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Author Topic: OATS Knee to Ankle  (Read 69200 times)

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Offline Audrey

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OATS Knee to Ankle
« on: March 30, 2004, 12:53:04 AM »
I have just been told that OATS is the next logical step to correct my ankle injury.  I had arthroscopic ankle surgery in November 2003.  After much PT and pain, my ankle continues to "seize up" and remains painful.  The OS wants to graft cores from my knee and place them in my ankle, in the damaged area.

Should the OS perform another MRI or another procedure to ensure that OATS is necessary?  The OS has been very wonderful and I have confidence in his knowledge and ability.  However, this is a major operation and I want all the information that I can get before making this decision.

What is the CPM machine? Why is it necessary?

What is the largest graft core which should be removed at one time?

Is it better to fill the donor area or leave it open? Why?

General vs. regional anesthesia?

Thanks you any information which you can provide

Offline goingforit

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Re: OATS Knee to Ankle
« Reply #1 on: April 06, 2004, 05:34:49 AM »
Hi Audrey, I had this procedure done on March 9.   I had several plugs taken from my knee and put into to fractures in my ankle (one fracture was 25mm and deep and the other was 8mm- i'm not sure how many plugs were used and how large they were).   I don't think you need another MRI if you have recently had one.   I had a CT scan done about 3 weeks before my surgery.   Also, it was recommend that I undergo general anesthesia.   I must say that although I am so far glad that I did the procedure, I was not prepared for the level of pain and immobility I experienced at the knee donor site.   It gets much better after the first 2 weeks!   It seems as though the OATS procedure on the ankle is still a relatively uncommon surgery.   Feel free to contact me if you have any questions about the whole process.  

Offline Audrey

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Re: OATS Knee to Ankle
« Reply #2 on: April 06, 2004, 06:13:47 PM »


Hi Goingforit,

Thank you so much for your encouragement and  feedback.  I have not yet confirmed a surgery date, it will occur by the end of this month.

Were you able to care for yourself, prepare meals, bathe, light housework or were basically confined to bed or the sofa during the first two-weeks?

Your comment about the donor site being far more painful was echoed by another person as well.   Any thoughts on why that is the case?

Will the donor core holes regenerate to close themselves?  

How long was the surgical procedure?   Was it done at an outpatient center or did it require an overnight stay in the hospital?

Once again, thank you for taking the time to talk me through this event.  God Bless you.   Audrey


Offline goingforit

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Re: OATS Knee to Ankle
« Reply #3 on: April 06, 2004, 08:51:00 PM »
Hey Audrie, Getting around the first two weeks was very hard.   I would recommend that you have a family member or close friend help out as much as possible.   I went back to work after a week, but I found that that was a little too early for me.   I also had my mom around for the week after surgery which was an absolute godsend, but also loooking back necessary.   I have no idea how I could have done it without her.  
I would strongly recommend that you have your doc write a script for a wheelchair- even if you only use it to get around the house/apt it is necessary.   The reason it is so much harder to do everything is the limited mobility you will experience in your knee.
I was in the hospital for three days!   I spoke to one person who did it outpatient, but I think most ppl spend a few days.  
The donor sites are left open and eventually should fill themselves in.   When you first start to move your knee you will hear cracking which is the blood refilling in to the spot.

Offline goingforit

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Re: OATS Knee to Ankle
« Reply #4 on: April 07, 2004, 04:29:33 AM »
Audrey, Do you know how many OATS procedures your surgeon has done on the ankle?   Even if your surgeon is great he may not have done many of these procedures.   If he or she hasn't then you may want to consider having the actual surgery done by an OS who has done many (comparatively anyway) of these surgeries.

Offline Audrey

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Re: OATS Knee to Ankle
« Reply #5 on: April 07, 2004, 07:03:12 PM »
Getting the actual number of surgeries and successful surgeries is on of the  list of 23 question which I sent to him a few days ago.  His assistant informed that he was in surgery most of this week.  I expect answers from him on Friday.  

Offline pj13

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Re: OATS Knee to Ankle
« Reply #6 on: October 26, 2004, 01:30:49 AM »
Hi,
My doctor just recommended the OATS procedure to me.  Right now I am looking up information and compiling my own list of questions.  Any chance you could share the questions you asked your doctor?  Maybe there's something there I haven't thought of yet.  Also, it would be really great if you could tell me about your experiences.  Mainly, did it help?  Would you recommend it?

thanks,
Phillip

Offline Audrey

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Re: OATS Knee to Ankle
« Reply #7 on: October 26, 2004, 07:46:24 PM »
Yes, I would recommend OATS.  As soon as I locate the questions which I sent to my OS and will forward them to you.    

I had my procedure done at the end of May 2004.  Like you I did a lot of reseach and asked my doctor many questions.  I also used this website to get and verify answers and to get a graphic idea of how the surgery would proceed:       http://drstoller.com/education.htm.  

My OS removed plugs of cartilage from my right knee and placed them in my right ankle.  The OS also place two screws in my ankle as well.  I stayed in the hospital for two and a half days.  The day on which I had the OATS and the next day I had a morphine drip to control the discomfort.  On the day they discarded me, they administered prececet.

I recouped at home for several weeks. I was not allowed to put ANY pressure on my ankle.  During this phase, even minimal pressure can move things slightly out of alignment. So you will need someone to help you care for yourself.  Someone to help prepare food, bathe, and other personal and general care tasks.  Get plenty of books, movies and/or craft projects which can be done from the prone position.  

Fourteen days after surgery they removed the big gauze cast like thing and the stitches.  The thread like stitches were was replaced with the paper type stitiches which you wear until they fall off.  

At this phase, my knee was more painful than was my ankle.  It is important to get your knee moving through its full range of motion as soon as you are released to do so.  Under the supervision of a PT, I started knee range of motion (ROM) soon after the stitches were removed.  I go to physical therapy (PT) three times a week to rehab both knee and ankle.  

Now, I am 5 months post surgery and doing well.  I continue to have swelling in my ankle by the end of the day and some pain.  My knee is getting stronger and does not cause me much pain at all.  On a scale of 1-10 (10 extremely painful), my ankle is a 4/5 where as before the surgery it was 7/8.  I still have pain but not with the frequency and intensity that I had before the surgery.  

I could go on an on about this but I will spare you. If you have specific questions please, please do not hesitate to contact me.

Offline pj13

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Re: OATS Knee to Ankle
« Reply #8 on: October 27, 2004, 11:10:39 PM »
Thanks for the reply.

I'm pretty sure I understand basically what is involved in the procedure.  I'm just trying to decide if this is right for me.  

The MRI indicates that the damaged area is 1.7cm by 1.0cm -- from the info I've found so far that seems pretty large.  They recommend taking tissue from a cadavar instead of from my own knee.  So, at least I wouldn't have to worry about that part of it.

For me, there was no particular injury that caused this.  I can't really remember a time when my ankle didn't hurt.  I first had x-rays probably 12 years ago -- given the choices then I decided to grin and bear it.  It has definitely gotten worse over time, more severe and more frequent pain, and now the surgery option is looking better.

Right now, I can go play soccer or basketball or whatever with very little pain while I play -- the pain comes afterward, and lasts a day or two.  My fear is that if I have this procedure done, then I won't be able to go hiking, or play sports anymore even after the projected 6 months of recovery.  Right now I *can* do that, and I just have to deal with some pain.  

If I can recover to the same activity levels, but with less or no pain, then of course it would be worth the recovery time.  But if I have to give up those activities forever to reduce the pain, then I'm not so sure I'm willing to do it.

You mentioned that you still have pain, but its less.  What was your typical level of activity before?  Do you think you'll get back to the same level?  What about getting a second opinion?  Like you said, I want all the information I can get before I make this decision.  

Then there's all the logistic problems.  My apartment is the second and third floor of an old house.  How do I get up and down the stairs?  Do I have to move to get this done?    Transportation?  I'm sure I can't drive during the no weight bearing stage.  (Luckily, I'm doing research right now, so with a laptop and an internet connection I can do a lot of my work, no matter where I am).  showering?  how tough is that?  lots of questions going through my head right now.

thanks again,
Phillip

Offline Audrey

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Re: OATS Knee to Ankle
« Reply #9 on: October 28, 2004, 01:45:18 AM »
Hi Phillip

Before the surgery, I walked a lot and worked out at the gym. I fully expect to return to my pre surgery level of exercise without the pain in the next few months.  Even at the risk of not fully returning to my pre surgery leve of exercise, I did not want this to worsen.

The deciding factors for me were: 1) injuries and pain seldom get better as we age; 2) present injuries/pain could cause other injuries or intensity; 3) injuries/pain seldom get better on their own and 3) healing takes longer as we age.   So I figured if I am in pain now, I should try to fix it before it deteriorates any further and adversely impact other parts of my body like my back and hips.  As you know the back and hips compensate for the abnormal gait.  

I got a second opinion and I do recommend getting one.  In my case the second opinion doctor offered an opinion counter to my OS.  Both doctors were OS, what I discovered is the second opinion doctor specialized in traumatic injuries. So my injury looked insignificant to him.  As a result, he did not think surgery was necessary. Be careful who offers the second opinion.
In my case, I had confidence in my OS and he had extensive knowledge of my injury.   For me, surgery was totally the right thing.  

I do not think that you have to move.  I live in a third floor condo- no elevator.  I do recommend moving things to one level for your convenience and safety.  Like wherever the largest bathroom is co-located everything, a bed, a small fridge, microwave and television/entertainment.  Negotiating the stairs on crutches is challenging even if someone is around to help you.  Once good way to tackle stairs is to sit and slide up and down them.  I was not released to drive for several weeks.  Luckily, I had a car service pick me up for medical appointments and PT.  Family and friends did my shopping and errands.

Bathing was challenging, you must have someone around to safely complete this task.  I could not wet my leg from above the knee to the ankle.  Definitely, get a shower chair.  I was resistant; it made me feel old and helpless.  After a few days without a shower, I gladly used a shower chair.  Get the one without the arm rest- less maneuvering to use.  Do not try to do this alone: water, soap, a plastic bag, and the use of only one leg, climbing over the tub surround. This could get ugly.

Lessons Learned:

Prepackage small meals which can be easily microwaved.

Store them in containers which can be tossed away (you will not feel like doing dishes)

Do your laundry before surgery

Put away things that you do not want prying eyes to see.

Have big sweatpants that can fit over the cast.

Make sure your mattress is as comfortable as it can be.


Phillip, I hope I am being of help. Keep the questions coming.  




Offline love2run

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Re: OATS Knee to Ankle
« Reply #10 on: November 03, 2004, 08:12:50 PM »
Hi Audrey,

I sent you an instant message instead of posting to this thread by mistake....

I read your messages to Phillip and am so anxious to talk to someone who had the OATS surgery for their ankle.

I had an Osteochondral lesion in my left ankle.  It took three years and several doctors to find out the problem after a severe ankle sprain running.  In March 2004, my orthopedic doctor did arthroscopic surgery to remove the lesion, which was detached.  I was on crutches for 7 weeks and went through PT.  The only physical activity I'm allowed to do from now on is walk, bike, & swim.   My ankle is still bothering me (almost worse than b/f my surgery).   I finally found an orthopedic surgeon who does the OATS surgery.  He said I am definetly a candidate.  I just had an MRI yesterday and am seeing this doctor for a second time Friday to discuss further the OATS procedure and to schedule surgery for January.   The reason I want the surgery is to have the ability to run again.  I just turned 30 and cannot imagine not having the ability to run ever again in my life or participate in any kind of high impact sport.  I was told that the OATS procedure should allow me to enjoy the activities I once did before my ankle sprain.  I would love to know your answers on the following:

-do you think I'm ridiculuous for thinking I'll be able to run again once my ankle has healed after the surgery?
-how is your knee?  I have no problems with my knees and I'm scared this surgery will cause me to have pain long term in this joint as well.
-did your surgeon recommend any physical activity restrictions once your ankle is healed?
-how long were you on crutches for? was your knee casted too?
-can you do any high impact activities now? pain free?

I would greatly appreciate a response.  I know my ankle will never be 100% better, but I'm hoping this procedure will improve my ankle performance now and in the future as I age.  I don't plan on running marathons, but I would like to be able to play a leisurely game of tennis and participate in an 5k runs here and there.

Thank you so much for your time :)

Offline goingforit

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Re: OATS Knee to Ankle
« Reply #11 on: November 03, 2004, 09:06:04 PM »
I had OATs on my right ankle in March 2004.   I injured my ankle running in a soccer game in December 2003 and did not have prior athroscopic surgery.  After the injury all I could do was swim and occassionally do the elliptical trainer (although I would have pain in the days following that kept getting worse so eventually I phased that out).  Here are some answers for you:
-do you think I'm ridiculuous for thinking I'll be able to run again once my ankle has healed after the surgery?
You should probably be able to run, but I guess that depends on your individual experience w/ the surgery.   My doctor actually recommended that I start running again to break up scar tissue.   I can only go a little at a time- maybe one mile in quarter mile sets, but I am getting better!


-how is your knee?  I have no problems with my knees and I'm scared this surgery will cause me to have pain long term in this joint as well.
I still have minor pain in my knee (and had no prior knee problems).   It is getting better.   I am hopeful it will be gone by the one year mark.

-did your surgeon recommend any physical activity restrictions once your ankle is healed?
Not really.
-how long were you on crutches for? was your knee casted too?
Too long!   knee was wrapped but not casted for 2 weeks.   I was non weight bearing for 8 weeks, and in a walking cast for 4 weeks (removable though for showers, sleeping, etc.)  In the hospital for 3 days.   I've heard some people only be nwb for 6 weeks, so this may depend on your doctor.

-can you do any high impact activities now? pain free?
Yes, running (see above).   I have some pain after, but it's not that same internal bone pain.   It's more discomfort.   I think that will fade even more as I become more active.

I would greatly appreciate a response.  I know my ankle will never be 100% better, but I'm hoping this procedure will improve my ankle performance now and in the future as I age.  I don't plan on running marathons, but I would like to be able to play a leisurely game of tennis and participate in an 5k runs here and there.

Thank you so much for your time :)[/quote]

Offline Audrey

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Re: OATS Knee to Ankle
« Reply #12 on: November 03, 2004, 10:23:40 PM »
Hi Love2run

Of course, I am not an OS but you should be able to run again. You may have to run less frequently but I think you will still be able to enjoy running.  

My knee is healing just fine. Post surgery my knee caused more pain than did my ankle.  After several weeks of PT, my knee is feeling just fine.  

My OS has not recommended any limitations on physical activities.  I have decided to refrain from impact activities until I am able to walk 5 pain free miles and feel great the next day.  My measure is not can I do something, but how quickly I bounce back and am pain free.

Yes, the large gauze like cast extended above me knee.  I was on crutches for both my knee and ankle.  As the plugs were removed from my right knee for use in my right ankle.  For the first 6 weeks, I was complete non-weight bearing.  Then "egg shell pressure" just enough pressure on my foot to crush an eggshell for another month.  Next, I only used my crutches as needed.  Now, I do not use any assistance.

I have decided to abstain from high impact activities for a while longer.  I am not completely pain free.  When I start to walk after sitting for several minutes, I am in pain.  

I am in less pain than before the surgery.  I use to run and fully expect to run again in the future.


I hope this was helpful. Write again, if you like. Thanks Audrey

Offline Audrey

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Re: OATS Knee to Ankle
« Reply #13 on: November 04, 2004, 07:21:59 PM »
Dear Philip and Love2run,

Below are the questions that I sent my OS before surgery.  I have a copy of his answers somewhere.  As soon as I locate the answers, I will post them.

March 30, 2004

Dear Dr. Guyton:

You recommended the OATS procedure for my ankle.  Please provide answers for the following questions:

1.      How long is this procedure?
2.      Will you or a resident perform this procedure?
3.      Is it outpatient surgery?
4.      Is this procedure performed under regional or general anesthesia?
5.      Give me a detail explanation of the recuperation time?
6.      I read that this is a fairly new procedure.  How long have you performed this procedure?
7.      How many have you performed?
8.      What is your success rate, i.e. patients fully recovered, from this procedure under your care?
9.      How do you determine the depth in which you remove the graft core(s)?
10.      Do the holes in the knee regenerate?
11.      How long does that take?
12.      Will the graft core(s) be taken in one piece or several pieces?
13.      What will be the size of the graft core(s)?
14.      Do you leave the graft core(s) area open or closed?
15.      What is the advantage and disadvantage of the closed and opened  core grafts?
16.      Are there things, which I can do pre op, which will improve the success of this procedure, for example, low impact strengthening exercises, flexibility exercises, or immobilization?
17.      In terms of healing, what can I expect?
18.      Did I hear you correctly, that two screws will also be inserted in my ankle permanently? If so, please explain the purpose?

As I am sure you understand, I need to have all of the pertinent information in order to make this decision.  Your timely reply is appreciated.

Regards,


Audrey McMillan

H:\Ankle.doc




March 31, 2004


Dr. G. Guyton

Just a few more questions:

I have learned that OATS has limited success with large and deep osteochondral defects?  Am I well within tolerance?

What are the problems generally associated with the donor site?

What are some of the surgical complications which could occur?

Is donor site morbidity a concern with this procedure? Please explain?



« Last Edit: November 04, 2004, 07:22:36 PM by Audrey »

Offline pj13

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Re: OATS Knee to Ankle
« Reply #14 on: November 08, 2004, 06:02:31 PM »
Thanks so much for the information and sharing your experiences!  This is really helpful for me.  Since my doctor recommended the OATS procedure I've been paying close attention to how much my ankle bothers me.  For the last week or two its been tolerable, so I was thinking I could put off the surgery.  Today is a bad day.

Logically I can tell myself that I should do this, the doctor recommends it, its more likely to work while I'm still younger, it's not going to get better by itself, it *will* get worse, but I've really been resisting committing to having this done.  

So, now I'm armed with a long list of questions.  I'll make another appointment with my doctor and grill him.  My parents are retired now and volunteered to come stay with me post surgery!  I'm thinking that will be a huge help.

Thanks again, and please post any more advice you have, maybe something you would have done differently, or any other comments you might have for me.

:-)
Phillip















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