling was somewhat different from microfracture.  After the MF, my knee felt "raw" (crunchy, sore with WB) for months.  I also wasn't NWB after the MF, which isn't typical. 

After the OATS, it hurt really bad for about 3 days.  Then I had really no pain at all until I started WB.  The first few days, though, everything was tolerable as long as the knee was elevated.  As soon as I put it down to sit up or walk, it was like getting whacked with a hammer!  Then all of a sudden, it didn't hurt at all (which was a big surprise for me, as I'd had bad pain 24/7 for a year from the AVN prior to the OATS).  From what I've heard, it takes up to 2 years for the knee to feel completely normal again.  It's hard for me to tell.  I felt 100% at about 12 weeks, then out of the blue at 5 months, fractured my MFC!  It took quite a long time to get over that one.  My knee hurt for a long time afterward.

Even now at a year and a half, it hurts from time to time and I have to back off my activity some.  I couldn't wear hard-soled dress shoes until about 1 year.  From time to time I get really stiff.  When that happens, I just ride the exercise bike (no resistance) for a few minutes and it goes away!

If you do decide to have the OATS (or if you're just curious) I have some ideas concerning NWB and post-op rehab that seem to work well, if you're interested in hearing them!

Danielle

[thkaa]

Danielle,

It would be great if you can share me some post-op exercise and how to take care of the bad knee. Last Sunday, I bought a stationay bike and waiting for the delievery. I really hope that the bike can train my muscle up before any surgeries. I can climb stairs or go down stairs without any pain or problems. But when I walk on the ground. I got sudden pain from time to time. I also can't walk for a long time at a normal rate. I only can walk slowly. I really want to have a scope to find out what's going on after 18 months drilling (Actually the operation done on my knee is not MF, it's two big holes of drilling).

I'm eager to learn from your experience.

Sammy.

[choclab]

please reveal your ideas on NWB as I am scheduled on the 16th of Oct. for OBI plug with at least 3 wks NWB afterwards...

[thkaa]

Hi Choclab,

How's your problem now? Can you walk with some pain or little pain? Do you know how big is your lesion? Did you have any surgery before? I'm sorry that I asked too many questions. I just want to know to what extent of pain will they consider a surgery. I hope you don't mind telling me. Thx much.

Sammy

[shade]

Choclab,

Hi there, here is a good site about chondral lesions. 

http://www.steadman-hawkins.com/knee_chondral/overview.asp

Here is a good site regarding OBI procedure.....

http://www.obi.com/images/TruFit/kit_components1.jpg

I've had an allograft w/OBI TruFit BGS behind the patella along with a TTT procedure.  This combination was a long rehab process but very worthwhile as I'm now pain free.  NWBing is tough but just remember the end goal.  Let us know how everything goes with your surgery and recovery.

Take care.  ~shade

[SallyW]

I am 1+ year post OATS (for a 1 cm OCD lesion). I was okay for the first months; about 4 months ago I started feeling the horrid, painful catching sensation. Synvisc helped some, but I'm still really uncomfortable. I'm functional if I take enough Advil (which I shouldn't be taking at all - Acid Reflux disease) and don't do anything too strenuous. Now my ortho has me scheduled for a scope - says he can't use an MRI to check for more damage, since it wouldn't be accurate for someone like me.

Maybe OATS works best for someone who does the "right" activities? I mean - Danielle, you say that you ride a stationary bike for exercise and carefully walk your dog? I ride an exercise bike 'cause I know I should to build my quads, but I also need to work on our property (can be pretty hard on the knees), would like to walk distances, hike, and snowshoe again. Right now I only dream of doing those things.

Sorry for rambling...I'm kind of discouraged right now - two weeks before I'll have any idea of what is going on "in there", and if I'll ever be able to have a normal, active life again. In the mean time, I'm going to have to keep trying to get things done around here - you know, live as much as I can!.

I'm glad for options like OATS - those operations are providing a decent life to people who might otherwise be terribly uncomfortable until the "right age" for a replacement. But remember - OATS isn't necessarily a sure fire cure for everyone.

[shade]

Sally,

Sorry to hear you're having problems, hopefully the scope will help find what's going on in there and your surgeon will be able to fix during this procedure.

Hopefully you'll be back snowshoeing and hiking again soon.  Good luck with the scope.  ~shade

[choclab]

thkaa..I have an 8mm defect and a torn meniscus...OS says he will be able to trim meniscus and may have to plug and may have to move patella...my pain is sharp upon climbing stairs. knee aches when I'm on it for while...I am on celebrex and I think that helps swelling.  I get less swelling when knee is taped.  I have had this for at least 2 years but got wrong Dx with other OS...no prior knee things but a ruptured calf tendon close to when I think this may have happened...oh well...I hope my age at 56 doesn't count...surgery on 10/16...get back to ya later...

[Beauzer]

Sorry, it's been ages since I've checked the site...

I've been very busy and I find that when my knee is OK, I tend to slack off the kneeguru site (not sure if that's good or bad)

Anyway, I can't speak for OATS overall, but I can share what my OS told me.

1.  Only works well for relatively small, discrete cartilage lesions in young people who aren't too overweight.  Don't know exactly what that means, but I wasn't really considered a good candidate because I had areas of arthritis around where the AVN and big defect was.  Even so, for me it was a last-ditch kind of thing and my OS was willing to try.  I also weighed too much to be a good candidate, but have been working on that one! (70 lbs lost since 4/25/05, the day of the OATS).

2.  You have to be absolutely committed to the NWB and rehab or there's no point in doing it.  My rehab was very, very aggressive.

3.  You have to be willing to accept the long-term limitations.  For me that was 2 years of really babying the knee, followed by no impact exercises EVER!  Really, I'm only allowed to stationary bike and swim.  I'm not really even supposed to be walking (meaning for exercise.  Obviously, I have to walk  )

As far as post-op stuff goes, this is what I did.
NWB for 6 weeks, PWB for another 2.
CPM for 20 hours a day for 3 weeks.
Home PT starting on day 2 for 30 minutes 2x a day.
Stationary bike (no resistance) starting at 1 week for 30 minutes 2x a day.
Pool exercises 3x a week starting at 3 weeks
Continued PT for 6 months

I think the bike and pool were the biggest helps.  I had good ROM from the bike.  In the pool, I started out just moving my legs or treading water.  Once I was allowed to be PWB, I started walking in the pool.  I started in deep water, barely touching bottom and progressively went shallower.  Basically as soon as I was allowed to be FWB, I could walk without any problem at all!

I hope everybody is doing well.
Danielle

[JulieRose6]

Its amazing to see the success rate that everyone has had. I am almost at a week recovery from my OATS Procedure. I have been able to walk which I'm quite amazed by it. I am hoping this is the surgery to end all my surgeries. I am 22 years old and this was my fifth surgery on my leg. I noticed that I get this burning coming from my scar every once in awhile, did anyone get that too? I have no outside stitches I think I am glued instead but I didn't know if I am the only person that has had this issue. I am on strict restrictions to not bend my knee at all for close to 6 weeks. DId everyone else could bend there knee immediately or at the most they can? I also heard that the cartilage can die inside of your knee  since I waited for a a donor cartilage.  Does anyone have advice on the recovery of this surgery? Also a random question is: How do they reattach a knee cap anyways?

Julie

PS Did anyone also Have a fulkerson surgery too?

[nicolek]

Hi everyone,

I would like to share my experience with the OATS and microfracture procedures, in hopes that it will help others.  In May of 2005 (I was 23), I injured my knee while sliding in a softball practice.  I had a microfracture performed in Oct. of 2006 on my femoral chondyle for a 1 cm defect.  That surgery gave me very little relief. The first time I bent my knee after the surgery, I felt that same arthritic feel as I passed throught the area of the defect. I pushed myself really hard soon after the 6 weeks of NWB, so that may have been a factor as to why it went poorly. I didn't know much about the procedure and wasn't aware how fragile the area is. But there was still so much pain and discomfort that it is hard for me to imagine it working, and therefore I have little faith in microfracture.  There was catching and sharp pain any time I took a step up or even when bending my knee in certain ways while laying or sitting down.  In July of 2007, I had an OATS procedure with Dr. Brian Cole, a truly great doctor.  Before I went in for the surgery, he wasnt sure if he was going to do OATS or ACI, but chose OATS because the defect was deep and small in area.  (He told me ACI works best for shallow and large defects.)  I was obviously in pain after the surgery, but from the first time I bent my knee, I knew there was a big difference with the problem area.  I am now at the 8 month mark and my knee continues to improve.  This is the best by far it has felt in 3 years.  I can walk for long distances, use the eliptical and bike, I can go up steps without pain, I can stand on it for a long time, and although I have only tried running about 20 feet (outside of the pool), it felt very good.  I can also bend it (NWB) in any direction without pain or cathing, which I think is a really good sign.  I think that this surgery is great because it uses your own cartilage attached to bone to fill in the defect, which to me felt alot different that the the clot that occurs from microfractue.  I took my rehab incredily slow this time, and let my therapist know if I thought something was going to be too much.  It is my knee, and the defect is incredibly fragile, and so I think it is important to look out for yourself.  I also made sure I had a therapist who knew how fragile this transplant is, and was careful about creating a program that strengthened but avoided my defect initially.  If I felt pain, I rested.  It was really difficult to be patient, but when faced with the alternative of pain for the rest of my life, waiting was much easier.  I just listened to my knee and let it tell me when I was ready for the next step, and tried not to have expectations based on how many months had passed.  The bike was great for strengthening.  And the pool was the best place to test out squats, running and jumping (which was further down the road).  I iced alot, and propped my leg up at work for a really long time (at a computer), and I got up atleast once an hour to move around.  I think the advice I want to give is take things slow, listen to your knee, and most importantly- don't push through pain.  I hope this is helpful to someone.   

[lis1]

nicolek

I have just read your post from 3/4 weeks ago and have found it very interesting.  I too had microfractures with aclr in oct 2006 and will be having an oats procedure in June.  I have delayed the surgery myself because of charity work in Africa or the OS would have already done it by now.  I basically am writing to say thanks for your post and the information that it has provided.  I really appreciate hearing from other people and the experiences that they have had because i feel that it will better prepare me for what i will be going through later in the year.

My physio who has been working with me on and off (i book in when i feel i need some attention at the mo) is very aware of the fragility of the graft and we already have a very good rapour so that will not be an issue.  I have been told that i will be NWB for 5/6 wks with about the same PWB so i guess the approach will be slow and steady and in order for it to work (i am too young at 38 for a TKR) i will be dedicated to doing what i have been told to do.

So yes, writing your experience down has been very useful to someone, that someone being me!!

Thanks

Lisa

[Cubs 2008]

Too bad this site doesn't show comments newest to oldest- it might keep the dialogue going a little smoother.

Anyway, I'm at day 6 post OATS on my right knee. The plugs, one 9mm and one 10mm, were harvested from my same joint. I'm NWB for 6 weeks, and on the CPM machine for 6-8 hours a day. I'm only supposed to go to 90 degrees unless the doc  tells me to increase it when I see him tomorrow. By day 4 I felt like I could do more than 90 degrees, and I no longer have to ease up to the 90 by starting at 45 and gradually increasing.

Pain was brutal for the first couple days but is much more tolerable now.

I know activites like football, softball, etc. are out of the question for about a year, but anyone out there have experience with golf or mountain biking after a few months?