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Offline Sharon

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OATS recovery
« on: April 05, 2007, 05:44:40 AM »
Hi everyone,

I'm scheduled to have my OATS in just about 2 weeks (April 18) and have been thinking about what my OS told me about the recovery, as it's very different from what I've been reading.  I'm having the grafts on the underside of my patella and on my trochlea.  When we discussed the surgery, my OS told me that I would be NWB and on crutches for 10 days to 2 weeks, just until I could weightbear without too much pain.  It seems like most other people on here who have had an OATS have been NWB for a much longer time.  The only restriction that he said I would have is that I couldn't put 100% of my weight, like going up or down stairs normally or doing one legged exercises in PT, on that leg for 2-3 months until the OATS sites have fully healed.  It's not that I don't trust what my OS is saying because I fully trust my OS.  He's world reknowned and has done this surgery many many times.  I'm just wondering if anyone else who has had an OATS has gone back to weightbearing so soon afterwards. 

Thanks for any help!
:)
Sharon
Left knee:
LR-5/99 & 9/01
Distal realignment and LR 7/02
TTT revision 6/03
screw removal/MUA 10/03
d/x with severe patella baja
7/05 patellar tendon replacement w/piece of quad tendon
4/07 OATS

Offline David3

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Re: OATS recovery
« Reply #1 on: April 05, 2007, 06:52:41 PM »
Hi Sharon,

I'm afraid I know little about OATS recovery. However, I also have grade 4 lesions on both patella and trochlear (same condition as you) and am trying to learn as much as I can about the alternatives before I see my OS on April 16th. May I ask how large your lesions are? Did your OS consider other techniques such as ACI (Carticel) and, if so, what made him/you choose OATS? Do you have any information about the success rate of OATS for combined patella / trochlear lesions?

Appreciate any thoughts you may have. Best wishes for April 18th.

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline maile433

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Re: OATS recovery
« Reply #2 on: April 06, 2007, 05:09:42 AM »
Sharon,

Hmm, that does seem like a shorter recovery than normal, but in many cases (as in mine), the repair is done on the WB surface of one of the femoral chondyles.  Maybe since the patella and trochlea don't bear weight they can get away with shorter recovery times.  Maybe something to ask your doctor.  One thing to keep in mind, though, is even once you are cleared to walk on your leg, the bone plug will continue to heal and usually takes up to a couple years to fully recover.  Don't push it too fast after the surgery!

Best of luck to you!

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

S_501

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Re: OATS recovery
« Reply #3 on: April 12, 2007, 07:33:28 AM »
Hey Sharon,
I dare say patella + trochlea is definitely weightbearing, moreso because of the super delicate biomechanics in that spot, so...yeah, your NWB rehab time definitely seems short. Like David says, it's maybe because of the size of your lesions combined with your previous and unique injury history. We're all different in minimal ways and the docs determine procedures like they're cooking.

I am a "lateral patella + lateral trochlea" waiting for my allograft to pop up. But I'll need a lateral release as well.

I am looking at about 3 months on crutches, 7-10 months rehab, overall one year before I can even attempt to safely try impact sports. Well...impact sports (like my beloved running) are not advisable in any case after a patellofemoral oats, ESPECIALLY if it's a "bipolar" transplant of any kind. Bipolar, to my shocking discovery, means when they're resurfacing two articulating surfaces, like a trochlea articulating against a patella. So, if that's your case too then you're not likely to perform as good as if you were, for example, resurfacing just the patella....it's kinda screwy. Let's hope we're all be that 60-75% that does "good to excellent results".

Anyhow, go easy on it Sharon and best of luck. Take more time for safety....

David,
you seem to be interested as much as I am to return to sports. What have you heard on your end about chances to go back to running after this kind of resurfacing (patella and trochlea)?? I'm compulsively trying to gather info about any success stories 'cause I can't even think having to give up running if I can help it (...moderately of course, but not completely)....
Who's your doc? Mine is Dr. Bugbee, San Diego CA.

Thanks guys.

Saida


Offline maile433

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Re: OATS recovery
« Reply #4 on: April 12, 2007, 06:23:34 PM »
I dare say patella + trochlea is definitely weightbearing, moreso because of the super delicate biomechanics in that spot, so...yeah, your NWB rehab time definitely seems short.

Yes, you're right, I mis-typed when I said it doesn't bear weight - meant to imply that it's just a different type of loading than straight on the end of the bone.  My apologies for any confusion.  I stand (or lean on my crutches) corrected.   :)

In any case, good luck with the surgery and recovery!!

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

Offline David3

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Re: OATS recovery
« Reply #5 on: April 12, 2007, 09:27:44 PM »
"David, you seem to be interested as much as I am to return to sports. What have you heard on your end about chances to go back to running after this kind of resurfacing (patella and trochlea)?? I'm compulsively trying to gather info about any success stories 'cause I can't even think having to give up running if I can help it (...moderately of course, but not completely)....
Who's your doc? Mine is Dr. Bugbee, San Diego CA."


Saida,  I have no real idea what the chances are of getting back to serious sport. I've always been heavily into sport. In mid-Sept 2006 (just before my microfracture), I was blissfully unaware that my injury was a cartilage problem. I knew I had a problem, but my ambition was to get back to running, hard skiing, aggressive cycling, etc. I have to admit that I'm rapidly recalibrating my ambition level. With the pain I've had over the past 6 weeks since my microfracture failed in my LK, and equal pain in my RK, I'm struggling to walk properly. If somebody told me now that, in two years time, my knee pain would be gone to the point that I could walk, cycle, swim, maybe play golf, and have fun with my 3 young children, I'd be ecstatic. In fact, the debilitating condition I've been in over the past few weeks has really scared me to the point that I have virtually concluded that I will never run again, even if I seem to make a full recovery.

Having said that, I have multiple lesions in both knees. If you have a problem in one knee only, the lesions are small, and you have a successful treatment, there may be much lower risk for you resuming sport once you're convinced you're OK.

My doc for microfracture was Dr Steadman in Colorado. Excellent OS, high integrity. Unfortunately, for whatever reason, microfracture hasn't worked out for me. I'm therefore looking at other techniques. I'll be travelling to Indianapolis next week to see Dr Jack Farr to get an opinion on whether ACI or other techniques might be a recommended next step (Steadman doesn't do ACI). I'll know more early next week.

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

S_501

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Re: OATS recovery
« Reply #6 on: April 13, 2007, 02:11:00 AM »
Sarah,
no problems there, we're all kind in the same pot here. The more info we share, the better decisions we'll make hopefully....

David,
thanks for your reply. I understand your fears, it's very hard for sportspeople to give up their "addictions", although like you're saying the prospect of having to give it ALL up puts things in perspective a little. I'm likely to have to learn and cope with it sooner or later.

I had a failed microfracture too during my arthroscopy back in April 06 where my lesions are, and waiting now for the allograft as salvage procedure. So now I'm wondering if my doc knew all the way that the MF was going to fail anyway! The problem with any knee surgery, I think, is that docs always want to make it be the patient's decision to have them in a very very clear way...so that they don't get sued afterwards, although I have no beef with my doc about the MF failing, it's just an attitude that I noticed.....

True to what you said, if the lesion is localized and small, then there're better chances for recovery. But from what I frantically researched on the net, it gets really tricky when it's in the patella+trochlea. So I don't feel any better, rather I tend to think that we're all kind of screwed here. I also don't know in terms of cm how "big" my lesions are and that's killing me!

I heard about Dr. Steadman, he's an awesome one. Please keep posting your updates, check our Dr. Bugbee too if you're recommended an allograft instead of an ACI eventually. He's, like, the top for allografts.

Saida


Offline David3

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Re: OATS recovery
« Reply #7 on: April 13, 2007, 02:55:27 AM »
Saida,  Another thought is that I've heard several places now that the chances of success of a combined patella/trochlear cartilage restoration procedure are increased if an 'unloading ostetomy' is performed at the same time. I'm not quite sure what this entails, but I'm presuming (perhaps ignorantly) that this is some type of TTT which helps relieve and/or redistribute some of the stresses between patella and trochlear. Several contributors to the ACI section of this bulletin board refer to an unloading osteotomy being planned for them in conjunction with patella/trochlear ACI. This is apparently still the case evn if alignment and patella tracking are good (as mine are). One person has received feedback that the (ACI) procedure is hardly worth doing without it - success rates for that lesion combination were apparently poor, but have increased significantly when done in combination with an unloading osteotomy. I don't know whether this applies to OATS / allograft, but my guess is that the same principles of stress relief still apply. This is definitely an issue I'll be asking Dr Jack Farr about when I see him next week. You might want to follow up with Dr Bugbee. How long did you have to wait to get to see Dr Bugbee by the way?

By the way, have just come back from swimming 15 mins ago - just did laps using arms only with my legs trailing behind me (leg kicks hurt!). Really nice to get a bit of an aerobic workout - anything else except upper body work is really difficult for me now. First time for a few days that I've felt something was really a pleasure.

2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

S_501

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Re: OATS recovery
« Reply #8 on: April 19, 2007, 04:37:53 AM »
Hey David,
sorry I didn't get to reply right away...
I've fairly superficial knowledge about osteotomy and it didn't get mentioned in my case..to my somewhat relief because I think it implies "cutting your bone" and realign it at will kinda. I'm just assuming that anything that involves cutting and rearranging (like the 6 million dollar man) is a super stress procedure for returning to sports. Now, like I said, don't know much about it and hopefully I will not in the future...
ACI is not good for me because my damage is down to the bone, although localized: I can clearly two see bare, cartilage-free spots in scope photos....I think ACI works better if there exists at least a "bed" of damaged cartilage to work with, but I might be wrong about it....

Bugbee is concerned a lot about my malalignment which is in fact responsible for eroding the cartilage on the lateral side of my patella and trochlea. He asked me several times if I ever dislocated my patella, which I never did despite all the "running stress" I put on my knee since I was 17 (I'm 36 now) and that makes me hope that a mere lateral release will do the job.
Again, these are simple calculations I'm doing in my mind based from what I gathered because I'm not a doc. But at the same time, I am the one with this knee and the fact that I've never dislocated my patella makes me assume that there's a lot of life left in this knee and hopefully I'll be a success case...
You said you've lesions in multiple compartments and that's kinda discouraging, but at the same time your correct alignment will spare you a lot of trouble!!

Let me know how it turns out....I'm glad you can pluck your endorphines in other sports. Me, I'm freakin' runner, period. So if I can't get it back it'll be a disaster.
I didn't have to wait to see Bugbee. What takes long is waiting for the "donor". Especially if it's in a dramatic place like patella+trochlea. My donor knee has to be almost "identical", like within 2 mm. It's taking forever, April is my 6th month of wait and I've never let go of the crutches.......so when you say you can barely make your way to the kitchen and get food, I know....

Saida

Offline maile433

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Re: OATS recovery
« Reply #9 on: April 19, 2007, 04:58:12 AM »
Saida,

Sorry you're waiting so long for the donor.  I hesitate to say this, but I waited over a year for a donor, after which my doc decided he would try an autograft instead.  Not sure if this is really an option for your location.  I kept being told the wait would be between 2-6 months.  I have a sneaking suspiscion that there was an insurance issue there.  At one point I changed insurance companies, after which the nurse said there were some different codes she could use.  Hmm, so does your type of insurance and codes used add to the list of qualifications for a donor?  In any case, hopefully that won't happen with you.  I think if I didn't call several times to check the progress I'd still be waiting, so if you haven't called just to make sure you're still on the list, you might want to think about that. 

At least I wasn't on crutches the whole time - I feel for you!  I hope you get a donor soon!  (Although I have to admit it was getting a bit morbid at times - every time I heard of a fatal car accident I thought to myself, "hmm, i wonder how big their knee is".  So terrible, but a reality, I guess.)  On a brighter note, your arms must be super buff now! ;D

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

S_501

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Re: OATS recovery
« Reply #10 on: April 19, 2007, 06:05:09 AM »
Sarah,
thanks for your sneaking insights. I call regularly to the point that the nurse in charge of scheduling the allografts surgeries knows exactly who I am. I did more, I complained to Bugbee himself and he copied an email to the nurse saying she should look "hard". He wasn't blaming her or anything, they just say that now that "sometimes" it takes longer...
I don't think they were trying to fool me from the very beginning, not yet at least. I also learned that Bugbee is the official "first recipient" for knees from the Tissue Bank because, I guess, of his rep and because he does so many. I didn't even know this piece of info until 2 weeks ago. So far I tend to trust them, but definitely THANK YOU for this addition....I'll keep it in mind. I reckon you're not from CA then.
Following this exchange of emails I know I am probably on the list for sure.  I have Blue Cross of CA for insurance, and a lot of people who go to Bugbee have it as well for allografts. I remember it took a month to approve last Oct.

And yes, sadly I take notice too of those fatal accidents myself......! And by now I'm buff where I don't need to be!!
Thank you.

Saida

Offline maile433

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Re: OATS recovery
« Reply #11 on: April 19, 2007, 06:55:46 PM »
Hmm, I am from CA and was originally using Blue Cross of CA, but changed to United Health Care.  Interesting...  It does sound like everybody is on the ball in your case, so hopefully everything will be taken care of soon!  It's such a pain waiting, not knowing when the surgery will be, not really being able to plan anything.  I finally gave up and planned a vacation to Hawaii last summer with my husband, then after we had everything planned my doc decided to just do the autograft, so no Hawaii for us.   :(  Hopefully you can just get your surgery done soon so you can get on with the rest of your life!  I'll keep my fingers crossed!

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

S_501

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Re: OATS recovery
« Reply #12 on: April 19, 2007, 10:54:15 PM »
Sarah,
who's your doc? just curious at this point....

Saida

Offline maile433

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Re: OATS recovery
« Reply #13 on: April 19, 2007, 11:05:02 PM »
My OATS was performed by Dr. Eakin, at Palo Alto Medical Foundation.  I have nothing but good things to say about him, and don't at all criticize him for the long delay, just the system in general.   :)  No matter now, I had the surgery, all is looking good still, though just a bit of a setback waiting for the bone to heal completely.  Had an MRI earlier this month and the cartilage looks good, but the bone plug itself has not quite healed yet.  I spent the last couple weeks on crutches which seems to be working.  I'm walking pain-free again for now, hopefully it will last! 

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

S_501

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Re: OATS recovery
« Reply #14 on: April 20, 2007, 11:34:05 PM »
Sarah,
good for you!! Your doc name doesn't sound familiar, I've seen a few in Ca though. So did they say anything about you returning to sports after this (if you do sports at all that is)?

Saida

Offline maile433

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Re: OATS recovery
« Reply #15 on: April 21, 2007, 03:40:47 AM »
He said I should (eventually) be able to do anything except running or jumping, but that's more because I have so little meniscus and not so much from the OATS.  But I suspect that it will still be quite a while before I can really start pushing it again.  All I've really been doing since the surgery in August is my PT, some light cycling (though very little because it was really irritating my hamstrings), yoga, pilates, and just walking around and apparently that was too much for the bone to handle this soon after the surgery.  When you do get to have your surgery I would return to things very slowly...I thought I was going really slowly and it was still too much.  Now I'm just really nervous about doing anything...  Ahh, the joys of surgery!

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

Offline maile433

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Re: OATS recovery
« Reply #16 on: April 21, 2007, 03:41:41 AM »
Sharon, I just looked at the original post in this thread again and remembered your surgery was two days ago.  How did it go?  I hope the recovery is going well!!!

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

S_501

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Re: OATS recovery
« Reply #17 on: April 21, 2007, 08:38:24 AM »
Sarah,
yep yep...it's so hard to try and make everything a bundle to predict general results. I'm reading that you had work done on your lat and med meniscus, plus the WB part of the condyle...that'd put you in danger for tibiofem arthritis I suppose later if you push it. So sad though, I mean it seems one wants to live life by doing the "right things" to get joy and we just get screwed instead....
I spent (and am now) almost 2 years on crutches since my initial injury in Nov 05 when my knee went from 100 to 0 in a week, then I did the arthroscopy and the MFract, then I recovered badly from the scope and the MFract, then I'm waiting for the allograft, etc etc. The prospect of at least one year OATS recovery including the 3-4 months crutch time (IF the allograft incorporates) seems like a stroll in the park. Ah well...

Saida

Offline maile433

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Re: OATS recovery
« Reply #18 on: April 21, 2007, 04:32:20 PM »
Saida,

All I can say is UGGGG!  I hope this surgery brings you relief!

Unfortunately, the arthritis is already taking hold in my knee, but I'm doing anything I can to slow it down as much as possible.  It was really hard to give up running and triathlons, but it's made me appreciate doing what I can do so much more.  The silver lining is always there...

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

S_501

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Re: OATS recovery
« Reply #19 on: April 22, 2007, 07:58:18 AM »
Yeah....UGGGG is right. Well, I'll post when I do the surgery.
It'd be nice to know how you'll turn out later on, best luck to you.

Saida

Offline maile433

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Re: OATS recovery
« Reply #20 on: April 22, 2007, 04:25:33 PM »
I'll keep you posted as thing progress.  I did push it a bit too much yesterday so I'm paying for it now.  Nothing too much, just had to do a little shopping which I guess was too much walking around.  I do feel like I've taken abotu 10 steps backward in the recovery, but hopefully this is just a minor setback in general.  I'm hoping this is just another little hump i have to get over.

Enjoy the rest of the weekend!
Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

S_501

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Re: OATS recovery
« Reply #21 on: May 31, 2007, 07:12:02 AM »
Got the call, oats surgery is tomorrow in SDiego.
After 7 and more months of wait I have this psichedelic mixed feelins that 1)I'm going on vacation 2)my life's moving on finally 3)happiness of the ignorant soul 4)plain freakin' out.

Saida

Offline maile433

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Re: OATS recovery
« Reply #22 on: June 01, 2007, 12:05:34 AM »
Wooooooo hoooooooooooooooo!  That is awesome!  Congratulations on finally getting a date for the OATS!!!!!  I hope everything goes well for you!  Keep us updated on your progress!

Sharon, are you still with us?  Saida & I have hijacked your thread, but know we're thinking about you and hope you're doing well.

Sarah
7/03 RK medial meniscus repair & partial lateral meniscectomy
2/04 RK partial medial meniscectomy & microfracture
1/05 RK medial & lateral partial meniscectomy & microfracture
8/06 RK OATS autograft LFC + LR

Offline Sharon

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Re: OATS recovery
« Reply #23 on: June 01, 2007, 05:23:13 AM »
Hi Sarah,

I'm still with you here.  It's been almost 7 weeks since my surgery (I posted about it on the surgery section of the board) and I'm doing okay.  I'm still in my brace locked when I'm walking, but unlocked otherwise and I'm still using crutches outside of my house.  I see my OS next week though and my PT said that she thinks my quad strength is good enough that he'll put me into a smaller brace.  My quads aren't great...I can only really do a SLR with my brace on, although I'm trying really hard to do one without the brace, it's just not happening quite yet.   I still have some pain in my knee but it's not as constant as it was before the surgery although I also have to consider that I haven't really gotten a chance to test it out yet as I can't really walk on it yet because of being in the brace.  There's also alot of soreness still just in the whole area of my kneecap, it's very sensitive and I can't really lay on my side or my stomach because it's just too sore to put that much pressure on my knee.  My other problem is with swelling.  Whenever I'm on my feet for more than 10-20 minutes my knee swells quite a bit.  I've never had this much swelling this far out after any of my other surgeries so I'm going to discuss this with my OS when I see him on Tuesday.  I don't know, maybe I just need to take an anti-inflammatory or something.  I've tried advil and alleve and that hasn't helped at all.  My ROM hasn't come back as fast as I'd like it to either.  I have a history of scar tissue problems, which is what brought me to the point of needing the OATS, so getting my knee to bend is a big deal.  My PT measured me today as being close to 90 and that was after I spent a good amount of time stretching myself and after she stretched me as well.  I'm not sure how my OS is going to feel about my ROM but I guess that's something I'll see about when I go to my appt.  So that's pretty much how things are.  Tonight the pain and swelling is really bad as I went to a NY Mets baseball game with my boyfriend tonight and it was alot of walking.  Thanks to my handicapped parking permit we got a parking spot really close to the entrance to the stadium but once we got in I stupidly walked around with him for a bit in the team store and stuff before going to our seats.  Tomorrow, well actually today as it's after midnight, is also my boyfriends birthday so we're going out both Friday and Saturday night with various friends.  Friday night won't be bad as we're going low key and going to a place where I know I can sit most of the time.  Saturday night...we're going to a bar.  My boyfriend is wonderful though and I know he'll do whatever he has to in order to make sure I have a place to sit.  I'm just a little afraid of being with all of those people (especially all of those drunk people) and getting bumped or something.  It's his birthday though and I don't want it to be ruined because of my knee...he's done so much for me in the past 7 weeks that he deserves this.  I promised my PT that I'd be careful and that's what I intend to do...it's just a little scary.  Anyway, I'll keep you updated and will let you know what my OS says when I see him next week.  Thanks for asking about me!

:)
Sharon
Left knee:
LR-5/99 & 9/01
Distal realignment and LR 7/02
TTT revision 6/03
screw removal/MUA 10/03
d/x with severe patella baja
7/05 patellar tendon replacement w/piece of quad tendon
4/07 OATS

Offline thehammah

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Re: OATS recovery
« Reply #24 on: April 18, 2010, 04:39:06 AM »
I am new to this board and had my OATS on Jan 21 of this year. I had gone to Dr Bugbee but since I live in LA i was recommended to another dr locally.  De Bugbee did a lateral release on me but told me my pain was "an inigma"  lol.  I only waited 6 weeks so he cant possibly be first in line..

two week nwb does seem awfully short to me but then again my lesion was quite large on the lateral trochea/chondyle area..  I am now 13 weeks post op and still have a fair amount of pain mainly due to an incision that is not healing well.  hope you do better than me.

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