Cartilage Allografts

[kellyg]

I would like to hear from people who have had a cadaver allograft.  I had unsuccessful ACI surgery and have been asked to consider this option.

[Brad]

Kelly,
I have not had the osteochondral allograft, but I am currently waiting to have it myself.  Having had a failed oats, I am hoping to regain at least some of the freedom I have lost since my initial injury.    I know that there are a few others on here who have had the allograft done.  A few of them helped me make my decision to go ahead and have it done.    
After reviewing what I found I strongly requested a fresh graft.  The data I have found seems to show a big difference in the fresh vs. the frozen.   The fresh does have a slightly higher possibility of disease transfer, but it is only like 1 in a 1,000,000 or less.  My first graft did not pass the quaritine period, so I am waiting again.  I will try to round up some of the most helpful links I found (most found through google).  Here are two of the more helpful I have:
http://medicine.ucsd.edu/ortho/genallog.htm
http://medicine.ucsd.edu/ortho/fresh.htm

Good luck,
BD
 

[Stacy]

Kelly,

I had a fresh allograft done on January 20, 2002 after a failed OATS along with several failed microfractures.

This was surgery #8 for me.   I am doing great.  I can't complain at all.  Before I had this surgery, I had pain every day no exceptions.  Now, I go days at a time where I sometimes forget I ever had surgery.  I still have some pain every now and then but that could be more of an arthritic problem than anything else.  Plus, I'm almost 6 1/2 months post op, and the doc said I can see improvement up to 1 1/2 yrs after, so I'm extremely hopeful.  

I had my surgery done by the guy Brad sent you the links on, Dr. William Bugbee.....one word for him.....awesome!!  He knows his stuff and is leading the research in this area.

I can ride my stationary bike for 40 minutes a day, ride my regular bike and work out with no problems, no swelling, no pain.  As I said, I had a failed autograft in 99 so I was only given a 70% chance of success.  I was not a candidate for the ACI because I had some damage in the underlying bone.  Plus, my OS (not the one who did the surgery, but another one) said he didn't like that surgery because there were no proven LONG term results from it.  Allografts have been being done for over 20 years, now they are just handling the cartilage differently, but the procedure is still the same.  

I'd be happy to answer any questions you may have, you can send me a message either on the board or through this new message thing they have.

Take Care,

Stacy  

PS  Brad, where are you having yours done???

[Brad]

Kelly, here are the links I have.  Most of them have a lot of the same information.  A few are specific information.  I have included a few links to tissue banks as it was important to me to see how they handle the tissue, before i made my decision to have the surgery.  Especially since where I am at and the insurance I have will not pay for me to go to one of the research facilities that have a connected tissue bank.  I know from talking to Stacy in the past, through Dr. Bugbee, you have your surgery like two or three days after the they receive the tissue.  In my case, it will be closer to 7 to 14 days after they receive the tissue.   Anyway, here are  the links:

http://www.kneeguru.co.uk/html/step_06_arthritis/step_06_tackling.html       Chondral defects
http://www.dcmhweb.org/news/details.asp?NewsID=63       allograft
http://www.orthopedictechreview.com/issues/janfeb01/case.htm       Allograft
http://www.sofarthro.com/ANNALES/ANNALES_1999/CARTILAGE/Allogreffe.htm       Allograft
http://www.sportsmed.org/CME/SD2002_Abstracts/Pearsall.pdf       Allograft
http://www.biomech.com/current/bone.shtml       Allograft/Bugbee
http://www.cryolife.com/products/ortho_oa.htm       Allograft/tissue bank
http://www.genzymebiosurgery.com/opage.asp?ogroup=1&olevel=3&opage=47       Carticel
http://www.mcmahonmed.com/wworks/CHARTS/knees/tables/table3.html       Chondral charts
http://www.anesthesiologynews.com/wworks/CHARTS/knees/text/surg.html      Chondral defect
http://drlanderson.com/index.cfm?fuseaction=ct.overview&content_id_int=56       Chondral defects
http://www.bioscience.org/1999/v4/d/frenkel/fulltext.htm      Chondral defects
http://www.cartilagedoc.com/New/Video/KneePainCase.pdf       Chondral defects
http://www.jointjuice.com/pdf/cartilagesubstitutes.pdf       Chondral defects

http://www.mcmahonmed.com/wworks/CHARTS/knees/text/restore.html       Chondral defects
http://www.proteamphysicians.com/default.asp       General knee (good)
http://slackinc.com/idirectories/orthonet-x.htm      Ortho directory
http://www.allosource.org/       Tissue bank
http://www.donoralliance.org/      Tissue bank
http://www.eamst.org       Tissue Bank
http://www.robi.org/       Tissue Bank


Let me know if I can be of anymore help.  

Thanks, Brad

ps, Stacy, I am having my surgery in central Illinois.   To my knowledge, my OS is the only one in my area that is doing the allografts, and the only one short of Chicago I would trust.  I am really confident with him and the things I hear about him. Also, I had sent you an email a few weeks ago, and I assume that because of the trouble others here were having, you did not attempt to read it.  Anyway, I was just curious how your recover was going and if you were still gald you had it done.  Although, now from your post, I assume that all is well, and you are glad to have went through it.  

Brad  

[Stacy]

Brad,

I'm sorry I didn't respond to your e-mail.  I did get a bunch of viruses from this website, so I didn't want to open any e-mails related to this site....sorry!!!

I am doing great......absolutely NO regrets on this surgery.  I had some tense weeks here and there where I wondered if I did the right thing, but over the last month and a half, everything feel good.  I actually did a little mini (and I stress mini) jog across the street today. No pain at all........

How long have you been on the list waiting?  I waited about 4 months or so..........the first few weeks were hard, but then I just went on with my life and didn't think much about it until they called!!!

Anyway, keep me posted on you!!

Stacy

[kellyg]

I would like to know if anyone can suggest something to help manage the pain while I wait for my osteochondral allograft.  I've been waiting two months and it seems like each day the pain increases.  Should I ask the doctor about a cortison or synvisc injection or just try and wait it out with the standard pain meds?

[ken]

Make sure that the cadaveric graft that is being used has been tested for all possible diseases.  The company that supplies the allograft should perform these test before any tissue has been shipped any where.  There was a patient in the US last year that died because the company did not perform test on tissue that was diseased.  The procedure was ACL reconstruction.  Usually when an autograft does not take why would an allograft any way.

[jslkw]

Brad,
I just checked out the anestesiology news website and it is excellent. I will have to look at the others. I had a chondroplasty and drilling 10 monthes ago. My OS says that the only way to know if it worked is to go in and look around again. No way! My damaged never showed up on the xrays or mris so i guess that's the only way. I never found out the exact size of the defect except i was told it was very large.  Thanks for the great link.

[The KNEEguru]

Regarding kelly.g's question - cortisone may give considerable short-term relief, but in all likelihood it will damage the joint further. Synvisc seems more benign.

[grmblfx]

Kelly,

I had a fresh allograft done on January 20, 2002 after a failed OATS along with several failed microfractures.

Hi Stacy,

do you know the reason why your OATS failed? I will have my first OATS on Sept. 3rd, and I'm horrible afraid of. And, in another message, you said that the long term results of the OATS seem to be not so good - do you have further informations?
I would be very grateful for any response, because at the moment I have very less pain and I'm not sure if I really should do the OATS.
Daniel (germany)

[Stacy]

Daniel,

I dont know where your defect is located, your age or history.  I had my defect in the middle of my weightbearing area, on the femoral chondyle.  It was small enough that they felt the OATS would work.  Unfortunately for me, it did not work.  I have heard several other stories on here that have had the same fate.  I have also heard success stories.  It just seem so to me there is no way to determine the success.  

The only thing I have been able to come up with from everything I've read is that the location of the defect may have something to do with the success rate.  It seems that people who have a defect that is not totally in the weightbearing area have more success.....Just my opinion.

You have to trust your doctor first and foremost, if you trust him and he feels like it wil work, you should go with it.  Everyone is different.  The one thing you should not do is let it go.  Cartilage defects only get worse and bigger over time.  So....handle it early.....

Feel free to ask me any questions you may have about the surgery or after with the rehab stuff.....you can send me a message directly if you'd like.

Take care and good luck......
Stacy

[grmblfx]

Hi Stacy,

thank you very much for your reply!
I'm 26, and it seems that I have a cyst or something like that in the patella. So, the cartilage above that cyst gives in. The defect seems to have 1,2cmx1,2cm in the lateral apikal (superior) right patella. I had no previous operations on that knee, but 5 on the left one (ACL, Meniscus, etc.). At the moment, I have almost no pain, only when I go over 90°, I feel a little "scratching". But my doctor said, he would do the OATS, because there is a risk that the defect becomes bigger.
I'm very afraid of the operation, because the success rate seems not so good, and no one can tell me about the long term results. And I cannot imagine a non-weight-bearing period of 6 weeks - plus 6 weeks of partial weight-bearing. Can I walk with crutches? How long? Can I go to the university? Move in the house? And what about the pain - most people say it is strong. I'm really very scared about and not sure if I really should do something that seems a little bit experimental to me.

I will go to holiday today with my girlfriend and try to enjoy the last 5 days where I can walk and jump - I will be back on Friday, the operation will be on Sept. 3rd.

I would be appreciate to get another reply this week!
Thank you so much.
Daniel

[Stacy]

I would tell you that if the defect is under the kneecap, go ahead and have the surgery.  I've heard they have pretty good success with it in that location.  Also, your doc is right, if you do nothing, it will get worse over time, no doubt about that.  The bigger the defect, the harder it is to fix and the more unstable it will become.  

As for the crutches...the non weightbearing is the key to success on this surgery.  6 weeks isn't all that long when you think the first two you'll probably be down from the surgery.  I went back to work full time after 4 weeks and just worked on my crutches.  (I manage a Veterinary Hospital, so I'm on my feet all day)  You should be able to go to school as well.

It was not an overly painful surgery. The first couple of days are always hard, but it gets better fast.  If you've had surgery on the other knee, you'll do fine.

This is not really considered experimental in the US, it's done pretty regular here.  I would say that given the location of the defect, if you do the non weight bearing and listen to the docs....you have a great chance of success.

Let me know if you need anything else......

Take Care,
Stacy

[grmblfx]

Stacy,

thank you a lot for your encouraging words!
I'm still very scared of the operation. I fear the possibility it could not work. What about your knee? You wrote your OATS didn't work - what did you do then? What possibilities remain? How are you doing now?

I think the main reason for my anxiety is that, at the moment, I have so few problems. So I think it could only get worse - first, at least. Of course I hope that, for the future, it will be better to have the operation.

I still cannot really imagine how I can do the non-weightbearing, because for the kneecap that means no flexion (or only little) and no use of the quadriceps. But they will tell me, I think...

I know that self-pity does not really help - but at the moment it's hard for me to get over it. I hope that after the operation, when there's no way back, I will manage it somehow.

Thank you very much for your help! I will tell you when I'm back from the hospital!

Daniel

[Stacy]

Daniel,

Any surgery you have has the chance that it won't suceed.  I was just one of the unlucky ones that I had several surgeries that did not work.

Once the autograft did not work I went on to an allograft (a fresh cadever transplant) and am doing GREAT.  I feel really good......It just took this surgery over the OATS to work for ME.  The autograft my work just fine for you.....you have to have faith in your doctor that he/she knows what they are doing.

I've read that you've had all kinds of other surgery on the other knee.  This surgery will not compare with those in my opinion.  Painwise, the first few days are bad but then it's all uphill.

As for the crutches...you'll manage.....you have to.....so you'll do it!!!  That's just the way it works.

Good luck with your surgery and let me know how you're doing as soon as you feel up to it!!

Remember, stay ahead of the pain with the meds and do exactly what the doctor says.....that is the key.....(no walking around before it's time or anything like that)

Take care,
Stacy