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Offline SallyW

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Re: Major disaster
« Reply #15 on: October 02, 2005, 04:35:13 AM »
What is considered a "large" autograft plug?

Things are going well for me, I guess, although my PT keeps telling me to not push rehab so much. He says I'll do better if I slow down. But hearing about others whose plugs have gone haywire after months of "great" results makes me nervous. Especially since it seems like those of us with OCD are at greatest risk, correct?

The only thing to keep in mind, I guess - aren't people who are having problems more likely to hang around here? The people with successful recoveries usually are all too eager to put their knee problems behind them - not think about stuff like this. So maybe this board doesn't offer an accurate picture of successful operations?
Right knee: LR/TTT 1995 Left knee: LR/TTT 2000, Microfracture & partial meniscus removal 2004, Synvisc 2004, Unloader 2004, OATS 6/20/2005, Synvisc 2006, Debridement 2006

Offline blackbeltgirl

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Re: Major disaster
« Reply #16 on: October 02, 2005, 04:22:11 PM »
Danielle -

How was that bottle of bourbon? ;)  Hope you're feeling a little better, mentally speaking.  No matter what happens, remember that your attitude can make a huge difference in how you heal.  Partly because it may be the only thing you have control over, but partly the seratonin level, or whatever that hormone is.  I always call it the happy hormone.  At least you know you're not alone, and have a support system here.  Imagine the patients going through knee trouble, whose family and friends don't quite understand, but they've never found kneeguru.  Here you can vent to your heart's content, cry big sloppy tears if needed, and get comfort, sympathy, and even voices of experience.

I'll keep my fingers crossed that it's just a fracture, and hope that you can get through the next step of healing without any new troubles.
Jess
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 JG

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Re: Major disaster
« Reply #17 on: October 02, 2005, 05:20:04 PM »
Sally,

I'm not sure there is such a thing as a "large" autograft.  I'm talking large allografts, shells and whole hemi chondyles.  Remember where they are taking the autograft from, there is not much donor area to take a large plug.  I'm not sure how large shell allografts are, but if a normal allo or autograft plug is say 6 mm to 12 mm, a shell has to be 2 or 4 times that size and they are not alway round in size but cut to the defect shape.  I've done tons of research on allografts, but don't have the research organized.  If I find it I will post it for everyone.  I did find some results for shell allografts (see below).

Here are some papers reviewed at the AAOS meeting last year regarding the utility of allografts in orthopaedics.  The bottoms one refers to shell allografts.

http://www.medscape.com/viewarticle/491618_2

Here is a picture of a shell allograft, just scan down the page (Figure 1b)

http://radiology.rsnajnls.org/cgi/content/full/219/1/35

I agree about this board being attended by mostly people who have problems, but this "poping" thing just seems strange.  Prior to my surgery I got a second, third and fourth opinions.  Because we knew I would have at least 10 (I had 18) plugs, I was worried about all of the plugs living.  Basically all of them said that if they survived the first 3 months, they would survive.  No one was worried about the plugs moving after three months.  But they all said the recovery would be 18 months to 24 months.  I didn't believe that part, but it was.

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline JG

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Re: Major disaster
« Reply #18 on: October 02, 2005, 07:26:06 PM »
Here is something I found about grafts coming loose...

"Peripheral containment of the lesion is another factor when subchondral bone is markedly involved. Ideally, the periphery of the defect should be rigid enough to contain the outermost grafts. This is intuitive and important from a mechanical stability standpoint; without adequate press fit, unconstrained grafts may loosen in the early postoperative period when range of motion is started, even without weightbearing."

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

shadehawk

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Re: Major disaster
« Reply #19 on: October 03, 2005, 01:54:00 PM »


Danielle and Scooter

This is going to be a tough week for both of you.  Danielle with the scope today and Scooter awaiting your news on Wednesday.

Our fingers are X'd,

Shade

Offline brattkids

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Re: Major disaster
« Reply #20 on: October 03, 2005, 04:54:41 PM »
Thanks for the info Janice, I find it really weird also that everones grafts are coming loose- what a coincidence.

Danielle, I sure hope things go well for you today!!!!!!

Paulette

4/04 microfracture
5/04 debris removal
8/04 OATS with synthetic plugs
11/04 OATS traditional autograft medial femoral chondyle
05/05 debris removal and OATS assessment
6/05 Cadaver Allograft OATS lateral femoral chondyle
9/05 OATS redone could not save allograft plug
12/2006 2007 and 2008 scop

Offline kathleenj

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Re: Major disaster
« Reply #21 on: October 03, 2005, 07:21:54 PM »
I have to agree that it is strange to hear about plugs popping out.  Last year when I was told that my plug shifted I didnt fully understand how that was possible.  I was told that after the first few months it would be incorporated.  I think I had a false sense of security when I had xrays at 2 months and was told the plug is looking good.  I was never told that it is still possible for it to move.  But there I was, 4 months post op being told that the plug 'shifted' and having to schedule the revision.   
Makes you wonder if just any doctor should be doing these.  My original OS implied that it was a piece of cake.  Like a hair transplant he told me.  HA!  I dont think so.  I have since moved on and have been plagued with many many other issues with the cartilage.  It all just really makes me wonder.............
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 Beauzer

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Re: Major disaster
« Reply #22 on: October 04, 2005, 08:55:34 PM »
Thanks everybody for the encouraging words.

I'm just back from the hospital.  Good news, although one plug was a bit broken, the rest didn't look too bad.  They cleaned up the broken one, which was likely responsible for the catching sensation.  I also fractured the surrounding MFC, explaining why everything hurt so much.  I ended up staying the night, because we couldn't get the pain under control.  I still feel really woozy today.

So, it looks like everything is going to heal with some TLC (and 6-12 weeks NWB - ouch).
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

shadehawk

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Re: Major disaster
« Reply #23 on: October 04, 2005, 09:45:56 PM »
Danielle,

Glad that you are back home again.  Hope that everything will go as planned now, sorry about the long time NWB - know that is a real pain.

Sending good vibes your way .......................

Shade

Offline brattkids

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Re: Major disaster
« Reply #24 on: October 04, 2005, 10:19:20 PM »
at least it wasnt as bad as you thought!! although thats a long long time for NWB  :'(

Keep me posted on how you are feeling

Paulette


HUGS AND GOOD VIBES YOUR WAY
4/04 microfracture
5/04 debris removal
8/04 OATS with synthetic plugs
11/04 OATS traditional autograft medial femoral chondyle
05/05 debris removal and OATS assessment
6/05 Cadaver Allograft OATS lateral femoral chondyle
9/05 OATS redone could not save allograft plug
12/2006 2007 and 2008 scop

Offline kathleenj

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Re: Major disaster
« Reply #25 on: October 04, 2005, 11:53:21 PM »
Danielle,

Glad to hear that it wasnt as bad as originally expected.  I think Janice  (JG) had some sort of fracture of the MFC or was it one of the plugs after her mosaicplasty...I cant remember exactly right now.  She may be able to tell you what to expect in regard to that.  Good luck with the NWB again.  I know it sucks but all in all things should be ok. 

Hang in there!!!
Kathy
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 scooter5

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Re: Major disaster
« Reply #26 on: October 05, 2005, 01:43:48 AM »
Danielle,

Glad to hear it wasn't as bad as originally thought.  NWB is a pain however, it will be worth it in the end.

Good luck on the recovery.  Keep us posted.

Scooter

Offline Beauzer

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Re: Major disaster
« Reply #27 on: October 05, 2005, 02:50:41 AM »
I ended up talking to my other OS (both did the OATS) tonight.  He suspects there still could be some AVN (osteonecrosis) of the MFC to go along with the fracturing.  So that's why the potentially long NWB.  We'll just have to wait and see.  Bleah.

I'm also now stuck in a brace (Breg T-ROM).  Overall it's nice compared to the other post-op braces I've had.  I'm just wondering why I have to wear it at all.  I didn't use one after the OATS.  Initially this time it was to make sure I didn't bend the knee, until we found out if I had disrupted my grafts.  Now I'm cleared to full ROM.  I guess it could help take pressure off the healing MFC fractures in case I put my foot down (not that I'm planning on it, mind you).

Has anybody else had postop fracturing somewhere other than the plugs themselves?  Or am I just weird?

Danielle
« Last Edit: October 05, 2005, 02:55:51 AM by Beauzer »
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline JG

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Re: Major disaster
« Reply #28 on: October 05, 2005, 04:33:17 AM »
Nope, you are not weird.  I actually was initially diagnosed with articular cartilage problems not from the MRI showing thinning cartilage but from a fracture running up my MFC into my femur.  There was synovial fluid running from my knee joint up the fracture.  They only way that happens is if there is no articular cartilage to stop the fluid from going up there.  I have been battling them since (almost 5 years).  I've also battled with periods when they thought I had AVN. 

I'm training for a century bike ride which is coming up in three weeks and after my training rides of 75 and 85 miles I had really bad swelling (like ROM of 10 - 100) for a couple days.  I called my OS about it and he laughed and said that he didn't need films it was probably either one of my famous stress reaction fractures or another fracture forming in my MFC.   I'm constantly battling all sorts of things with my MFC (subchondral cysts, bone bruises).  I get them for no reason at all really.  It's amazing my grafts looks so awesome.  The underlying bone is shakey at best.

Danielle, you should really look into seeing Gross, Cole, or Bugbee about the shell allograft.  At minimum your OS should call for you.  My guy made me talk to 3-4 of the top guys before he would do my big mosaicplasty.  The one thing I've not had, popping plugs and failing plugs, but I was NWB for a very very long time and I waited and waited to get back to normal life...like 9 months before I went for normal walks (3-4 miles).  That was key. 

Good luck,

Janice
Sept-99 - L knee LR
Aug-02 - L knee LR/menisectomy
Apr-03 - L Knee Mosaicplasty Using Allograft (18 grafts)/LR/debridement/menisectomy; Right Knee menisectomy.
Apr-04 - L Scope - LR/Lysis Adhesions

Offline Beauzer

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Re: Major disaster
« Reply #29 on: October 06, 2005, 04:26:08 PM »
Pain is a funny thing.  So after nothing but excruciating pain since last Friday (when I apparantly crunched my MFC), today I woke up with none at all.  Gone.  Doesn't make much sense to me.  In fact, the very thought hadn't occurred to me until I realized that I had hopped straight out of bed and WALKED to the bathroom.  Oops.

Interestingly, that didn't really hurt either.  I mean, I'm a little sore, like normal post-scope sore.  But I haven't even taken anything today (not even tylenol).  So...  What does this mean?  I've been cautiously doing short hops around the house off the crutches and it feels OK.  Something certainly hurt like the dickens for the past few days, but whatever it was seems to be gone now.

My OS's don't really agree on what the significance of my MRI is or whether or not there is actually fracturing of the MFC.  One thinks the marrow edema may not be abnormal for this stage postop OATS and once the symptoms are gone, we just re-image it and go on about normal life.  The other thinks I should be strict NWB for 6-12 weeks.  Certainly, life would be much easier with the shorter course of NWB.  I just don't know.  Maybe everything was just from the screwed up plug.  What to do, what to do? 

The issue is that the literature on AVN doesn't really support conservative treatment in adult patients (once the growth plates are closed) because it generally doesn't help heal the area.  It may be helpful short-term for symptoms, but doesn't change the outcome.  I don't know if I'm different because I'm post-OATS or not.  Even my more-conservative OS says that if this whole thing is AVN, there really isn't much to do with it.  Just watch and wait and see what happens in the future.  So if NWB only helps symptoms and currently I'm not having any, why exactly should I be NWB?  If things hurt while I'm putzing around without crutches, I guess I'll have my answer.
« Last Edit: October 06, 2005, 04:35:47 PM by Beauzer »
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05