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Author Topic: A few Questions for all of you OATS peoples :)  (Read 6218 times)

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Offline gogoose16

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A few Questions for all of you OATS peoples :)
« 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
05.04 L Knee Scope Debridment
10.04 L Knee Scope Debridment
12.04 L Knee Scope/LR/Medial Imbrication
03.05 L Knee Scope/TTT
10.05 L Knee Hardware removal
01.05 L Knee Scope/ ACI Harvest

Offline blackbeltgirl

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Re: A few Questions for all of you OATS peoples :)
« Reply #1 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.
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline stgiles16

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Re: A few Questions for all of you OATS peoples :)
« Reply #2 on: April 18, 2005, 05:06:43 PM »
Couldnt have said it better myself, good advice blackbelt
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline gogoose16

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Re: A few Questions for all of you OATS peoples :)
« Reply #3 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!
05.04 L Knee Scope Debridment
10.04 L Knee Scope Debridment
12.04 L Knee Scope/LR/Medial Imbrication
03.05 L Knee Scope/TTT
10.05 L Knee Hardware removal
01.05 L Knee Scope/ ACI Harvest

Offline kathleenj

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Re: A few Questions for all of you OATS peoples :)
« Reply #4 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.
right knee oats 12/03 scope autograft
right knee revision oats 6/04 open autograft
loa, plica excision, chondroplasty 12/04
synvisc 5/05
patellofemoral OA
patella baja

Offline blackbeltgirl

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Re: A few Questions for all of you OATS peoples :)
« Reply #5 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.
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

brattkids2

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Re: A few Questions for all of you OATS peoples :)
« Reply #6 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


Offline poohpoohknee

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Re: A few Questions for all of you OATS peoples :)
« Reply #7 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

Offline gogoose16

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Re: A few Questions for all of you OATS peoples :)
« Reply #8 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?
05.04 L Knee Scope Debridment
10.04 L Knee Scope Debridment
12.04 L Knee Scope/LR/Medial Imbrication
03.05 L Knee Scope/TTT
10.05 L Knee Hardware removal
01.05 L Knee Scope/ ACI Harvest

Offline stgiles16

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Re: A few Questions for all of you OATS peoples :)
« Reply #9 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
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline blackbeltgirl

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Re: A few Questions for all of you OATS peoples :)
« Reply #10 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.
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline stgiles16

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Re: A few Questions for all of you OATS peoples :)
« Reply #11 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
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline gogoose16

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Re: A few Questions for all of you OATS peoples :)
« Reply #12 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?
05.04 L Knee Scope Debridment
10.04 L Knee Scope Debridment
12.04 L Knee Scope/LR/Medial Imbrication
03.05 L Knee Scope/TTT
10.05 L Knee Hardware removal
01.05 L Knee Scope/ ACI Harvest

Offline Patty0513

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Re: A few Questions for all of you OATS peoples :)
« Reply #13 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

Offline gogoose16

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Re: A few Questions for all of you OATS peoples :)
« Reply #14 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.
05.04 L Knee Scope Debridment
10.04 L Knee Scope Debridment
12.04 L Knee Scope/LR/Medial Imbrication
03.05 L Knee Scope/TTT
10.05 L Knee Hardware removal
01.05 L Knee Scope/ ACI Harvest