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How long did you wait for an osteochondral Allograft?

1 month or less
4 (57.1%)
3 months or less
0 (0%)
6 months or less
0 (0%)
6 months to a year
0 (0%)
More than a year
3 (42.9%)

Total Members Voted: 7


Author Topic: Allograft waiting list  (Read 10973 times)

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Offline hopalongcasualty

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Allograft waiting list
« on: January 11, 2006, 03:57:15 AM »
Hello everyone, I am on the list to find a match for a (left) lateral femoral condyle.  I was wondering in your experiences, how long have you had to wait?

R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline stgiles16

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Re: Allograft waiting list
« Reply #1 on: January 15, 2006, 05:55:07 PM »
Good question. I am soon to be put on a waiting list so I would like to know the answer myself.

I have the choice between OATS  or PKR, I choose OATS. I want to put off PKR for as long as possible.

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 brattkids

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Re: Allograft waiting list
« Reply #2 on: January 15, 2006, 10:06:20 PM »
I think that I am an exception but I only had to wait for 26 days. I have heard that it could take up to a year to get a graft. I sure hope you guys dont have to wait that long


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 JG

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Re: Allograft waiting list
« Reply #3 on: January 16, 2006, 12:41:28 AM »
I'm the single vote and I was less than 30 days I think.  I went on the list either very late in February or early in March and had surgery on April 1.  I got the call 4 days prior to surgery.  When my surgeon said 4-6 weeks I didn't believe him.  I figured it would be 2-4 months.

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 hopalongcasualty

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Re: Allograft waiting list
« Reply #4 on: January 16, 2006, 02:39:27 AM »
Janice,

Thank you, I have a more confident feeling that I won't be in limbo for months to come. 

Again, you were right and the surgical coordinator for my OS's office was mistaken in scheduling the procedure in advance.

Hopalongcasualty
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline kittykat

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Re: Allograft waiting list
« Reply #5 on: January 19, 2006, 01:14:23 AM »
Hopalong,
This is my first post but I have spent alot of time on the site as a guest.  I felt I must respond to your question as it was the one question I could never get a straight answer on while I was waiting.  I waited just short of 14 weeks or 3.5 months.  All my surgeon would commit to was "months".  I had basically convinced myself that it was never going to happen.  When the call came on Monday afternoon and I was told I was scheduled for surgery Wednesday morning, I freaked out.  The short version is that I had a 2.0 cm by 2.5 cm traumatic defect on by medial femoral condyle created when I tore my ACL and medial meniscus.  Allograft and ACI were both presented to me as an option, my surgeon and I decided allograft in place of ACI.  I work in an academic medical setting and did all the research and I am 100% comfortable with our decision.  The surgery and recovery was easier than I expected (needless to say it was not my first).  I am 7 months post op and although I am not without some issues, I would say it is a success.

Kittykat

Offline stgiles16

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Re: Allograft waiting list
« Reply #6 on: January 19, 2006, 01:54:22 AM »
Kittykat, can you give us some more information on your rehab? what else have you had done in the past? How did the OATS compare to other surgeries?  I am facing OATS in the very near future and would love to hear more of your experience. feel free to PM me if you would rather chat that way.
thanks
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 hopalongcasualty

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Re: Allograft waiting list
« Reply #7 on: January 19, 2006, 05:04:04 PM »
Kittykat,

First of all, thanks for the information and I am pleased to hear you are doing well and that you are confident with this procedure.  I did my homework too, I tried suggesting several different options to the Docs ACI, OATS, etc.  The concensus has been that the defect is too large for long term sucess from these procedures; especially considering the rest of the knee is in pretty good condition.  I am not saying that a Dr. Stedman or somone like that would not try it, but I do have the limitation of Medical Insurance Network Docs to work with. 

I am comfortable though with the Allograft option because I did pay for a consultaion with an "Uber" Knee Surgeon at UT SW Medschool.  He confirmed that this was the appropriate way to go. 

I also think it would be beneficial to hear some of your current challenges and knee issues, not that they will discourage us in any way, but if we experience similar events, we will not panic.

Thanks,

Hopalongcasualty
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline stgiles16

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Re: Allograft waiting list
« Reply #8 on: January 20, 2006, 03:51:00 AM »
I was told today to make a decision between an allograft procedure or PKR. My OS said that the tissue bank would take 6-8 mnths most likely to find a match. OATS would also require 2 seperate surgeries whereas I can have my PKR at the same time that I get my next LOA. He offered to do it tomorrow and I almost had a stroke. After I have decided which one that I want to do, I have to call and schedule the surgery. I will probably schedule it for some time next month. Could some of you guys share your experiemces so that I can make a more informed decision? Any advise appreciated.

what would you guys choose? I am leaning towards PKR but not sure yet. HELP.

thanks 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 brattkids

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Re: Allograft waiting list
« Reply #9 on: January 20, 2006, 12:35:33 PM »
Oh Missy,

What a shock that must have been!! I cannot tell you what proceedure to go with but I do want to offer my support. The best of luck to you in making your choice!!!

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 stgiles16

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Re: Allograft waiting list
« Reply #10 on: January 20, 2006, 01:17:59 PM »
Thank you Paulette, I am leaning towards the PKR since I have not had much luck with microfractures, I am afraid to chance the allograft because it has the possibility to fail. I also would rather not have 2 more open surgeries. 10-15 years before the next surgery sounds very good to me. I still need to do lots of research before I make a decision. That is one of the reasons that I would like to hear other people's experiences. A PKR just sounds so FINAL to me. I feel too young (everywhere but my knees) to have one , I am 42 but then again, the lure of no pain without living on crtutches for months at a time is also appealing.
thank you for your support.
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: Allograft waiting list
« Reply #11 on: January 20, 2006, 01:34:53 PM »
hopalong -

I may have asked you this before, but how large are your lesions?  I ask because I got the exact opposite response to the question allograft vs. aci.  I went to a lead researcher in cartilage issues, who performs both procedures so he can really evaluate the patient for which is best.  And I was told that ACI had better odds of working because of how large my lesions are.  AND he said that if I tried the ACI and it failed we couls still try the allograft, but if an allograft failed my only alternative would be a TKR.  So I'm curious why you got the opposite response.  Of course it may be more than size - it could be location of the lesions, and the degree of bone damage.  My OS estimates that I have a window of a few months before the bone damage gets to be too great for ACI to work, and then of course, I'd be stuck trying an allograft.  As I said, just curious.  I've come to find all the nuances fascinating, and I like learning the different methods, and decision factors surgeons use.

Good luck-
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: Allograft waiting list
« Reply #12 on: January 21, 2006, 07:22:05 AM »
Jess,

Even though my surgeon is not an ACI guy he gave me the same type of response as Missy's doctor.  Also when I/we spoke to Cole, Minas, Bugbee etc., they all felt my lesions were too big for ACI anyways so allograft was my only choice.  Actually, of the 5 or so I spoke to only 2 agreed that I was even a candidate for allograft (the other said TKR by 40).   Dr. Cole has done a good job of outlining which procedures are indicated for specific defects sizes (see page 9).  I would imagine in your research you have stumbled upon this.  ACI actually has the greatest range of use.  I'm still very very intersted in your ACI to the TP.  I have continued to search for information about this with no luck other than access is very poor and it can't really be done.  I think I tore the scar tissue that was covering my LTP defect and it been really bad for a couple weeks.  I would love to try ACI on it at some point. 

http://www.cartilagedoc.org/downloads/sek/g4368.pdf#search='chondral%20defect%20and%20treatment%20options'

Missy,

Are you having a large allograft procedure rather than allograft plug procedure.  With a large allograft they take an entire hemichondyle or tibia plateau and replace it (I mean the whole thing).  It's a pretty serious deal with months on crutches.  My surgeon and I discussed it as an option for my LTP but it was way too early to seriously consider it.  Why is it that your OATS would be 2 procedures and not 1.  It sounds like you are in a lot of pain.  I'm pretty lucky.  I only have bouts of pain, nothing too constant.  You know I'm a big fan of the allograft procedure, but it comes with it's own set of problems.  Don't let any doctor rush you into a decision.  Take your time.

Here is a good overview on allografting:

http://www.cartilagedoc.org/downloads/knee/FOAT.pdf

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 hopalongcasualty

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Re: Allograft waiting list
« Reply #13 on: January 21, 2006, 04:47:42 PM »
BBG

the lesion is traumatic in nature, the length is 5cm and the width is 2.5cm at their respective apexes.  Probably a shell allograft.  Not overly happy abpout the thoughts if it. 

The defect runs from the anterior lateral condyle to the distal end. 

Amazingly the lesion was relatively asymptomatic until September and quickly degenrated. 
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline stgiles16

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Re: Allograft waiting list
« Reply #14 on: January 21, 2006, 09:19:59 PM »
Janice, the reason that mine would be 2 surgeries is the first surgery is going to be an open LOA and then he would take a tissue sample to send to the tissue bank for matching. The second surgery would be the allograft procedure. I dont know if he would do plugs or the entire hemichondyle. I was also offered to be in the clinical trials for the arthrosurface hemicap. It is an large metal screw that fills in the defect. I think that is the way that I will go. He said that I would not be NWB and that the recovery is much easier. I need to find out the financial aspect of this before I make my final decision. The more that I read about OATS, the less that I want to go thru it. I hate crutches and the thoughts of being on them for months is down right depressing.

I wiilll post the detail about the new PKR when I get them.

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 JG

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Re: Allograft waiting list
« Reply #15 on: January 23, 2006, 12:01:37 AM »
Hi Missy,

Your decision is interesting...not the decision to go with PKR versus allograft, but to go with something that hasn't been used in patients for years.   I have an insiders knowledge about clinical trials and physicians relationships with for profit companies (pharmaceutical, device, etc.).  Physicians don't do clinical trials free.  There are multiple forms of "payment" they receive.  If I had a life threatening condition or had exhausted all existing treatment options, I would be happy to participate in clinical trial.  However, there are so many established options for you.  Yes some may require you to be on crutches for a long period of time, other not.  But to go with a "device" that is not been seen in 1,000 of patients for a knee condition for me personally is not something worth risking.  If this goes bad, what's next?  And the fact that he pushed it and wanted to do it less than 24 hours after your appointment is to me a little suspect.  Did he present any other PKR products or just this one?  Did he present the informed consent form?  Also, he should have explained the allograft a little better.  Plugs versus who hemichondyle is a huge difference in terms of recovery.  When it came down to really deciding to go with what I did, I sat down with my physician and asked tons of questions.  And this was after all the second opinions I received so the procedure was explained to me over and over.

I do understand why you don't want to be on crutches for any extended period of time.  Instictually, I want to say that the PKR will take care of your pain better than allograft long term.  The reality of it, this procedure is a pain management option.  You've obviously exhausted medications and the reparative procedures so some type of restorative procedure is all you have to manage the pain.  I've been lucky with pain.  I tend to form stress fractures and it doesn't effect my life very much.  My problem was the underly bone was not very healthy and the cartilage just did have any firm edges and kept falling off the bone.  I still don't understand why they would need to to send a tissue sample to the tissue bank.  Really doesn't make any sense since cartilage is avascular and tissue typing is not required for allografting.

Well I'm rambling...good luck with whatever you do.

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 stgiles16

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Re: Allograft waiting list
« Reply #16 on: January 23, 2006, 01:40:51 AM »
Janice, You are right, this is a pain management option. I have done everything that the OSs and pts have said for almost 5 yrs now and my pain is increasing, not decreasing. My body does not act like most people's. I have dealt with unsuccessful ligament reconstruction and then revision, unsuccessful microfracture and revision  which then triggered arthrofibrosis. I have dealt with bone spurs, plica syndrome (which was cut out but grew back) I had my fat pad removed because of scar tissue and it has grown back. My microfracture has now worn out and the scar tissue is causing much pain. I am forced to use a cane and my  knee collapses without warning on a daily basis. I am only 42 yrs old with two active teenagers. I want my life back. I have known of the option of alllograft for quite some time but have dreaded it. I do have the option of the traditional PKR but I would rather try this new version. It has been oked in Europe. It has been oked for the hip and shoulder in the US. It is not like I am letting them do some out of this world weird thing to me. I will still have enough bone left to convert to a traditional PKR or TKR in the future. I have spent approx. 2 1/2 years out of the last 5 on crutches, the idea of not using crutches after this surgery is REALLY appealing.

As for the OS being paid to be in the trials, who cares? The man is brilliant and is more than happy to do a different surgery if I wish. He is not pushing me either way. He said that he would do the LOA and PKR the next day most probably to mess with my head. He knows me well enough to know that I fight every surgery and we will argue back adn forth for weeks before I finally give in. We have a unique relationship. I mess with his head, he messes with mine. He did not present a consent form because he knew that I was going to think about what I want done and get back to him. He did offer the traditional PKR. He has also explained the allograft procedure on other occassions. He has been my OS for quite a while.

I did not ask about the tissue sample being sent off because I would rather not have allograft surgery PERIOD. My microfracture wore out in 2 yrs, I dont havve much faith in my own body healing like it should. IF a piece of metal will improve my pain for 10 yrs, sign me up. I dont expect to be painfree, I do hope to have less pain. I have been in pain management for a year and wont stop just because of this surgery because I also have fibromyalgia so I hurt anyway. If I did not trust my OS, I would not let him do ANY surgery on me. I do trust him and if the finances work out, I will go ahead with this surgery next month. IF someone didnt agree to be in clinical trials, there would never be any medical advancement.

The one thing that I dont understand from your post is why does it bother you that it is a pain management solution? I would not have any surgery if I were not in pain. To me, pain management is the entire idea of having surgery. I will post when I make my final decision and when I schedule my surgery.

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 JG

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Re: Allograft waiting list
« Reply #17 on: January 23, 2006, 03:19:01 AM »
Missy,

You've misuderstood my post.  This doesn't bother me, why would that bother me?  Given that you don't want to deal with being on crutches and your pain levels are high, PKR is a great option, probably much better than allograft.  I was responding to your post that basically read like, "my doctor gave me two options, allograft or a clinical trial PKR" (not that he discussed at length other options or that you two have a unique relationship).  All I knew was he offered you was an experimental PKR (and within 24 hours), I was trying to give you a counterpoint about having a non-FDA approved product placed in your knee.  The physician being paid was a reaction to the 24 hours issue.  The manufacturer-physician relationship more often than not influences how physicians advise patients, just look how sales reps do it every day with drug samples.  Heck, how do I know that you have this unique, "I mess with his head, he messes with my head" relationship?   Yes I understand it's approved for other joints and other countries, but not in the US for the knee.  And yes I do understand that if people don't participate that new drugs or devices won't move through the development process.

Again, good luck with the PKR.  I'm sure it will work out great.
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 stgiles16

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Re: Allograft waiting list
« Reply #18 on: January 23, 2006, 05:25:41 AM »
I sure hope it works. I have not signed on yet. I have to see about the financial stuff first. One positive note about this surgery is that it leaves plenty of bone for a traditional PKR or TKR, whatever is needed in hopefully 20 or more years. How is that for optomism? I have researched everything that I can on this new thing and plan to have a meeting with my OS with all of the questions that I have written as I researched. IF I decide to go with the allograft, I will deal with the crutches. I have to keep in mind, that if it sounds too good to be true, it usually is,,,, so I am going to check this out further before I commit.

thanks for your caring.

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 hopalongcasualty

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Re: Allograft waiting list
« Reply #19 on: January 23, 2006, 07:10:26 PM »
Has anyone heard what the largest plug Allograft used is?  I would need either a mosiaplasty or a 50MM plug, just wondering.  MY doc is working with the vendor on tools for this procedure and has not given me a final decision on what exactly he is wanting to do.  Ahhhh Limbo... 

He has explained the allograft procedure and all that will go along with it, just I hate not knowing exactly what tools and the detailed action plan for the procedure.  I am an engineer and am used to getting minute details on most everything I work with. 

I keep getting asked by medical professionals, if I am a doctor because I ask so many questions and seem to already have the answers they are suspicious because they know I am quizzing them on thier knowledge and experience in the subject at hand.  I wish all patients would have researched the subject before going to the office visit, because the doctors would have to step up thier "A" game all the time. 
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline blackbeltgirl

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Re: Allograft waiting list
« Reply #20 on: January 23, 2006, 07:32:59 PM »
The largest allografts are "shell" allografts - where the transfer an entire femoral condoyle.  The doctors seem to have their own preference, between a shell allograft and mosaicplasty. 

The largest of my 3 lesions is just a little bigger than yours.  We'll have to compare notes as we go through our recoveries, for the rare others with lesions as big as ours.  If you haven't noticed, most of the folks who've been treated for cartilage damage have much smaller lesions (not necessarily small, but small in comparison to the 15-18 sq cm you and I are facing).

Do you know which your doctor is planning?
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 hopalongcasualty

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Re: Allograft waiting list
« Reply #21 on: January 23, 2006, 07:46:01 PM »
I think he is on the fence based on tools and the availability of a fully compatable shell graft or if he has to use a plug(s) due to the geometry. 

I am going to start putting a bit of gentle pressure on his PA to get me more info, I know I am not his only patient, however, I AM one of his more interesting procedures  ::).  LOL
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline hopalongcasualty

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Re: Allograft waiting list
« Reply #22 on: January 23, 2006, 07:53:10 PM »
I swear that the lesion feels like it is bigger than before.  I also have had some catching on the anterior-lateral meniscus the last couple of weeks and the patella feels like it is catching at on the lateral aspect of the trochlea groove at about 30 degrees during extension.  I am fearfull that I am having degenteration of the knee fairly quickly and hope that by the time they are ready to do the procedure there is not more CRAP wrong in there that will require more surgery.   I am not too worried about the patella thing, with my hx of scar tissue buildup it is likely that that is all it is I HOPE  :-\
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline JG

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Re: Allograft waiting list
« Reply #23 on: January 24, 2006, 03:30:06 PM »
A shell allograft is very different than taking the entire chondyle.  I have pictures (or link to pictures of this).  Shell allografts are much bigger than plugs (and not round) and I'm not sure what they us in terms of "tools".   Bugbee does a bit of this.  Typically they use a entire chondyles to tibia plateaus in traumatic events (like severe fractures).  These are totally two different things.   The rehab for a shell is similar to a typical OATS or ACI.  The rehab for an allograft chondyle is like months and months on crutches.  I will post pictures later tonight.

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: Allograft waiting list
« Reply #24 on: January 24, 2006, 03:32:03 PM »
Here is a picture of the shell allograft, as you can see it just a odd shaped plug rather than the entire chondyle.

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

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 blackbeltgirl

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Re: Allograft waiting list
« Reply #25 on: January 24, 2006, 03:41:50 PM »
Thanks for the correction Janice.  I thought a shell allograft was an entirte condoyle.  Learn something new every day.
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 hopalongcasualty

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Re: Allograft waiting list
« Reply #26 on: January 24, 2006, 04:11:21 PM »
Janice,

Thanks for the link, Really Cool!!! What a great resource.  I am going to pester my PA for what the decision was for plug vs. shell in my case. 

Regards,

Phil
aka "Hopalongcasualty"
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline JG

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Re: Allograft waiting list
« Reply #27 on: January 25, 2006, 04:13:42 AM »
Phil,

There are lots of ways to go for the surgeon.  I think if they use a shell, the process is a tad more rigorous in terms of the match.  I think (but don't really know) they take various measurement of the chondyle.  Then they find a suitable donor.  That could take a long time.  When we talked to Bugbee (second opinion doc for me) and this was brought up he was worried because I have a very deep trochlear groove and it would take a very long time to find a suitable donor had I gone with a shell.  In my case with the plugs they don't worry about that and we too the first available graft.  By using many plugs and being on a CPM machine for 8 weeks the contour of the chondyle was allowed to be shaped with that of the surrounding bone/cartilage.

I'm just taking my first break from work today so when I find the pictures of the allograft I will post the link.  I think they are on my old laptop that died on me. 

Jess, I corresponded with a women who saw Dr. Gross in Canada.  He did an large allograft procedure on her.  He is the king of this stuff.  Her recovery was scarey long in terms of being on crutches (like over 6 months).  She was in MVA and crushed her TP.  My physician said this was an option for my TP in the future, but after talking to her, I was like "no way!"  I would rather have a retrograde plug which is very very technically challenging before that.  Large allograts are very extreme and for traumatic injuries it sounds like.  Now you know why I can't wait to hear about your ACI on the TP.  ACI might not be good for me since I am a fairly significant scar tissue former and the chances of my over scarring would be pretty good.  However, if they can get in your knee and do it, I'm in!  I would definitely try it.  I been waiting for someone to tell me they've had it done on their TP. The place where I work out (my PT office) said they've seen an increase in shell procedures (especially on young athletes) rather than microfracture when the defect is large.  They really don't see too many ACIs even though my PT wrote the original PT protocols for the ACI procedures (for Genzyme). 

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 blackbeltgirl

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Re: Allograft waiting list
« Reply #28 on: January 25, 2006, 01:31:21 PM »
Janice -

I'll keep you updated.  My surgeon was supposed to be calling the insurance company yesterday for a peer-to-peer review.  I'm trying to practice moderate patience, and will wait until tomorrow to call and see how it went.  2 of the 3 reasons they denied the coverage in the first place were the "off-label" uses - lesion greater than 10cm squared, and tibial lesion.  I have yet to see any articles or studies that address tibial lesions, so I don't know how that will play out.  Keep your fingers crossed, and I'll let you know how it goes.

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 hopalongcasualty

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Re: Allograft waiting list
« Reply #29 on: January 25, 2006, 02:13:53 PM »
Jess and/or Janice,

Have either of you found studies on the "appropriate" size protocol for the different procedures.  I know the GUIDELINES are out there; however, I have yet ro find the documentation.

microfracture is effective upto X sq cm.
ACI is effective upto Y sq cm.
OATS is effective upto Z sq cm.
etc, etc, etc.

I realise that there may be different criteria for each joint and that there might be a different criteria going from the Femur vs. the TP.

IF either of you or anyone else out there have links it would be wonderful. 

Thanks,

Phil
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline blackbeltgirl

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Re: Allograft waiting list
« Reply #30 on: January 25, 2006, 02:30:58 PM »
I haven't got links, BUT

microfracture is generally goot for up to 2-3 sq. cm
ACI is FDA approved up to 10 sq cm, femoral condoyles and trochlea only.  (My OS has done ACI on lesions up to 36 sq cm, however, one of the reasons I've chosen him)
autograft OATS is good for up to 2-3 sq cm, after that it's allograft
and for allografts, depending on technique and surgeon, they've done entire femoral condoyles

NOW - what's been done successfully by a handful of surgeons, and what the standards are, is also different.  Obviously my surgeon has done ACI well beyond the FDA requirements.  I've seen studies that list 20 sq cm as the max for ACI.   But I've read so many articles in the last year that I couldn't find sources for most of this info if I had the entire morning to dedicate to the effort.

Did that help?  Or was it just more confusing?
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 hopalongcasualty

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Re: Allograft waiting list
« Reply #31 on: January 25, 2006, 05:21:26 PM »
That was helpful, I have spent many evenings with google searching for this stuff.  This must be one of this secrets held close to the vest by the Illuminati (DaVinci Code Refernece).

I would think that there should be a .gov resource where this kind of info would be available.  Instead all i keep finding are books to purchase, what is the fun in that?

Thanks again.  We should keep putting our heads together and compile a database of FREE references that we could start posting.  Just a thought.  ;)
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline hopalongcasualty

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Re: Allograft waiting list
« Reply #32 on: January 25, 2006, 05:28:54 PM »
I also know that the phrase "it depends" is very important when dealing with surgeries.

Some people heal better than others, weight is also a factor, varus/valgus angle and all that kind of crap. 
Some would never try the BIG ACI procedures because they are afraid it will fail and the patient will sue. 

I would prefer a Vangard surgeon who will try something if I am a good candidate.  (I have read many posts where young folks had a unicompartment failure but ended up with TKR, because PKR is "experimental")  I want (hope) a chance, and apparently so do you. ;D

Phil
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline blackbeltgirl

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Re: Allograft waiting list
« Reply #33 on: January 25, 2006, 06:46:57 PM »
I agree.  It's important for people to educate themselves, so they don't go into surgery either under-informed, or with insane expectations.  YOu see it all the time here - people who had surgery and "Are never the same again".  Many have recovered to the point where they haven't had to change their lifestyle, but every now and then it still hurts.  But they're disappointed, because the knee isn't perfect.  Or people find out they have some arthritis, in addition to the torn meniscus, and want to know how to get rid of it.  Some of them are younger and should be trying to resolve the issue, some only have random bad days or weeks, but haven't had to make major lifestyle changes, and some are in their 40s, 50s or older, and want to be able to conitnue playing aggressive sports several times a week.  And while I respect that need, if your body is 50 years old, you may just have to switch sports and get over it.  I didn't mean to rant, just that people expect to be 100% immediately after surgery, and many middle aged folks seem to think doctors should be able to give them 20 year old knees in their 50 year old bodies.  Education can prevent those crazy expectations, and the disappointment that's bound to follow when the expectations can't be met.

OK, totally off the soap box now.  But maybe you can tell me why, procedures that are approved by the FDA for years, are still considered experimental by insurance companies.  I SO don't get that!
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 hopalongcasualty

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Re: Allograft waiting list
« Reply #34 on: January 25, 2006, 07:50:26 PM »
MONEY!

I am hoping for a 47year old's knees in my 37year old body.  Instead I have as much difficulty as my 63yr old mother (needs 2 TKR).  Granted her's is wear and mine was from tear ;D.

Yeah those folks with occasional aches and pains from weather change or they over did it on the soft ball field.  GMAB  :-X(give me a break)

Folks have got to learn, you will never be PERFECT again, although good with occasional flair ups is great. 

I would like to be able to go up a few flights of stairs, walk arround the mall or simply be able to enjoy the beach without popping, snapping, twinge, stab, burn and aching.  If I have set for more than a hour, I have to wait a few minutes to start walking for all of the theatricks to cease and the joints to function.  OH I am on the Soap Box now, you want it back? LOL.

Phil   
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline stgiles16

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Re: Allograft waiting list
« Reply #35 on: January 25, 2006, 08:26:40 PM »
Hopalong, my dream is to just make the pain low enough to be able to ignore it again. I dont expect 100%, I would be thrilled if I could get 60%. I think that I am about to truly try an experimental new PKR that is currently in clinical trials. If the finances work out, I am going to become a lab rat. My 70 yr old mom can out walk me while shopping. That is depressing because I love to shop. I dont even mind the cracks and pops, I just want to be able to walk for more than 10 mins and not have to take narcotics.

Jess, I am right up there on that soap box with you. Arthritis is a natural part of aging and when 50 -60 yr old folks get on here complaing because their knee hurts if it rains, I just want to scream. I am only 42 and my knee hurts if I BREATHE. They want to play tennis, golf, rodeo, ect and I just want to WALK.  To me, it is like comparing apples to oranges. There is no similarity.

off the box now.
hope you both have a good day.
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 JG

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Re: Allograft waiting list
« Reply #36 on: January 26, 2006, 11:59:08 PM »
Phil,

Go to page 9 of this document.  It outlines all the procedures and the lesions size that they are effective for.  I posted earlier in this thread.

http://www.cartilagedoc.org/downloads/sek/g4368.pdf#search='chondral%20defect%20and%20treatment%20options'

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 kittykat

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Re: Allograft waiting list
« Reply #37 on: January 27, 2006, 01:03:41 AM »
Hi everyone!
I posted earlier in this thread about my allograft and got some responses but it has taken me a while to have a chance to respond.  Yes, I admit my defect was alot smaller (2.0 by 2.5 cm) isolated and tramatic in nature but I can say that I am 100% glad I made the decision to go with the allograft.  I mentioned the recovery was easier than expected and you asked what I meant by that.  What I meant was that it was much easier than recovery from my ACL reconstruction.  After my ACL it was like someone else had taken control of my leg.  It was not that way this time.  ALthough, I must admit that I had really worked on my quad strenght pre op and had a much more aggressive PT program with the allograft.  I guess I also need to tell you I was 42 years old when I had my ACL done and 45 years old when I had my allograft.  I would say I am in average shape for my age and goal was to walk without pain and the nasty limp I had develped.

As you may have noticed from other posts, it seems every OS has a different idea on how long you should be non weight bearing after allograft.  I was totally non weight bearing for only three weeks and then toe touch weight being for 2 weeks.  Everything went fine and continues to go good.  I had a small set back about 5 months post op when I started having medial pain again.  The concern was that I had fractured my graft.  MY OS explained that at the point in time when the bone in becoming yours it gets weak and I remember reading this.  The good news is the MRI showed no sign of fracture just alot of tissue swelling.  The MRI could not assess the cartilage.   I agreed to take it easy for 2 to 3 months and wear a un loading brace bascially around the clock.  We are also in the process of doing a course of supartz (some literature supports it can protect cartilage).

The good news is that the pain in much better.  I am anxious to lose the brace to see it the pain returns.  If so, the plan is a scope to check it out as I might have a cartilage flap based on my physical exam.  If so, it should be easy to clear/clean it up.

Even with all this, it is much improved and I still think it was a success.

Missy, your clinical trial decision really interests me although our situations are somewhat different.  I look forward to your posts.

Kittykat

Offline hopalongcasualty

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Re: Allograft waiting list
« Reply #38 on: January 27, 2006, 02:38:45 AM »
JG - thanks I found it.  Just glad it wasn't a snake or I would have been bitten. 
R Knee
83-LCL,ACL&Medial Meniscus tear
86-Debridment
87-TTT Houser Manuver
89-TTT Maquet Procedure*
92-Meniscus Tear
04-Supartz Injections
05-Contusion
L Knee
05-tibia & patella dislocation w/MCL tear & large lateral condyle defect
2-15-06 Lateral condyle osteochondral Allograft ::)

Offline stgiles16

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Re: Allograft waiting list
« Reply #39 on: January 27, 2006, 04:38:17 AM »
Kitkat, I think that our situations sound very similar. I started on this rollercoaster with a defect on my medial femoral chondyle (trauma induced) from a car accident. If I can just get rid of this medial knee pain, I will stop complaining LOL. I would love to hear more about your recovery. Allograft is my other choice if I dont do the PKR.

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 kittykat

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Re: Allograft waiting list
« Reply #40 on: February 01, 2006, 12:40:50 AM »
Missy,
Not sure exactly what to tell you about my rehab so I guess I will just start typing...  Had surgery, had a femoral pain pump which was the best.  It delivered a base line amount and I could give myself additional doses as needed.  I basically had no pain unitl they took it out.  From talking the the nurses at the hospital, it sometimes works really well and some times it does not.  It seems that the catheter placement is critical and it must be very close the the nerve that supplies the knee.  I could move my leg but had zero pain.  I guess I was one of the lucky ones.  The doc said that if you can keep the pain under control for the first 24 hours it should not be unbearable and he was correct. 

I spent one night in the hospital.  I was started on my CPM pretty much immediately post op.  Had good range of motion to 90 degrees within 24 hours.  Took my CPM home and spent 8 to 10 hours or more in it for 2 weeks.

Started PT 5 days after surgery even while NWB to maintain my muscle strength.  OS insisted that I go to the PT program that he uses for all this patients which was a sports medicine focused program.  Once I started weight bearing, I went 3 times per week and they kicked my butt.  I had to on occassion remind my therapist that although all his other patients planned to return to competative sports in the near future, I did not.  I was a real love/hate relationship.  I must say I believe it really made the difference.  Released for PT after 7 weeks.  Still actively doing my exercises at home.  If I only had a dollar for each straight leg lift that I have done.

I was released to do basically anything I wanted at 4 months except run or ski.  Once I started having pain, we went to nothing strenuous.  Having been wearing a doy joy custom unloader while awake since Thankgiving time.  It is not to bad.  My biggest issue is always having one pant leg that is hiked up after sitting. 

Just let me know what other questions you have.  Hope this helped.  So have you made a final decision?? 

Kittykat

Offline stgiles16

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Re: Allograft waiting list
« Reply #41 on: February 01, 2006, 02:39:42 AM »
Thanks Kittykat, I have made my decision. I am going forward with the surgery on feb 15th. I am not getting alot of support at home but I have to do what is best for me. My OS has not mentioned the CPM yet and I hope that he doesnt. I hate those things. I had one after one of my surgeries (dont remember which one).
I hope that your medial pain gets better.
good luck
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















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