Allograft waiting list

[hopalongcasualty]

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?

[stgiles16]

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

[brattkids]

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

[JG]

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

[hopalongcasualty]

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

[kittykat]

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

[stgiles16]

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

[hopalongcasualty]

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

[stgiles16]

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

[brattkids]

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

[stgiles16]

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

[blackbeltgirl]

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

[JG]

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

[hopalongcasualty]

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. 

[stgiles16]

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