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Author Topic: OCD and subchondroplasty  (Read 4780 times)

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Offline bradyj7

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OCD and subchondroplasty
« on: November 12, 2014, 05:28:35 PM »
Hi,

Has anyone any information on the subchondroplasty procedure and its use for treating OCD?

Thanks

Offline dal_knee

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Re: OCD and subchondroplasty
« Reply #1 on: November 22, 2014, 10:24:35 PM »

If you are referring to Osteochondral defect, my physician told me there is not much data or set of case studies for its use in isolated OCD's without concomitant osteoarthritis.   Essentially as it stands, the procedure is geared toward those with diagnosed arthritis.    That being said, the physician still thinks someone like myself (isolated ocd with adjacent subchondral edema ) may benefit, there just is not the set of hard data to support.    Keep in mind the procedure is quite new. 

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline bradyj7

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Re: OCD and subchondroplasty
« Reply #2 on: November 23, 2014, 03:11:14 PM »
Hi,

I'm like you. I've have isolated OCD. I had an osteochondral autograft procedure with 2 plugs 2 years ago. I've been really good for the last 2 years but am experiencing a lot pain now, which is very disappointing having gone through the surgery. 

Had am MRI last week and I 'think' that I can see some edema behind the in the graft. I'm waiting to see the doctor next week.

My reasoning is that all the pain arises from the nerves in the subcondral bone. After an OATs procedure the bone is bound to be weaker and have micro fractures/cracks due to the very nature of the procedure. If its minimally invasive I'd like to get it because a) it might decrease the pain and b) it might slowdown the onset of OA by hardening/repairing the bone?

Are you gettings it done?


Offline dal_knee

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Re: OCD and subchondroplasty
« Reply #3 on: January 12, 2015, 11:44:52 PM »
Bradyj,
I got it done 3 weeks ago!!!    I can update  my progress periodically if you are interested.      Right now, I feel like I'm "waiting" for the next improvement.    Continuing to be patient but am experiencing more pain than prior to the surgery.  Remember that the surgeon drills through the bone, and bone takes quite a while to heal.    My diagnoses was "stress fracture" of the medial femoral condyle.   I have a 1cm grade 2 and grade 3 chondral defect.   

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline bradyj7

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Re: OCD and subchondroplasty
« Reply #4 on: January 13, 2015, 09:49:01 AM »
Hi Dal_knee,

Yes please do update, thank you.

You do have an isolated Osteochondral defect or a stress fracture? What happened to you?

John

Offline dal_knee

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Re: OCD and subchondroplasty
« Reply #5 on: January 13, 2015, 04:54:00 PM »

I have both those conditions...osteochondral defect and bone marrow edema/stress fracture.  Just to clarify, the bone marrow edema is what is diagnosed on MRI and then it is up to your physician (not radiologist ) to diagnose the "method" that caused the bone edema to appear.  In my case, that diagnosis is stress fracture (repetitive loading of weakened bone).   My bone edema is exactly adjacent to my OCD lesion.  I'm nearly certain that first the articular cartilage degraded, which then exposed the bone to stress that it would normally be able to handle, assuming intact cartilage.  I would just like to say that I'm female, 39, 6'0, and very slim.    (I'm just trying to politely convey that my cartilage issues are not due to obesity)

My background is that I had a partial meniscectomy in 2007 that resulted in destabilization across the joint surfaces.   At the time of surgery, my articular cartilage was in pristine condition, shown in both pre-surgical MRI and at the time of that arthroscopic surgery.   However, the surgeon actually damaged my knee.   I was never able to walk again without significant pain/discomfort.   Via MRI, 2 years after the surgery that damaged my knee, it showed the chondral defect and associated bone edema.    By this time,  all my functions decreased...not able to ever again run, ride bike, do elliptical, stairmaster etc.    No doctors have really helped me.  I just stuck with physical therapy, which didn't help much.

On my own, I did seek more information on this bone edema and found the information on subchondroplasty.    Then I sought out a couple docs to consult with on that.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline bradyj7

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Re: OCD and subchondroplasty
« Reply #6 on: January 14, 2015, 05:20:22 PM »
Hi,

Thanks for taking the time to describe your condition. Would you by any chance a picture of your MRI? Its no problem if you don't, I'm just curious to compare mine with others. You didn't mention if you had your OCD lesion repaired (i.e. with OATS or ACI etc) or are you hoping the subchondroplasty will help that.

I'm a male, 30 and also slim :D. I developed my lesion playing sports a 2 years ago and I had 2 plugs from a non weight bearing part inserted where the damage is. I made an okay recovery, about 75% and went back to everything I love, mainly cycling and light weights.  I was never able to run or use elliptical without pain though.

In the last 3 months though my pain has come back, very disheartening and I'm having a camera put in on the 23rd on Jan to see articular surface. A tibal osteotomy is a possibility soon but I am hoping and praying for a less drastic/invasive outcome.

Cheers
John

 




Offline dal_knee

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Re: OCD and subchondroplasty
« Reply #7 on: January 14, 2015, 07:28:18 PM »
HI John,
I will try uploading a pic.  Give me a day or two.  I would say mine, compared to yours, is more evenly diffuse.   
Subchondroplasty won't address cartilage issues, just bone marrow edema. 

I am not intending on addressing the cartilage lesion with surgical interventions.  The success rates just are not good enough in my opinion.    My plan is to get an , unfortunately expensive, stem cell injection in the next 2 or 3 months to help regenerate or improve the state of my cartilage.     Because I already had one major surgical failure where the doctor made me worse-off during a simple, routine procedure, I am gun-shy (read: terrified) of allowing  a doctor to attempt any surgical reparation of soft tissues (meniscus, articular cartilage).   I even suggested to the subchondroplasty surgeon that we should write a contract that would prohibit him from attempting any not-planned interventions there.  I'm that adamant, no microfracture, no nothing.   But my background is different than yours, however.   

I'll be honest, in that, I'm a little afraid for your case in that you say after two years the OATS effect seems to be worsening enough that you are really looking at the next surgical options seriously.    Let's face it, aren't we as patients hoping to limit the number of surgeries we have?   When we go in for surgery, we're hoping it's good for like 10 years at least.    Any orthopedic who tells you that the industry really has cartilage repair under control is lying.   

Do you have info from the surgeon on whether subchondroplasty can help if you already had OATs in the past?     This surgery is so new, I'm not seeing information on that.    I would suggest even trying to get in contact with Peter Sharkey (inventor of subchondroplasty) and asking him.      He may feel ethically obligated (I hope) to have this discussion with you. 

Are you aware that osteotomy is only good for 7-10 years, after which the only option is knee replacement?   It is not intended to be  a long-term solution.        None of the current options are.   

I should state that my long-term plan is to keep my activity low enough to avoid avoid avoid avoid the surgeon's office at all costs.     Hoping/thinking that the stem cell injection will at least give it "a boost".  Because I did have one positive experience with PRP, I'm willing to take it to the next level and absorb the elevated cost of a stem cell injection, again, with the hopes of avoiding the orthopedist in the future.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline dal_knee

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Re: OCD and subchondroplasty
« Reply #8 on: January 15, 2015, 02:54:17 AM »
I've uploaded two views:  frontal and medial.   
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline bradyj7

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Re: OCD and subchondroplasty
« Reply #9 on: March 01, 2017, 07:37:06 PM »
Hi Dal_knee,

I was wondering if you could give an update on how you are doing since subcondroplasty? Can I ask if you were on crutches after?

I'm thinking of getting it done in the summer.

Thanks
J

Offline dal_knee

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Re: OCD and subchondroplasty
« Reply #10 on: March 01, 2017, 10:10:18 PM »

Yes, I spent 5 days full non-weight bearing with crutches.   Then after that I gradually was able to put some weight down, while still using the crutches until about day #9 or so.   Thereafter, I took the crutches with me wherever I went simply by leaving them in the back seat of my car and there were a few days where I did have to pull them out and depend on them, in partial weight bearing mode.  Generally, recovery was pretty painful, which they warned me about.  I couldn't take any less than the maximum dosage that the pain prescription allowed, around the clock for several days.  You get through it, but it really was a tad more than what I was imagining beforehand.

My update is that overall I'm happy I did it (except that I sustained a cartilage injury immediately adjacent to the pre-surgery one a few months later after having only climbed my stairs while carrying very heavy weight), but it's not a "life-changer" in terms of activity levels.  I still can't do basic physical therapy, so I avoid many activities other than walking.  ( I need a solution to the associated cartilage defect, my overall function I'm not happy with but at least severe bone pain is much improved).  Your situation is different however.
 
Hey so I know this procedure is generally used in OA patients only and I'm wondering what kind of commentary your doc has provided regarding its use to help heal the margins between the plugs and your native bone, which is the area that your bone edema comes from I believe??? 

Are they doing this (subchondroplasty) in Europe yet?
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline bradyj7

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Re: OCD and subchondroplasty
« Reply #11 on: March 02, 2017, 04:40:58 PM »
Hi,

Thanks for getting back to me, I appreciate it.

My OS was not keen on doing it when I suggested it. I am having an MRI at on Sunday and then he said we could talk again (current scan is 2 years old). He said it is risky as you could make it worse. I didn't realize that they drill into the bone. I didn't ask him how many he has done but very few is my guess.

Cheers
















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