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Author Topic: What other options are out there besides OATS?  (Read 3210 times)

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Offline Cinammo

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What other options are out there besides OATS?
« on: April 04, 2006, 06:02:08 PM »
Well since it looks like my son will not be getting this surgery I would like to know what other options there will be for him?  Are there any that work?
My 17 year old son had the OATS procedure on November 29th, 2006.  He has two previous scopes on the right knee and one on the left.

Offline blackbeltgirl

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Re: What other options are out there besides OATS?
« Reply #1 on: April 04, 2006, 06:20:47 PM »
Depending on what he's had already, the first step treatment is usually microfracture.  For smaller lesions, and in younger patients, it has pretty good results.  (Look at the bone marrow stimulation section on the boards.)  OATS and Carticel are  generally considered 2nd tier options.  Meaning if the microfracture fails or wears out, you proceed to one of these options.

Check out www.cartilagedoc.com, patient resources, knees.  You will find an entire library of articles on articular cartilage health, treatment options, and treatment algorithms.
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 Cinammo

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Re: What other options are out there besides OATS?
« Reply #2 on: April 04, 2006, 06:41:53 PM »
Thanks.  I will read what I can on microfacture.  Wonder why that option was not presented to us initially?  All he has had done are two scopes both diagnostic in nature.  First one was by our local OS who found the problema(cleaned his knee up) and referred him to cole.  We had thought he needed the ACI surgery but cole said he could fix it with the oats instead.  I have also asked coles office on other options.  They are supposed to be getting back to me.

Thanks
My 17 year old son had the OATS procedure on November 29th, 2006.  He has two previous scopes on the right knee and one on the left.

Offline Jakem

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Re: What other options are out there besides OATS?
« Reply #3 on: April 17, 2006, 12:46:10 AM »
With all articular cartilage injuries there are 5 options and none of them are very good.  Once you get one, it is a tough road ahead.  I have been on these boards for 5 years now and have read about 100s of these cases and it is not pretty.

1) microfracture -- any doc can do it and the success rates are far below the 85% that doctors will tell you.  It only works as Blackbelt girl said if the size is small <2 cm2 and the patient is young.  You are non weight bearing for 6 weeks.  They also take 1-2 years to heal completely IF they work.  When they fail, they fail way before that.  Just from reading this site for 5 years, I estimate the real success rate is about 20%.  Also since it is just fibrocartilage they eventually wear out.

2) Oats- tough to get insurance approval and only good for <2cm2 defects and insurance usually makes you get microfracture first.  Success rates are far lower than the 80% the literature claims.  Also you are robbing Peter to pay Paul so you damage good cartilage in the trochial region as the donor site.

3) Alographs- Need to wait for donor.  tough to get insurance approval.  Can do on bigger defects but even the literature says only a 60% success rate at 10 years after placement.  I bet the actual success rates are lower.

4) ACI- the mother of all surgeries.  First need a surgery to get the cells and grow them, then months later the massive open surgery.  Only about 10 docs in the country who can do it.  Cole is one of them.  Official success rates quoted by docs are 88% but if you look at the recent poll issued on the ACI section of Knee Geeks the actual success rate is about 50%.  It produces real hyaline cartilage but for some reason it is not as functional as before the surgery.  Less than 20% return to any vigorous sports activities.  It takes 12 months rehab for femoral defects and 12-18 month for trochial and patella defects If you are successfull.  also non-weight bearing for 6-8 weeks and partial weight bearing for another 3-6 weeks.  Insurance is nearly impossible to get approved and surgery is outrageously expensive.  As a minimum they will make you get microfracture first.  Even if ACI is successful will cause massive disruption in your familiy's life for many, many months.

5) do nothing - This is an actual option.  What happens is few people go with this option but because they hate the pain and think that there has to be a solution "with all the advances in medicine".  So, like me, you read all the literarture and talk to docs and you get high hopes and try these various procedures.  However if you took a poll of everyone of the people who has had any of the other 4 options above, a large minority of them will tell you they would have been better off doing nothing.

I am not saying you should do nothing.  I am saying when you get a chrondal defect it is a significant disaster in one's life and although there are various options, none of them work as well as advertised and when they don't work you are ofter worse off than before surgery.  Not trying to scare you but to inform you of how serious these injuries are and how still limited doctors are in treatment of these injuries.  Have very limited expectations with these surgeries and it is very important that you throughly research the rehab protocols for each one and carefully follow them closely which will increase your chances of being one of the lucky success stories.  For example, many docs have people weight bearing soon after microfracture and OATs so there is no chance of success.  You would assume a doctor would no better, but after reading these boards for 5 years you would be shocked.  Get rehab protcols from the literature, not your doctor.   Also, as I said before don't believe the success rates the literature says.  One of the reasons you are not informed of all the various options is because none of them are great even when considered a success.  I wished someone had informed me of this 5 years ago.  I just read the literature and studies by the doctors and they all sound great with high success rates.  The reality is far different.

I wish you best of luck

Offline blackbeltgirl

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Re: What other options are out there besides OATS?
« Reply #4 on: April 17, 2006, 02:47:36 AM »
Go to orthosupersite.com.  Membership is free, and they publish a lot of recent studies on a variety of orthopedic issues.  There have been a number of studies published in the last year relating to all of these procedures.

Yes - all the positive statistics should be taken with a grain of salt.  But also, don't assume that the folks hanging out here are the "norm".  We're still here because things didn't work out.  When I first started posting here, I got an e-mail from a "lurker", who had actually had ACI performed by my surgeon here in Richmond, VA.  SHe contacted me, we met a couple of times, and while she never really posted her experience here, it was a good one.  She is not the only patient who didn't take the time to crow about her success on kneeguru.  But those of us still fighting - the knee, the doctors, the insurance companies, etc. put a lot more time into staying active, doing research, and asking for support.

From everything you've said in the past, your son is an ideal candidate for many of these procedures.  His damage is not HUGE, he is young, and he is seeing one of the top 5 articular cartilage docs in the country.  He may still have a less than ideal outcome, but at least the odds are in his favor.  As part of the decision making process, your family will have to evaluate if better is really good enough.  If his daily pain levels are at a 7, and the surgery gets him to a 3 or 4, was it worth it?  The ideal is that you eliminate daily pain entirely, but how much improvement will make the process worthwhile?

Just a thought.
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: What other options are out there besides OATS?
« Reply #5 on: April 17, 2006, 03:39:23 AM »
I second what Jess said on many fronts.  First, this is not where the "normal" people hang out.  People on this board more often than not have more complex problems.  I had a fairly complex procedure over one very large lesion and another large lesion and have done well despite statistics, etc.  My pain level is now very low and I'm pretty active (cycle 100+ miles per week and do my rehab 2x per week...2.5 hours per session).  Remember statistics apply to populations not individuals. 

Your son is young and that is really really important with all these procedures.  Now getting your insurance to approve is another thing.   I've encountered many young active individuals who have been in your son's shoes.  Three year later, I still rehab at the place I did my PT.  I've seen may young patients with cartilage problems come through the door.  Some have gone through OATS, others had a shell allograft, and still others microfracture.  The young ones do well and often return to their normal life.

Another thing to consider, the mental part of this.  It's really critical.  I just went for my 3 year check up and my OS said he was surprised and not surprised I've done well.  Surprised because what needed to be fixed was so massive and everything really worked, but not surprised because of my mental attitude.   My PT and trainer always said that I would to well because I thought I would do well.  I just always thought this would work for me despite the second opinions that believed my knee was beyond any of the available salvage procedures. And today, I'm open to whatever is available to fix my other lesions (LTP and LFC) as long as it's not TKR/PKR.

There is nothing wrong with the microfracture procedure as the first option.  At least Dr. Cole can get in there really assess the problem and get things rolling.

Also, Dr. Cole is great.  He was one of my second opinions and was more in favor of me trying to salvage the knee with mosaicplasty.  Jess is right, he is one of the top 5 in the country.

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 shade

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Re: What other options are out there besides OATS?
« Reply #6 on: April 17, 2006, 12:51:14 PM »
Hi,

A positive attitude has to be very helpful and also think that fixing any alignment issues at the same time is very necessary for success.  These procedures have a long rehab time and many people are NWB on crutches for at least 6 - 8 weeks and then start rehab.  That is my protocol anyway, so you have to be mentally & physically prepared for this process.     

I've read alot about the patella being unloaded and aligned to enable the restorative techniques to work.  I'm wondering if this might be a big factor in failure rates.  Maybe more attention should be paid to proper leg alignment and unloading of the patella, so that after surgery the lesions won't be rubbing or getting irritated and wearing the cartilage down again. 

Good luck to your son, let us know how everything goes.  ~Shade
« Last Edit: August 12, 2006, 03:08:41 PM by shade »
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline stgiles16

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Re: What other options are out there besides OATS?
« Reply #7 on: April 17, 2006, 05:33:27 PM »
I am another one on here with chondral lesions. I have had two microfractures and also a new clinical trial type of PKR. What it actually is ,,,, is a large titanium screw put into a chondral lesion and the top of the screw fills the hole so that I have smooth articular cartilage. My first microfracture failed (large lesion, too soon weightbearing) My second one worked and as of Feb. 06, stilll looks good according to my OS. This was a large lesion on the medial femoral chondyle. The hemicap (screw) was put into a lesion that I did not even know that I had. I am now 8 wks post op and really doing much better.

Jess is right, those of us  here have had complications, we are NOT the norm. There are lots of people out there who have had articular cartilage surgery and doing great, they have no need to post here and ask questions and continue to research.

Do your research, talk to your OS, ask questions and keep up the positive attitude. Your son will probably do very well. The odds are in your favor. I think Jakem's statistics may be a bit on the pessimisstic side unless he is referring to those of us still hanging out on this site. Remember, those are statisitics in his opinion, not from a formal study.

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

Offline Cinammo

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Re: What other options are out there besides OATS?
« Reply #8 on: April 19, 2006, 01:36:39 PM »
thank you for all of your inputs.  i think I may have a long talk with my son today to see how he feels about some things.  I am not in his shoes so I need to really talk to him about the options.  Maybe he will just want to leave it alone.  I know he just started a job as a bus boy at a new local eating establishment and came home and said his knees hurt so bad he could barely stand and he took a vicodin.  Life goes on.  We are now waiting on the formal review from our insurance.  Have been told microfracture is not an option, something about the lesion.would be nice if the pain one day just went away for him.  Thanks again.
My 17 year old son had the OATS procedure on November 29th, 2006.  He has two previous scopes on the right knee and one on the left.

Offline stgiles16

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Re: What other options are out there besides OATS?
« Reply #9 on: April 19, 2006, 09:54:09 PM »
From what my OS has told me, if you dont have the lesion addressed, it can get progressively worse. you might want to talk to your son's OS and ask him what would happen if he does nothing. I am sorry that he is in such pain. good luck. keep us posted on how your son is doing. AS the mother of two teenagers,  I can only imagine the stress of having to deal with all of this stuff with one of the kids. It is not fun as an adult, it must really stink for a teenager.

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 Cinammo

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Re: What other options are out there besides OATS?
« Reply #10 on: April 19, 2006, 11:01:05 PM »
Thank you.  I will ask that question.  Tomorrow he goes in for a cortisone shot.  I cleared that with Dr. Cole so our local OS can give the shot and we don't have to drive all the way to Chicago.
My 17 year old son had the OATS procedure on November 29th, 2006.  He has two previous scopes on the right knee and one on the left.

Offline stgiles16

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Re: What other options are out there besides OATS?
« Reply #11 on: April 19, 2006, 11:23:15 PM »
My son is also 17 and has Osgood Schlatter's disease. That was bad enough to deal with, I cant imagine going thru articular cartilage regeneration with him. It is a tough recovery, no matter which option you choose. I hope the cortisone shot helps him.

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