KNEE ARTHRITIS - Cartilage plug transfer :
Osteochondral Allograft Recovery and Prognosis? - - Posted by Kari (Kari), 12 April 2003
What should I expect with an osteochondral allograft procedure?
Are there differences in procedures? I think I need top of tibia, and lateral meniscus, as well as bottom of femur.
How long is the recovery?
How long until you walk and drive a car again (right leg) ?
Long term prognosis?
Thanks for your knowledge.
Posted by JG (JG), 13 April 2003
I just had this procedure on April 2. I had my trochlea area to the lateral chondyle and a sizable section of my medial chondyle. Although I do have a large defect on the lateral tibial plateau, but my surgeon was not comfortable fixing it at the same time he fixed the rest. My procedure was really stretching the boundries of this procedure and took 18 plugs. It took two hemi-chondyles (this is how they are ordered by your surgeon). According to the person at the Muskuloskeletal Tissue Foundation, they have never had two hemichondyles requested for a single knee. Of the 6 surgeons (including Bugbee, Cole, Minas, Buckwalter) I talked to, only 2 would perform the procedure on me. The remainder said wait for a TKR.
All said it would be the biggest procedure they have performed.
The pain has not been a problem (I tolerate pain well). Being non-weight bearing is the problem. It will be 8 weeks before I can partially weight bear. If you have a graft on the weight bearing aspect of the bone, they you cannot walk. Basically for 8 weeks you can do nothing. I am driving because it is my left leg. In terms of success for my procedure, my surgeon said because of the extensive nature of the problem and replacement, may be 75% tops. Research shows that success of a single defect (a couple plugs) is between 85 and 95%.
There is tons of literature out there, you need to search by "osteochondral allograft". Do you have "kissing" defects, meaning does your tibia defect and you femur defect touch each other? Do you need you lateral meniscus replaced or just cleaned? Are you on the wait list at this point? Also fixing the tibia is not an easy thing. According to my research, very few phyisicians do it and the surgical approach is not good. They either go in at an oblique angle or a retrograde approach through the tibial (from below).
Posted by Kari (Kari), 13 April 2003
Thank you for your response. You are obviously very knowledgeable. I have been referred to the only surgeon in Canada that will do the procedure. Unfortunately because of SARS they are not booking anyone. Best case scenario I will see him in the next 3 months.
From what my surgeon (very respected) has told me, my tibia and femur could be touching (he said my pain is from the two bones rubbing on one another). My original injury is a massive tibial plateau fracture. He said the surgeon he is referring me to will likely remove part of my tibia and replace it (along with the cartilage) from a cadaver. He also said he would likely replace the entire medial meniscus.
I was interested to read (from you) that it is done by plugs, similar to OATS. I had the impression it was one big graft. I have done a google search on osteochondral allograft, and read a fair bit, but only one of the referenences I read talked about recovery. I have read an 80% success rate, but the papers never define "success". For me success would be relatively normal activity again. I know I will never do high impact sports again, but walking pain free, riding a bike pain free, maybe skating etc with my kids would be success. That's why I wondered about recovery.
I can do eight weeks non-weight bearing...the tibial plateau fracture was 14 weeks non-weight bearing.
I am glad the pain isn't to bad for you. It is encouraging to hear your story.
I broke my leg 8 months ago. I figure it will be 3-6 months before I see the new OS, then what...maybe a 6 month weight, then a 6 month recovery? That will be between 2 and 2 1/2 years of my life. I am 33 with 2 little kids (4 and 6), and I it seems so unneccessary for me to lose so much "quality of life" at this time. I'll gladly trade quality now for bad knees at 80!!
Keep in touch. And please, send me any good websites, or articles. I certainly want to be well informed.
Posted by Mikesk (Mikesk), 23 November 2003
It is good to hear from you about the procedure that you have done. I have a qusetion for you and others as well. Where do find surgeon who would do such a procedure for you. All the good ones I talked to here in california are after money. Based on what they can make, they propose a procedure for you, and some of them won't even do it as the money is not enough for them for their hard work; one OS even told me, and I have to offer a present to do what I medically needed. Two of them wanted cash, and they won't even bill the insurance as a curtesy. One of them did not like me as I was seeing his competitor. This is a sad situation for patients like me for not being able to get proper advice and treatment. Everything about money.
Anyway, I lost the medial meniscus as my first ACL failed due to an OS puting the ligament on the wrong spot, and I did a meniscus transplant and only 30% survived as my OS did not catch that I had a 4 degree varus. So, now I developed condromalasia grade 3 including 40% of my weigh barieing surface. So, what is my option here?. I am thnking about doing an osteotomy and another meniscus transplnat, but i don't know if the meniscus transplant will help my weight bearingn surface. My tibia and femor touch at sleep and casue a littel pain. Also, I have difficulty in walking now. All theswe happened iin 2 years. That is why Im very upset and depressed to come from doing sports to not being able to walk.
I like to hear your advice. My email is email@example.com
Updated Thu Apr 29 2010