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Author Topic: Really Crao Knee Alert - Loads of information about Osteochondral Allografts!  (Read 5853 times)

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Offline knee-will-be-great

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  • Open-wedge HTO & ACL allograft done (YES!)
    • ACL Allograft #3 Post-Surgery Rehab/Wellness Diary
Dear Fellow Knee Geeks,

I have Googled "Osteochondral Allograft" and have come up with a lot of links that may be helpful to you.

A few people I know have that this knee-saving procedure done on them, notwithstanding some Orthopaedic Surgeon's advising them that they should have a TKR or PKR.

Arm yourself with information dear fellow Geeks.  I beleive that this is my next step in terms of joint preservation, so I wanted to pass this info on .....

PS #1  - I included one USA insurance company which even lists Osteochondral Allografts as an accepted and recognised procedure for crapped-out knees.... better in my humble opinion that TKRs and PKRs - because you still have your knee bones to work with.

PS # 2 - Dear Geeks, find out from your insurance companies as to what is sheaper to do - Osteochondral Allografts OR TKRs ... investigate the procedure thoroughly.  I know that this is what I will be doing in my spare time, prior to seeing an OS who specialises in this surgery.

Now if only this posting could be put on the Knee Replacements and Cartilage Transplant topic listings on this website.  Could perhaps prevent some TKRs/PKRs until folks are older and retired.

Cheers to all from Knee-Will-Be-Great!!!!!!!!!!!
_______________________________________

http://coe-dmha.org/xzone/apmmc/2005files/Monday/4A/4ABottoni.pdf

http://www.wnycrc.buffalo.edu/services.html

http://www.cigna.com/health/provider/medical/procedural/coverage_positions/medical/mm_0071_coveragepositioncriteria_allograft_ofthe_knee.pdf

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10028117&dopt=Abstract

http://www.ejbjs.org/cgi/content/abstract/71/5/704

http://medicine.ucsd.edu/ortho/procedures/allografting.shtml

http://www.orthspec.com/osteochondral_allografting.htm

http://www.ejbjs.org/cgi/content/abstract/88/4/762

http://www.allaboutmydoc.com/surgeonweb/surgeonId.2729/clinicId.1432/theme.theme3/country.US/language.en/page.article/docId.41126

http://www.orthopedictechreview.com/issues/janfeb01/pg36.htm

http://medicine.ucsd.edu/ortho/faculty_and_staff/bugbeehome.shtml

http://www.orthspec.com/PDFs/Cartilage-Injuries.pdf

http://www3.aaos.org/anmeet2006/podium/podium.cfm?Pevent=151

http://www.irmc.org/body.cfm?id=323

http://www.ismoc.net/procedures/oca.html

http://www.mtf.org/tissue/osteo.html

http://www.medicalnewstoday.com/medicalnews.php?newsid=20336

http://www.orthopedictechreview.com/issues/janfeb01/case.htm

http://www.news-medical.net/?id=7945

http://www.eorthopod.com/eorthopodV2/index.php/fuseaction/topics.detail/ID/79791a8f7dd9f446b38653cbeab9a955/TopicID/a93dd54cd3d79c0d8bedae1537bc7659/area/17

http://www.regence.com/trgmedpol/surgery/sur106.html


Medial Menisectomy, 1 ACL Autograft, 3 ACL Allografts, HTO, numerous debridements, good now :)
ACL Allograft #3 Post-Surgery Rehab/Wellness Diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37218.0;all
ACL Reconstruction VIDEOS http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=37773.0

Offline brattkids

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Those are some great informational sites!!!

I know with my insurance company they would not cover my allograft they said it was investigational and experimantal. I have Blue care network/michigan. So my insurance company said they would rather pay for a TKR than the allograft. I only got the proceedure covered because my OS was gracious enough to bill under a traditional autograph proceedure. With regard to the cost, at least with my OS, the cost of the TKR was significantly less. He stated to me that parts for a TKR, since they are so commonplace, are significantly less that waiting for someone to die and taking their tissues. Hope that made sense.

I am sure different OS offices have different prices and so do hospitals so that would be some great research to do.

p.s. my OS, who did my allograft, is listed in one of the articles you have posted here!! He is no longer my OS as he no longer takes my insurance. He got tired of being rejected for claims- not just mine but lots of different patients. He believes that if you need something done and a physician orders it that an insurance company should agree after all is it the insurance company that examines you??


Thank you for the information!!

Paulette
« Last Edit: August 11, 2006, 06:46:59 PM by brattkids »
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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Hey Paulette,

So he absorbed the cost of the allograft?  To my understanding they are not cheap.  I don't recall how expensive they were but it was well over $5K per and I had two hemi-chondyles which is very very rare.  My insurance did pay.  I have Blue Shield of Ca.

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 brattkids

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Janice,
Im not sure if he aborbed the cost. I got a bill from the hospital for $15000 and his bill was $8000. After he rebilled under traditional OATS my insurance approved the claim so I dont think he had to absorb the cost.

How are you getting along???
Im still doing pretty good and I start my nursing clinicals August 24th!! Im really excited

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 SandraMcCrary

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Im Scared about OATS Procedure, Im having the OATS procedure done on the 15th of August, and Im totally terrified, I have heard so many different things about it. Ive been told I will have a huge scar, my meeting is on Monday morning with the surgeon and Im sure he will discuss all of this with me, I just wanted to know if some of you can help me out and give me a little information on the procedure.
Thanks ~Sandra~ ???
~*Sandra*~

Offline DJK

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Sandra, I just had my OATS done on the 10th...everything is going good, just icing and elevating...I update my experience everyday in the Post-Op Diary section of the site...feel free to ask any questions you may have--DJK
L knee
scoped/debridement 10/02
Fulkerson 12/03
got unscrewed 9/04
scoped/debridement/LR 8/05
Allograft w/OBI plugs 8/10/06

Offline JG

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Paulette,

I'm doing ok.  I go for my 5th Hyalgan injection on Monday (8/14).  My existing allograft stuff seems to be doing well, it everthing that we did not fix that has me concerned.  As you might recall, we fixed the "easy" stuff then (lateral to mid trochlea and MFC).  But did not fix the LFC nor LTP.  I've started to have LTP and medial trochlea problem over the last 3-4 month.  Nothing too bad, but last time I said it wasn't too bad I found out I was grade IV in all compartments.  So that's got me sensitive to problems that last more than a couple weeks.  The other problem is my common peroneal nerve problem is back.  Last year I had it decompressed which worked great.  However now I've got sural and deep peroneal nerve symptoms which is not great.  My surgeon and I agreed to just get through the shots then discuss the knee and nerve.  I'm managing the nerve fairly well.  I haven't developed any drop foot so that's good.

I rode in the Lance Armstrong Foundation LiveStrong Ride in Portland two weeks ago.  I didn't do the 100 mile, but the 70 mile (advise from OS that I finally listened to).  Honestly, I didn't really train and I could have gone another 30 had they not been hilly.  He actually is quite impressed that I can do what I do, but I would go crazy if I didn't.

So Monday I will start talking to him about my nerve.  Probably just get the lay of the land in term of tests (another round of EMG/nerve conduction).  He told me a few week ago that it likely anatomical which is bad...really bad. The surgery to fix it is only done by a handful of people in the US.  So, I'm doing my best to keep my nerve calm.  As for the knee, I don't know really.  Probably an MRI.  I really wanted to avoid any type of surgery this year.  I really feel I needed a break this year.  I think he has a plan, but we agreed to just do the shots and talk after.

Oh well...I gotta run.

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

S_501

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Hello you all fine people out there,

I saw the links at the start of this thread. I actually will go with Dr. Bugbee at UCSD (who now just moved at Scripps Green, SD). I'm on the waiting list, been for almost 3 months now.

Was wondering, did anybody do it.......? How did it go........? I'm new to this site and I am in utter desperation!! I kinda know by now what to expect in terms of surgery, but I am DESPERATELY trying to hear out from other people if there's a chance to go back to sports, specifically RUNNING!!!!!!!!!!!!!!!! :o
Dr. Bugbee advises against running of course, but he acknowledges that some people have gone back! and it's not like I am willing to pick up a damn bike either as a substitute.

Here's about me: I'm 36, female, longtime runner.
I'll need fresh allograft to patch up 2 places: one under the lat facet of my patella, one in my lat trochlea, like about 2cm each. I also have some chondromalacia. Injury is due to overuse and malalignment that has caused cartilage to wear to the bone.
So...it's unicompartmental, that's good prognosis I hear, but right now I can't walk. My joint space (between femur and tibia) seems to be well preserved, still the scope was useless and now I have been on crutches for more than a year WAITING now for this allograft miracle.
But is it a miracle...?

PS: about the CPM machine....do people who have this allograft surgery have to RENT the cpm machine after the hospitalization...? how do I find this thing?

Thanks you all!!

Offline LadeeStingray

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hey 501
Lets see if i can help you.  I personally could not and will not run again ... but ive had more complications and need other surgeries.  I do know of 3 people that have been able to return 100% after their OATs  (auto/allo).   They are doing fine.  Of course they just had to take it slow.  I believe the one guy was back to "joggin" in about 3 months   As far as i go ... my graft (3 plugs  1 of mine 2 synthetic are doing great... its the rest of the knee that im having trouble with now )

As for the CPM ... your doc office should set this up for you.    With my insurance i had to pay 20% of the rental fee for every day i had it.  I had to keep the CPM 6 weeks. 
10/05 Rt medial meniscal tear repair 1/06 synvisc injections
3/06 cortisone injection   6/06 open OATs MFC
9/06 drained/cortisone  11/06 biopsy for ACI surgery
6/07 scoped again....failed OBI plugs
awaiting approval for HemiCAP

S_501

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Thanks for your reply, Stingray.
I want to say your info is encouraging although I feel for you.....really, I understand so much. I am living my worst nightmare if you know what I mean. People have their own things you know?? so if you have to give up what you love, whatever that is subjectively, that's a nightmare. Especially if it's something that's harmelss and healthy and all the good things!!!! you think you just don't #@#ing deserve it!!!

I'm assuming the one guy who returned to jogging after 3 months must've been a teenager, was him?

Was wondering, what kind of other problem exactly do you have with your knee? Do you have trouble in other compartments? And how many cm were your oats? Did you have the oats in just one compartment?

S501

Offline LadeeStingray

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Hey 501

The guy that i know personally that returned to running is in his mid 30s.

As for my knee i had 3 plugs on the MFC 29mm total in size.  I continued to have pain ... actually more pain than what i had before the surgery.  Doc decided that i needed the lesion on my patella done so i went in to have a second OATs in Nov. and thats when everything was soooo wrong.  The graft they did in June is fine ... but now i have an area measuring 20mm x 30mm surrounding the plugs that has crumbled.  Along with that my trochlea now has a triangle shaped lesion 15mm x 25mm  and then there is still the lesion on my patella.   Doc decided that OATs would not do the job this time so he did the biopsy and im waiting for my ACI surgery to have all 3 areas done at once.  Problem here is my doctor has never done 3 lesions at a time.  He is consulting with other doctors to see how to go about this.  With a little bit of luck i should hear something this week. 
Im online almost all day long... look me up on MSN messenger.
This will make my 4th surgery in the last 17 months on this knee.  Ive had 2 scopes on the left knee in the past.  So i had to give up softball which was the love of my life, about 6 years ago.  I went to bowling for something to do and now ive had to give that up also.  :-\
10/05 Rt medial meniscal tear repair 1/06 synvisc injections
3/06 cortisone injection   6/06 open OATs MFC
9/06 drained/cortisone  11/06 biopsy for ACI surgery
6/07 scoped again....failed OBI plugs
awaiting approval for HemiCAP

S_501

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Stingray,
I am so sorry to hear that!!...... I really don't know what to say other than keep it up. Sounds so stupid a comment though. Human beings adapt by nature, although I might become the exception.
S501

Offline djs60

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HI s_501,

Your situation sounds somewhat similar to mine.  I have a lateral trochlea grade IV lesion, some patella issues (he thinks grade II) and a "crack" on the lateral femoral condyle.  I am a long time runner, but haven't been able to do much since all this surfaced.  My surgeon told me I could return to running if I had a good result, but probably not for at least a year.

I think a big part of this is the malalignment issue.  My surgeon told me he will probably do a realignment at the time of the ACI.  This makes complete sense to me, as the reason I wore down the cartilage in the 1st place is the patella rubbing against the trochlea too much in the 1st place.

It's funny how you can change.  two years ago I was deeply disturbed by the idea of never running another marathon.  Now I feel like I'd settle for being able to ride a bike without any limits.  But I really do hope I can get back to running, even though I am not counting on it.
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

S_501

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Djs60,
thanks for sharing your story...you're a fellow runner and I DO understand your pain, believe me, I'm a wreck!been on crutches (not for short distances) for over a year now while waiting first to rehab from the scope and now, since it failed, waiting for the allograft (been on the waiting list for 3 months already).  This site gives us an opportunity to talk about the knee to people who simply won't just say "Aww, you'll be alright" and maybe we won't be.
Are you from CA? Who's your surgeon? So you're doing the ACI, will that be enough though? I reckon your injury is chronic.....like I said in my other posts, if it's just one cmprtmt there's a better prognosis, let's hope so.

Thank god I work from home, but as you'll probably know, quality life is horrible. Can you walk at all or you just can't run?

I've always been kinda 80% in sports, I knew my left leg sneakers were going strangely flat on the external side every time. But I went from this 80% to 0 in a week. That was Nov 05.
Keep me posted about your surgery please!! Good luck!!!!!!!!!!! >:(

Offline Stacye

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Hi Im going to Dr Bugbee tomorrow for a consultation Did you like him a lot how many surgeons did you talk to ??/















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