The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - Osteochondral autografts and allografts (eg OATS & mosaicplasty) => Topic started by: Kari on March 19, 2003, 09:10:53 PM

Title: OS Allograph????
Post by: Kari on March 19, 2003, 09:10:53 PM
So confused.
My surgeon just told me he thinks the only thing that can be done for me is an OC allograft.
Can anyone tell me what that is...he tried to explain it, but I just don't understand.

I want to be well informed, I just don't know where to look for information.  Please help.
Title: Re: OS Allograph????
Post by: lizl on March 20, 2003, 01:05:50 AM
Try these links:

Good luck!

Title: Re: OC Allograph????
Post by: Kari on March 20, 2003, 01:42:35 AM
Thanks Liz.
That's a good start for me.  I have more questions now, and that's usually a good sign...before I didn't even know what to ask.
The only information was really from others that had posted.  
The allograph one was about ACL...that I had as an autograph 8 years ago.

I am being referred to the only guy that really does the OC allograph in Canada (according to my OS).  It sounds like just the consultation will be 3 months from now!!!!! AHHHHH...they want me to live like this until then!!!!

Thanks for your help.  Form the sounds of things I'll be here for awhile.

Title: Re: OS Allograph????
Post by: The KNEEguru on March 20, 2003, 11:41:00 AM
Just a small correction to help you with your searches - it is 'GRAFT' not 'GRAPH'.

'allograft' (a transplant graft from one person to another)
'autograft' (a transplant from a person to him/herself)
'xenograft' (a transplant from an animal to a person).

Title: Re: OS Allograph????
Post by: The KNEEguru on March 20, 2003, 11:46:17 AM
Are you sure he means an ACL graft?

I think OC is inferring 'osteochondral', although one generally uses the full term, not an abbreviation. In an osteochondral allograft, joint surface cartilage cells ('gristle') (the 'chondral' of 'osteochondral') together with a plug of underlying bone (the 'osteo' of 'osteochondral') are taken like coring an apple from the donor knee joint (usually, but not aways, a dead person) and transplanted to your knee.
Title: Re: OS Allograph????
Post by: The KNEEguru on March 20, 2003, 11:52:15 AM
An allograft is a TRANSPLANT and there are laboratories which 'harvest' and store the body part until it is requested, eg

Title: Re: OS Allograph????
Post by: The KNEEguru on March 20, 2003, 12:01:12 PM
This link may be of interest:
You will find a reference to OC allografts here.

If you do not have Acrobat to read the .pdf (it is a free download from Adobe, then here is the .html version of the same article -
Title: Re: OS Allograph????
Post by: The KNEEguru on March 20, 2003, 12:04:35 PM
You must speak to your surgeon and be quite sure what he is suggesting to you. It is YOUR knee and you owe it to yourself.
Title: Re: OS Allograph????
Post by: Kari on March 20, 2003, 03:32:46 PM
Thanks physio Jim Millard in London, Ontario wanted to know what you had to say...sounds like he knows you!
I do know that it is an OC allograft (thanks for the correction on spelling) that he is suggesting.  My ACL is fine, it was repaired 8 years ago and has been awesome.  Although I question whether the tibial plateau fracture is related to the original ACL reconstruction...they do drill through the tibia, right?

My recent history.
I "exploded" my tibial plateau into 3 big pieces and "lots of dust" in early August 2002.  Fracture occurred when helping prevent someone else from falling.  They did not fall on me, but their weight transferred into my hands applying the wrong force to the wrong angle of my knee.  I felt and heard the bone crumble before I fell.

Repair completed.  Adhesion under the kneecap prevented good ROM, a quick scope fixed that.
Learned from the scope that the cartilage "looked terrible".  I asked what terrible meant, and the resident said huge cracks in the lateral cartilage.  He then spoke of needing a major repair involving reallignment of my femur to put pressure on a different part (medial I guess) part of my knee.
(this conversation occurred with the orthopod resident in the recovery room...I was still a little foggy).

OS at next appointment said.  Yes lateral side looked bad, but no more surgery if it didn't bother me.  I was having shooting pain during sleep on medial side.  He said it wasn't medial damage...and he gave me anti-inflammatories.

OS next appointment.  Told him that I have flare-ups that give me a great deal of pain on lateral side and below kneecap, also slightly lateral.  I have tolerable discomfort at other times, but if I do anything to push the knee I end up with these flares that last for 4 or 5 days.  By pushing the knee I mean...anything openchain...also the elliptical trainer...anything new that my physio introduces.  Otherwise if not during a flare I can ride a stationary bike and do some simple leg press, step downs exercises.  During the flare I get what I describe as "catching" under the knee, slightly lateral.  It happens when walking, when riding the stationary, any movement.  It happens frequently, and brings tears to my eyes, but is short lived.
Physio thought it was meniscal impingement on lateral side.
OS says he doesn't think so, thinks it's ??? patellar-femoral pain.  OS says"wait and see", there is nothing he can do right now.  I ask if it will get better on its own.  He says probably not.  I start to cry (I hate when this happens).  He says that the only thing that could be done is the OC allograft.  He thought I might eventually need it anyway, and it's a long process, so we may as well start it now.  He is referring me to a different city, where the OS does almost all the OC allografts for the country (Canada).
I am scared.  I am not sure who or what to trust.  I don't want to feel like this.  I am not sure I can handle (or actually if my family can handle) me being "out of commission" again.  
I have gained 30 lbs :o in the 7 months since I have stopped running.  I need to do some cardio.  I need to be able to be active with my kids.  I need to lose the weight.  I need the sun to shine.  I need my family to be more supportive.  I need to understand what my life is going to be like now!

Sorry for rambling on and on.  I really feel this is the only place I have to turn right now.  I am so glad this board is here for me.  Thank you.  

Title: Re: OS Allograph????
Post by: The KNEEguru on March 21, 2003, 12:50:29 PM
The sun WILL shine again, Kari.
Just a few odd bits you might be interested in:
Title: Re: OS Allograph????
Post by: Kari on March 21, 2003, 02:26:49 PM
Thanks KneeGuru...You are amazing...
I am starting to understand my knee a little better...and am I developing some questions for my OS.
Everything you have sent me I am reading over and over.
Any other great sources of information?

I am trying to figure out the differential diagnosis.  I need to understand why THIS surgery.

Thank you, Thank you, Thank you..I bow to your wisdom ;D ;D ;D ;D ;D ;D ;D ;D ;D ;D
Title: Re: OS Allograph????
Post by: The KNEEguru on March 22, 2003, 09:33:11 AM
I think we are all gaining in wisdom as we struggle with each other's issues. I would imagine some of you questions should be -
1. How effective has the ACL repair been? Is there any residual laxity which might be allowing excess abnormal joint movement and stress on the joint surface and meniscus?
2. How good has the healing of the tibial plateau fracture been? Is the joint surface congruent, or is there a bump where the fracture healed, or a step, or anything which might lead to further joint stress?
3. If there is sufficient joint cartilage damage to warrant an allograft, how much is there? Size? Grade (depth)? Is the area too big for an autograft OATS or mosaicplasty?
Title: Re: OS Allograph????
Post by: Kari on March 23, 2003, 08:21:02 PM
Thank you for your support and suggestions.  I will be calling my OS tomorrow, and I have 2 pages of questions for him.  
I have one question for you.
A TKR is very serious, but also often very successful.  I wonder why you wouldn't just have a total knee replacement, instead of the OC Allograft?
I am not keen on donor tissue at all.  My position on blood products (and tissue I guess) has always been that it should only be used in life saving situations.  Although I don't think I can live with my knee the way it is certainly isn't life trhreatening ;)
Sincere thanks.
kari :-/
Title: Re: OS Allograph????
Post by: JessToni on March 24, 2003, 03:01:52 AM
hi Kari,
I am actually waiting to have an osteochondral allograft myself.  I have been waiting for the donor graft since late nov, which is frustrating.  I am actually going in for an arthroscopic scope this friday in order to look at my lesion again since the pain has intensified in the last month and my doc just wants to get a better look at it and make sure there is nothing else going on.
Anyway, i need the allograft surgery because i had a piece of dead bone and cartilage removed a few years back and the area never healed properly.  The lesion is too big to correct with my own cartilage (autograft).  I was concerned about the donor graft as well, but did a lot of research and it seems safe and best way to go for me.  
the problem with a TKR is that they don;t last forever, so depending on your age it might wear out and you would have to have it redone.  I am only 23 so it was definitely not an option for me.
one last note...i sympathize with the weight gain!  i was so active before this and now i can barely walk a few sucks!!

Title: Re: OS Allograph????
Post by: The KNEEguru on March 25, 2003, 09:37:44 AM
A total knee replacement certainly is an option, but once it is done there is no going back. In an older and relatively inactive person, it would probably be a good choice. An allograft may offer a younger, active person the chance of improving the current joint surface, but you are likely to be on crutches for quite a time after surgery - that is another question to add to your list.
Title: Re: OS Allograph????
Post by: The KNEEguru on March 25, 2003, 09:50:23 AM
Your weight is also going to be an issue whatever you have done. You would be wise to consider it a part of your problem and an important element in your treatment.
Title: Re: OS Allograph????
Post by: eurofrenchie29 on March 30, 2003, 04:06:56 AM
Dear Kari

Your letter almost put me to tears.  It was so sad.  I could feel your frustration in wanting to loose the weight and wanting to play and spend time with your kids.  I am experiencing the same problem.  I am also from the London Canada area and my doctor is Dr. Mac Leod.  My injury was a result of a fall on a patch of ice. (Which I am currently suing the company)
I miss playing tag, and I can't shop for as long (blessing in discuise) my knee just can't take it.  I can't run, and walking for more then an hour is killer.  
But with all this I try to think about this:  it could be worse!
I get sad, but then I am thankful for the privilage of even being able to walk at all, being able to see.  Sometimes it works sometimes not.  I've posted this comment before and I will recommend it to you.  Try yoga (with your doctors approval) You can still loose weight, tighten muscles, you balance will improve, as well as it teaches you relaxation techniques.  So when you do experience pain, you will know how to breath properly and to take it one step at a time.
Title: Re: OS Allograph????
Post by: Kari on March 31, 2003, 05:14:01 PM
Knee Guru.
I agree about needing to get the weight off.  It's probably part of the problem at this stage.  I have hired a personal trainer to complement my physiotherapist.  I have also signed on with a nurtritionist.  I am committed to doing the best I can with this injury. ;)

I got the OR reports from my original injury and my scope.  I also have my CT and X-rays now.  I have faxed some questions regarding options to my OS, but have not yet heard back (1 week ago today).  I will place another call today to make sure they received the fax.  You hate to be the "P.I.T.A." patient, but gosh it's hard to get answers!!!!

Thanks for your advice, and this site! ;)
Title: Re: OS Allograph????
Post by: Helen_uk on April 01, 2003, 06:06:36 PM
I too have had an allograft in july last year it is a big undertaking and you will be out of action for a while see my journal.
It has been a long haul and I still have a few problems but my knee is more stable than it has been in years, but it wouldnt be suggested to you unless the os thought it was absolutely necessary.
I too had to loose weight so I increased my activities as much as I could and have cut back big style however it has taken me nearly 2 years to lose 3 stone and i still have 2 and a half stone to lose but it has helped and I am determined to lose the rest you can do it.
I am on crutches permanent and I use a wheelchair so i understand how hard it an be when you are not so mobile but to be honest it has boosted my confidence more thatn helped my knees and it has given me more energy being lighter too so good luck and feel free to chat further to me
H xxx ;)