KNEE ARTHRITIS - Cartilage plug transfer :
OATS on left knee, meniscus on right - - Posted by MarshallBuckeye (MarshallBuckeye), 21 April 2004
Hey everyone! I'm scheduled for an OATS procedure to replace destroyed cartilage on the back on my left patella on June 9th. When I scheduled I told the nurse that I think my lateral meniscus is torn in my right knee. She said she would have my OS look at it on my pre-op on the 8th and maybe have him do it at the same time. Please tell me any info you guys know about OATS and having both knees messed up at once. Also, everyone is talking about the CPM machine and nerve blocks and stuff, and my OS said he doesn't do either because he's really aggressive with physical therapy and stuff. Should I try to get in sooner to see him about my meniscus? I'd like to know if I'm having TWO surgeries...and waiting until the day before stresses me out. If He does both knees will I have to be in the hospital with a catheter and everything? Please give me any info you guys can.
Posted by MarshallBuckeye (MarshallBuckeye), 21 April 2004
I just found my surgeon on the KneeGuru doctor list....does that mean he's good or that he just applied and paid a fee to get on the list. Dr. Frank Noyes. He's a great surgeon...but his bedside manner sucks, and I don't always feel like he responds to all of my concerns.....which is why I'm appealing to all of you KneeGurus for help!!!! Thanks in advance for all of your posts!!! 
Posted by hmaxwell (Heather M.), 21 April 2004
Dr. Noyes is one of the best of the best. You are in excellent hands--he is famous through the country for his expertise with knees. I actually have only heard good things about him and his consultations, so maybe you caught him on a bad day and his bedside manner suffered because of it? They are human, too....
As for doing both procedures, I really don't see how you could. OATS post-op generally involves no weight-bearing, if I'm not mistaken. So it would be really, really tough for the other knee to also be out of commission. Especially since you don't know what is wrong with it. Maybe it's a meniscal tear that can be repaired, in which case the protocol is also for non-weight-bearing (usually). There is also the possibility that the good knee is misbehaving because it's pulling an extra load with your other limb out of commission. I have a 'good' knee that complains very vigorously on a regular basis, but after my last surgery I didn't hear a peep from it just because I was so involved with rehabbing the other knee. It's actually not given me any trouble, and my doctor said repeatedly that it's possible the best treatment for my 'good' knee is to get my bad knee working and pulling its own weight again.
Anyway, it's probably pretty dangerous to assume that you'll have both knees worked on based on the offhand comment of the nurse-scheduler! See Dr. Noyes and talk to him. He's the doctor, after all. But regardless of his suggestions, you are allowed to refuse any treatment you're not in agreement with--so if you're not comfortable with the prospect of both knees out of commission, then explain that you'd like to know what's up with the other knee but that you're not willing to deal with it surgically until other options have been explored. That's probably the best course of action.
Take care and let us know what happens.
Heather
Posted by MarshallBuckeye (MarshallBuckeye), 23 April 2004
Heather, thanks for the response. I was suprised to get such a good answer so quickly.
Yeah, I know docs have bad days too, but I've met with Dr. Noyes many a time...he did my proximal/distal realignment 2 summers ago. He's nice enough...I don't know. He just seems to rush and can be kinda demeaning. Last time I was there he patted me on the head.....I'm 21 years old. But whatever, I know he's the best.
His personal secretary is extremely compitent and knows every detail of all of his surgeries and his protocol for recovery on all of them and she said she didn't think it would be a problem. I've had a meniscus repair about 6 years ago (Dr. Noyes's colleague Thomas Lindenfeld). It was non-weight bearing for awhile. If Noyes cut out the damaged part of the meniscus I could be back on that leg pretty quickly, but I'd rather have it repaired, because I'm way too young for the arthritis I already have and I don't want more.
You said in your post to tell him that I want other options explored. What other options are there for a torn meniscus that's killing me? I know it's torn, because I've torn one before...this time it's the same symptoms but worse.
Thanks for your post
Kristin
Posted by hmaxwell (Heather M.), 23 April 2004
There is the possibility that you have a torn meniscus. But it could also be that the knee is suffering from what the doctors like to call "overuse syndrome secondary to compensatory weightbearing." They love this expression. I've heard it at least half a dozen times, and so have many others on this board. I swear it's a pat phrase they're taught in med school! It's very, very common to have the good knee flare and often hurt even more than the bad one. I've been having this for 2 years, so I'm familiar with the frustration. It's infuriating, isn't it? The 'bad' knee is quiet for ONCE, and yet you're still counting your heartbeats in the throbbing of your so-called good knee! It's enough to make you want to pull out your hair and agree to anything.
But while you probably know what a torn meniscus feels like, the fact is that there are many knee conditions that can cause pain, swelling, joint-line tenderness, etc. A torn meniscus is just one of them. And then there's the fact that something like 1/3 of the population is walking around with asymptomatic meniscal tears. So it could be that you do have a torn meniscus and that your knee is painful...but it doesn't necessarily have to be the meniscus that is causing pain. And it could be that removing or repairing the meniscus won't resolve the pain. Talk about frustrating! 
And in the back of my mind is the fact that you want your OATS knee fixed right and to give the graft every chance to take and succeed. That would be tough if you were non-weightbearing on your OTHER knee as well. Of course that's a worst-case scenario, i.e. meniscal repair if you had both knees scoped at once. But since you have a declared preference for repair, you have to look at that very real possibility.
If the knee must be operated on, can you consider having it done in the future? That way you give both knees the best possible chance for a full recovery with all structures intact. And if your OATS knee recovers full strength and has a good outcome, maybe the other knee will stop complaining so much. If the knee isn't locking or something, it really could be overuse or even a non-complicated tear that won't hinder your life once the bad knee is back to pulling its full weight.
Again, this is all supposing that the knee is non-critical, not locking, and doesn't have something unstable like a bucket handle tear. And it's also based on advice I've been given myself. My current OS is in the league of Dr. Noyes--one of the best of the best. People travel from around the world for his advice, and he's been doing knees for over 40 years, so I trust him without question. And I *do* have a torn meniscus in my good knee (MRI and positive exam), along with some other problems. But he will not *touch* the good knee until the bad one is stable and able to take my full body weight as I sit down and stand up from a chair--which may be never. His thinking is that to do surgery on both would leave me literally without a good leg to stand on...which would jeopardize the outcome of both surgeries.
Every doctor's protocol is different, but I couldn't see having a complicated repair on one leg and OATS on the other, unless you are very fond of wheelchairs and slow rehab. The only person who can answer the question in your case is you, along with your doctor.
It's a decision you have to make, but I just don't understand why people would try to do non-simple procedures on both knees at once. On the other hand, I don't have any trouble with general anesthesia and seem to tolerate the arthroscopic procedures fairly well. Others get violently ill and so would do anything to maximize each anesthesia opportunity. I really can understand that. I'm just hesitant use the 'throw in the right knee while you're at it' philosophy, because outcomes are simply never guaranteed.
Best of luck, and let us know what you decide. BTW, do you have any information on the success rates of OATS on patellar lesions? I have several of those as well, and would love to hear about the selection criteria for this procedure. Take care.
Heather
Posted by JG (JG), 27 April 2004
Marshall,
I had a very large mosaicplasty procedure (OATS using allograft (freeze cadavar) rather than autograft) on my LEFT knee. In total, I had 18 grafts, 13 trochlea and 5 medial femoral chondyle. To say the least if was a very large procedure. I was NWB for 8-12 weeks. I am now 12-1/2 months post op.
Interestingly enough, my OS had been saying for the last couple years that my right is probably starting to degenerate as well. So during my pre-op a couple days before my mosaicplasty surgery, I asked my OS's PA about doing my right knee as well. She said that she would ask the OS about it. Well sure enough, he did a menisectomy and minimal debridement on my RIGHT before the mosaicplasty. We never even talked about it.
I had no problems at all handling it. It was like I didn't have surgery on my right. There was no way my surgeon would have done anything but what he did. Good news my right knee looks great.
One thing I can tell you, depending on how many grafts you are having transferred and where, it is a long recovery. I just has a scope to see how things healed over the last 12 months. Prior to my recent scope, my MRI revealed most of the trochlea grafts were still healing. So be patient with recovery.
Janice
Updated Thu Apr 29 2010
