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Author Topic: Osteochondral Allograft (OATS or Mosaicplasty)  (Read 9437 times)

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Offline JG

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Osteochondral Allograft (OATS or Mosaicplasty)
« on: January 21, 2003, 08:04:48 PM »
I am curious about those who have had this procedure.   Allograft mosaicplasty has been recommended by my surgeon (BACKGROUNDER below).  My question to those who have had it - what prompted your decision as to when to go forward?  Too much pain, too much damage?  I am very functional given that I have severe arthritis/articular damage.   My arthroscopy pictures have been seen by a number of the top articular cartilage physicians in the country and all agree that I should not be very functional...so I am very lucky.   I am inclined to proceed forward with this even though I am functional.  I am too young (34) and no interested in TKR given my lifestyle.

However, I work very hard at being functional.  I do CV work 5 times a week (between 60 and 90 minutes - cycling, running (more comfortable running than walking), and eliptical trainer) and 3 - 4 times per week I do strength training (60 minutes of hard leg work).  The reality here is that my knee is not likely to get better, only worse; however, I feel pretty good (besides the common arthritis problems - stiffness on inactivity, difficulty with stairs, etc.).  I do cycle up and down in terms of the pain and swelling, but I can usually control the problem with drugs/exercise/rest, etc.

Backgrounder:
09/99 LR Left Knee, no notable articular cartilage problems/arthritis; Post surgery DVT which required 7 days hospitalization and 7 weeks minimal activity.  Because of the DVT, things really went downhill.  
08/02 (after noticing serious grinding, popping, some kneecap subluxation) LR, Lateral Menisectomy (20%) Left Knee - diagnosed with Grade IV defects in three compartments.  Main problem medial femoral chondyle and trochlea and lateral tibial plateau.  I recovered from LR/Menisectomy really really quickly.  Recommened allograft mosaicplasty 2 weeks post surgery.  At my 4 week check up.  Surgeon suggested that we wait on the procedure since I recovered almost 100% 4 weeks post op.
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 mj/usa

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #1 on: January 21, 2003, 11:15:30 PM »
Hi!
I had an oats procedure done 4 mos ago because of a defect on the medialfemoral condyle.  I had had plica excision 15 mos before that and at the time the defect was discovered.  I never regained a fully functional knee after the plica op, in fact my knee was getting slowly weaker.  That, and the fact that I was told by my os that defects can grow if you just leave them alone prompted me to have the operation.
Now, 4 mos down the road I am VERY glad that I went ahead with this.  My knee is really great, I have full rom and my quad strength is getting there.  
It isn't an easy decision to make, but since you seem to heal very quickly and well, perhaps it is worth looking into. In my case I thought that it is better to do the oats now, when my knee is still in relatively good shape, then to wait and see and then have to do it when it is in bad shape.  I did a round of pt before the operation, so I had pretty good strength going into surgery.
Good luck to you--keep us posted about your decision.

MJ
plica excision 05/01,  followed by OATS 09/02

Offline JorJor

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #2 on: January 22, 2003, 12:19:41 AM »
JG-
Thanks for your post. I am in the same boat as you and have been thinking the same things. It looks like the lesions on my articular cartilage (Grade IV Medial Femoral Condoyle) maybe too big (more than 20mm) for the OATS procedure therefore I may need the bigger (scarier) surgery, the ACI (Carticel Implant). I am pretty active for the most part...I have be partly inactive the last few months from pain and frustration but now back in the gym and working through it all. I really want my legs to be a strong as possible.  I have taken great strides over the years to be as normal and functional as possible. Most people that don't know me would never guess that I had soooo much damage to my knee and have had 4 surgeries (going on my 5th). I guess I am more afraid of giving up my life to rehab after this surgery, not knowing if it will be worth it...what will life be like afterward, etc.
I am having a scope on 2/13 to take a look see and clean up the crap as much as possible. I will know more then.  Again, thanks for your message...If you want to chat more about this please email me [email protected]
Jori
5 surgeries (2 Micro-Fractures)! 8 rounds of Synvisc, Hylogan(sp?) & Supartz.  5th Scope 2/13/03 chrondoplasty & rp m. meniscus. Won't let it stop me...walked 60 miles in 3 Days for Breast Cancer.

Offline JG

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #3 on: January 22, 2003, 02:59:00 AM »
Thanks for the responses.  I guess I have another question (for Jori)...did the Synvisc injections help?  Anyway, my surgeon is not really very positive of the ACI procedure.  The size of my defect is more than a 1.5 cm2 (not mm!) and I have three of them.  I actually went to my surgeon today (I called after I submitted my post this morning and got in today...the clinical is really together).   I am going to have another MRI on Saturday evening and will review the results with my doctor on Tuesday afternoon.  He did agree that eventually we would have to do something.  My fear is a TKR at 34 which I told him was out of the question.  I am basically pushing him down the road of allograft mosaicplastry at this point.   He suggested that I get the MRI, maybe try Synvisc, wait and see, and last resort try the surgery.  Are you waiting for an allograft.  He said we cannot do an autograft...to much damage for the most part.  I think I am boarderline qualified for this procedure so the sooner the better is what I am concluding.

Thanks again...J
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 JorJor

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #4 on: January 22, 2003, 08:46:33 PM »
Yes, the injections did help. I have tried all 3 of the drugs that are on the market now in the US. Hyalogen (sp?) I feel worked the best for me, but they all worked to some point. I have had 6 series of these injections over the past 3 years. For me, each series releived my pain for about 6 months on average. I am very glad that I tried these injections and would be willing to use them again depending on what the next scope says.
I have been holding off on any extreme procedure of any kind (surgery). My last surgery was 6 years ago and my lesions measured over 20mm. After seeing my latest x-ray, we are sure that they have grown. Right now, I am awaiting this upcoming scope so that we can see how much the lesions are grown therefore I (we) can make an educated decision on what will be next. Personally, the thought of either OATS or ACI scares the crap out of me but know that eventually something will have to be done. I am also not interested in TKR for a long time, if ever. Take care...Jori
5 surgeries (2 Micro-Fractures)! 8 rounds of Synvisc, Hylogan(sp?) & Supartz.  5th Scope 2/13/03 chrondoplasty & rp m. meniscus. Won't let it stop me...walked 60 miles in 3 Days for Breast Cancer.

Offline Roach22

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #5 on: February 03, 2003, 09:05:38 PM »
I am going for my 3rd opinion today.  I have had 4 other surgeries in the last 13 years staring when I was 15.  The surgeries consisted of placing screws in my knee to hold a loose bone in place and then removing them after 3 months of being non weight bearing.  
In December my knee suddenly locked and to make a long story short an X-ray showed that the bone has fallen out and is floating in my knee.  So I have to get the bone removed and the question is what to do with the hole.  The OATS procedure is what each doctor has suggested.  One doctor told me if I did nothing I would have arthritis but another one told me that I already have arthritis so then what would be the point of trying to fill the hole and going through the months of recovery?  To those who have had the OATS procedure how long were you non weight bearing and wearing a brace.  Did the brace allow you to move your knee at all or was it locked at 0*degrees.  What is the pain like after the procedure.  I have a 3 year old so being non weight bearing will be tough.
I am just wondering if anyone has any tips or whatever for me.
Rachael

Offline mj/usa

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #6 on: February 04, 2003, 11:14:49 AM »
Hi Rachel!

I had an oats operation 4 mos ago--I have a string of posts about it, perhaps you can find it by searching the kneeguru site. To make a long story short:  I had almost no pain at all after the operation (I spent the first night in the hospital with a pain pump, but only used it 2-3 times).  I was on crutches on in a wheelchair for 6 weeks (yes, it was hard, but I managed) and I used a cpm (continous passive motion machine) for 3-4 hours a day for the 6 weeks.  This kept my knee moving and  I am sure it contributed significantly to my regaining full rom after a relatively short time. I had a brace, but only when I went outside.  The first 10 days it was locked at 0 degs, after that it was locked at 60 degs.  I didn't have to sleep with it on, or anything like that.  I also used a cryocuff ice pack to keep the swelling down, that worked very well, too.
So all in all I found the operation not nearly as bad as I had feared and I am veyr glad that I did it.
Feel free to contact me for more info, I'll be glad to help.
cheers
MJ
plica excision 05/01,  followed by OATS 09/02

Offline Roach22

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #7 on: February 04, 2003, 08:55:51 PM »
Well I went for my appointment yesterday and the doctor told me I wouldn't be non weight bearing just light weight bearing for 3 weeks and that I wouldn't have a brace and I could start bending my knee ASAP.  He told me that the hole is about a half inch big...what ever that means.  So we now have to wait on insurance and schedule surgery.  I am so much happier with this doctor then that last few I have seen.  He has done this procedure around 30 times so that makes me feel a lot better.
Hopefully I will get the surgery next Monday (he is out of town until the weekend) so my knee will stop locking on me.
Thank you for your info that you shared!
Rachael

Offline mj/usa

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #8 on: February 04, 2003, 09:01:14 PM »
Rachael--

Good luck to you when you have your surgery!!! Let us know how you fare.  Your defect seems about the same size as mine was.
Take care

MJ
plica excision 05/01,  followed by OATS 09/02

Offline JG

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #9 on: February 04, 2003, 09:06:41 PM »
Hey MJ,

Remind me.  Did you have an autograft or allograft?  If allograft, did you have fresh or frozen?  My MRI last week showed that I may have some bone necrosis in three spots.  He thinks there is an 80% chance that the patella is necrotic, 60% chance the lateral trochlea area and 50% chance on the lateral tibia plateau.  So for me autograft is not even an option. He was very surprised that I could walk comfortably, much less stay very active.  However, he suggested we go forward with the mosaicplasty sooner rather than later which means he wants to use a frozen graft.  My concern now is that the viability of the chondrocytes of a frozen graft is much lower than a fresh allograft.  Any knowledge on this? I have done a ton of research, but very little is out there about the viability of a frozen versus fresh graft.  Everybody just states that the fresh has better viability.  He said that 99/100 physicians would not even try the mosaicplasty on my knee because of the extent of the damage and that multiple compartment transplant success is lower than single compartment (sounds like you had single).  Any feedback on type of graft is appreciated.
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 mj/usa

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #10 on: February 05, 2003, 11:23:22 AM »
Hi JG--

I had an autograft (from the lateral edge to the medial femoral condyle, bang in the middle of the condyle) and I only had a single defect.
My research prior to the operation got me the same info as you---the larger the defect, the harder it is to do the operation, the less the success rate.
The size and location of the my defect meant that it  was right on the border between OATS and ACI.  It was my surgeon's own personal operating experience with ACI that led him to favor  OATS.  So far, it has been wonderful and has I think it has  worked really well. But then, as my os said, I had the really classic indications for OATS--smallish, single non-kissing (meaning there was no corresponding defect on the tibial side of the knee) defect.
Good luck to you in your quest  I hope you get some good answers for treating your knee.
MJ
plica excision 05/01,  followed by OATS 09/02

Offline Victrola

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Re: Osteochondral Allograft (OATS or Mosaicplasty)
« Reply #11 on: February 08, 2003, 01:47:12 AM »
 :-X OK hi all, this is my first time posting here and maybe someone can give me some direction to go...I fell in '99 and damaged my patella and my medial femoral chondyle....I have had three surgeries since then and went in last week for Mosiacplasty but came out of surgery with nothing being done...I never quite understood the reason he said he couldnt do it but he didnt and said that I would have to deal with the pain another 20-30 years since I am too young <33> to have TKR...I have tried synvisc and cortisone injections with no help..I am a nurse and am on my feet all day and it has been very difficult this past year and I cant see how I can wait another 20 years....OS says that my patella has a large hole with no cartlidge on it and that it doesnt meet my other defect unless my knee is 100 degree flexion and that the femoral defect it deep into the bone...not a ridge and that was why he couldnt do it....if anyone knows the reasoning for this I would like to know since I dont have my follow up appointment with him until next week...so I guess my question is what else is there to do? Is there any alternatives for a large defect like that if Oats or Mosiacplasty isnt an option? Ok thanks and hope to hear some feedback....thanks Vicki
Chondroplasty '99, Chondroplasty '02, Attempted Mosiacplasty '03















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