KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: gogoose16 on April 18, 2005, 05:26:44 AM

Title: A few Questions for all of you OATS peoples :)
Post by: gogoose16 on April 18, 2005, 05:26:44 AM
Long story short. I'm 19 and am looking at OATS or ACI. Tore up my knee playing soccer, had a scholarship for college but failed my physical because of my knee. Anywho, I've seen 3 big time surgeons in the Raleigh-Durham area. Each one has reffered me to someone else, obviously not wanting to deal with my problem. I have a large defect in my lateral portion of my femoral trochlear groove.  The only surgeries that have been suggested are OATS and ACI, i've read up on both and have spent several hours discussing them with doctors i work with at the hospital. I've seen a few contradictions in what people say, and what some of these surgeons are telling me.  These are first rate surgeons too...head and associate professors at unc and duke. yada yada. So I dont feel i'm being mislead. Anyways my questions are....

About how long is the operating time for each procedure? (I work in Anesthesia, getting put under freaks me out a bit now)

Is NWB totally essential? I've been told i'd be allowed to be on my feet as soon as possible? Could this be because my defect is in the patello-femoral joint and not on an essential weight bearing surface?

Did your insurance company cover it? I have BCBS.

One last kind of weird question....My chondral defect, under my kneecap i guess, is a grade III, while my femoral defect is a grade IV...The doc says even though the injury to my knee cap isn't as bad, it is the main problem.  What is to say they can't just recap the surface of my knee....kind of like a partial knee cap...why cant they just use the same prosthetic for the knee cap that they use in total knee's and put it in mine?

Answers to those questions and any others would be greatly appreciated! Thanks!

Zach
Title: Re: A few Questions for all of you OATS peoples :)
Post by: blackbeltgirl on April 18, 2005, 02:12:38 PM
Let's see.  I'm facing some similar decisions in the future, and I haven't come close to making a decision.  I do know I'm not a good candidate for OATS, because 2 of my 3 lesions are too large.

There is a guy in Atlanta who is supposed to be fantastic with cartilage injuries, and then there is Dr. Minas in Boston.  There are others who have done more than a few of these procedures, but if you're really worried, I'd make the trek to see the experts.  I plan to.

As to weight bearing - ALL of the literature I've read does require NWB for a period of time.  If it's only the trochlear groove, it is a shorter period of time, but you don't want to stress the joint while it's healing.  And as to insurance - overall, BCBS does cover ACI, I don't know about OATS.  But it is rarely considered a 1st line treatment.  If your defect is small enough for OATS, then it is small enough for microfracture.  BCBS may require that, especially at such a young age, you treat with microfracture 1st, and they will pay for the more expensive surgery if it fails.

In all cases - microfracture, OATS, or ACI - REHAB is the most important step.  If your dr. says NWB, LISTEN.  All of these have long time frames for recovery, and if you don't follow the protocol, you're putting your chances of success at huge risk.

Good luck with your decision.
Title: Re: A few Questions for all of you OATS peoples :)
Post by: stgiles16 on April 18, 2005, 05:06:43 PM
Couldnt have said it better myself, good advice blackbelt
Title: Re: A few Questions for all of you OATS peoples :)
Post by: gogoose16 on April 18, 2005, 06:47:01 PM
Thanks for your reply. I've already had a TTT, LR, chondroplasty, and medial reefing done. That, obviosly, failed. Would they still possibly require a microfracture first? I have an appointment with a Dr. Alex Creighton. He is suppose to the the best cartilage Dr. in the state, i see him next friday. Anyone have an idea on length of the procedure? Any other pertinant information would be much appreciated :) Thanks!
Title: Re: A few Questions for all of you OATS peoples :)
Post by: kathleenj on April 18, 2005, 06:59:30 PM
Ive had two Oats.  First one done with scope...78 minutes.  Second one, open procedure...50 minutes.  Now keep in mind that is the exact surgery time...it doesnt take into account the prep time or closing time.  I'm sure its only a few more minutes though.
Good luck.
Title: Re: A few Questions for all of you OATS peoples :)
Post by: blackbeltgirl on April 18, 2005, 07:29:05 PM
I don't know if all the other treatments will encourage BCBS to pay for OATS without microfracture.  To the best of my knowledge, none of those procedures is designed to regenerate articular cartilage, or replace it.  But the past history will certainly give your dr's office a strong argument in your favor.

Good luck, and let us know how everything goes.
Title: Re: A few Questions for all of you OATS peoples :)
Post by: brattkids2 on April 18, 2005, 08:47:01 PM
I have had two OATS and have BC/BS but the hmo BCN and they required that I try microfracture before the OATS and my lesions were large. Considered by my OS to large for microfracture. Just check with your insurance first to be sure.

I too have been told that you should be NWB even if the site it the trochlear groove. My next proceedure is in that groove and if I need OATS with allograft I was told I would be NWB for 4-8 weeks.

For my first OATS I was in for 58 minutes and the second around 90.

As for the kneecap thing I would as your OS!!

Hope all goes well for you

Paulette

Title: Re: A few Questions for all of you OATS peoples :)
Post by: poohpoohknee on April 19, 2005, 02:27:33 AM
I'm having OATS done on 4/26/05.  My OS said it would take "about an hour or so".  As for anesthesia, you may be able to have a spinal.  For my last two scopes that is what I had.  I become extremely nauseaus under a general, so my OS recommended a spinal.  I still get a SCOP patch for nauseau, but have had none of the horrific nauseau.  You are awake for the procedure and the anesthesiologist can give you a liitle or a lot in the way of sedative to relax you.  I ususally get a little bit to relax me and my OS lets me watch the procedure on the TV monitor.  He explains what her is doing as he does it.  It's acutally very interesting.  And if I become too anxious during the procedure, they can up the sedative.

Diane
Title: Re: A few Questions for all of you OATS peoples :)
Post by: gogoose16 on April 19, 2005, 05:21:48 AM
The anesthesia part is just freaky for me, i'm an anesthesia tech at the big hospital around here, so I help put people to sleep.  The only type of anesthesia i haven't had for any of my knee surgeries was a spinal. Hurt much having it started/put in?  Does anyone think a maquet procedure might still work? It's the type of TTT that only elevates the patellar tendon.  With my last TTT, i believe it was a fulkerson, i had it medialized 10mm and elevated 1cm.  Would a maquets procedure, elevation of patellar tendon 2-2.5 cm be enought to lift the patella out of that defect, and prevent it from digging into the defect on full extension?
Title: Re: A few Questions for all of you OATS peoples :)
Post by: stgiles16 on April 19, 2005, 12:43:43 PM
Do you realise how that sounds? YOu see anst. so it frightens you? What on earth would us non medical people think if we saw what you saw? OK, give, what do we NOT know that is going on???????? Should we be scared too? I am a chicken by nature but havnt worried tons over that part.

come on,,,,, give up the info. LOL

missy
Title: Re: A few Questions for all of you OATS peoples :)
Post by: blackbeltgirl on April 19, 2005, 01:05:34 PM
I don't know anything about TTTs, but I had an epidural for my 1st knee surgery, when I was 17.  I was concerned about feeling the needle in my back, but didn't feel a thing.  They had me sit up, started the sedation, and somehow I was done with my surgery.  When I had my last knee surgery in December (at 30 y/o) my dr. was opposed to the epidural.  As you know, with general they have a lot of control over when the anesthesia wears off.  I was heading out about 45 minutes after I entered the recovery room.  The epidural can easily take 2-3 hours to wear off, and you cannot leave the hospital until you can walk on your own w/crutches, go to the bathroom, etc.  Of course, if you want to watch your procedure on the screen, and your surgeon will let you, general won't work.

Good luck.
Title: Re: A few Questions for all of you OATS peoples :)
Post by: stgiles16 on April 19, 2005, 01:16:45 PM
I had epidural and spinal for a c-section (they missed with the epi so had to do a spinal) I will never do it again. I had a bad experience with it. My epi definately hurt. I have been knocked out for 8 surgeries so far and when i tell them my ususal response to anth. (being sick) they usually give me meds that help with that.  If I get a choice, I want to sleep, I have no desire to watch them operate on me,,,,,, I think that I would probably have a heart attack LOL>

missy
Title: Re: A few Questions for all of you OATS peoples :)
Post by: gogoose16 on April 19, 2005, 03:49:34 PM
Ha, as for the concern on anesthesia..i've seen the complications that happen because of anesthesia...the things the anesthesiologist says happens 0.0001% of the time, i've seen. Therefore me being jittery about that. Just a weird feeling i guess.  No one has any idea if the Maquet's procedure would still work or not?
Title: Re: A few Questions for all of you OATS peoples :)
Post by: Patty0513 on April 19, 2005, 04:11:55 PM
Hi Zach,
   I have had the Maquet procedure done on both knees and the OS elevated the TT 2 cms.  Unfortunately it didn't lift the patella off the joint very much in either knee (there is very little difference in the pre- and post-op xrays).   I'm not sure why, perhaps a scar tissue issue.  Basically I am not sure if it would lift it far enough to decrease the pain or, more importantly, stop further damage. 
   On another note, I had a spinal with no sedation for both TTTs and the OS let me watch on the TV monitor (he had one of the OR techs hold the arthroscope so that it would show the surgery, he wouldn't let me just sit up and watch!).  It was pretty cool to watch the procedure.  Good luck and I hope you can find the answers to your question.

Patty
Title: Re: A few Questions for all of you OATS peoples :)
Post by: gogoose16 on April 19, 2005, 05:06:05 PM
Thanks for the info, though I didn't really want to hear that the Maquet didn't work to well.  Was it weird hearing your own bone being cracked and broken? I get to see any kind of surgery i want at the hospital, i've watched a few TTT's and cringe when the TT is "scored transversely" as the Dr's call it. I'm sure my next question is one that many have asked before...why can't they just put an implant on the back of the kneecap? like they do in total knee's? It seems this would be an easy fix to my problem, but i guess they just can't do that? Hate to ask so many questions, and sound annoying, but I just like to be informed as i can when i go to my 3rd and 4th opinions.
Title: Re: A few Questions for all of you OATS peoples :)
Post by: Patty0513 on April 19, 2005, 05:31:39 PM
Hi Zach,
   It didn't bother me, although the anesthesiologist was watching closely in case I started to freak out.  I also wondered about implants on the kneecap.  My OS told me that they weren't having much success doing it on the underside of the patella because of the stress, especially with malaligned patellas.  I am not a candidate anyway as I have no cartilage left on the patella nor the femur.  He also wasn't too big on the microfracture procedure although he said that we could try it after the TTT didn't help ( I opted not to ).  I also asked about a partial knee replacement, but I am not a candidate for that as my knees are in too bad of shape. 
   Part of the problem with the TTTs may have been me deciding to do PT on my own.  When I did opt to go to PT with the last one, 16 months after surgery, the PT told me that I waited too long and everything in my knee is too tight now and some of the structures would be really hard to stretch at this late date.  He also thinks I have patella baja now because of scar tissue.  So I would strongly recommend going to PT what ever procedure you have done.  Good luck!  Let me know how things work out!

Patty  
Title: Re: A few Questions for all of you OATS peoples :)
Post by: gogoose16 on April 19, 2005, 10:39:17 PM
Thanks for your reply, I talked to a few of the anesthesiologists at work a few minutes ago, yes im still at work :), they all said as long as my OS had no problem with a spinal that it wouldn't be a big deal.  They all did agree that any procedure that involved anything more than arthorscopy would be "unusual" to have only a spinal and no IV regulated sedation.  Luckily since I work in the hospital i get to choose my anesthesiologist, CRNA, surg tech, 1st scrub assist or PA and my PACU nurse!  As for the patellar cap, i guess is what they are called, i know my patella is not malaligned anymore, as the TTT took care of that, the problem is that the surfaces are just so sh*tty that the joint wont glide, just like everyone elses on this board.  SO maybe that would work for me? I'll be sure to ask. Another random question, does anyoen have to sleep with their leg having off of the edge of the bed, bent, to feel comfortable?

Cheers,
Zach
Title: Re: A few Questions for all of you OATS peoples :)
Post by: blackbeltgirl on April 20, 2005, 12:59:38 PM
Zach -

I definitely do not sleep with my leg hanging off the bed, but I have spent many nights with a pillow or pillows propped under my knee.  It keeps it elevated and bent, which can be quite comfortable.  I'm usuallly a side sleeper, so I now have a body pillow which really cushions the knee nicely, allowing me to sleep in my usual position without crushing the knee in my sleep.

As to your surgery, it sounds like you are asking the right questions. Since you're so young, just be sure to ask how durable any solution is expected to be.  YOu don't want to get something done that will only last 10 years unless you have some idea of what the options may be in 10 years.  They may be able to repeat a procedure, or there may be new things in testing and development phases.  Just be sure you consider the life you want at 30, not just at 21.

Good luck.
Title: Re: A few Questions for all of you OATS peoples :)
Post by: Patty0513 on April 21, 2005, 10:57:04 PM
Hi Zach,
   I don't know much about the patellar cap.  I hope it is something that will work for you.  I slept with my leg elevated for a long time, now I just sleep with a pillow between my knees (I too am a side sleeper) and it does help the knee as well as the hip.  I would second what blackbeltgirl says about doing what is best for the long term!

Patty
P.S. It is unusual to not have some sort of sedation with a spinal for major surgery and the anesthesiologists weren't thrilled about it.  However my OS knows me very well (I have been going to him for 20 years) and he said what ever I wanted was OK with him.