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Author Topic: Osteochondral Transplant Allograft Blog  (Read 8191 times)

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Offline kneedit

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Osteochondral Transplant Allograft Blog
« on: November 21, 2015, 06:14:43 AM »
Hello,

I just had an osteochondral transplant with an allograft on my left knee a few days ago.  I wanted to start a blog to detail my recovery and to share some insight.  I am 25 years old and had a healthy knee prior to a sports injury where my patella was subluxated sometime in May, 2014.  I had two arthroscopic procedures since then to "smooth" damaged cartilage with two different orthopedics which didn't really do much.  I was then referred to a cartilage specialist who suggested the OATS procedure for a ~1.5cm defect beneath my patella.  My goal is to play sports at a recreational level again...I'll try to update this blog until the very end of the rehab process
Date of Procedure: 11/18/15

Today (11/20/15) - 3 Days Post-Op:  The procedure went well and I had to stay at the hospital overnight for an observation period.  Surprisingly, there was minimal pain probably due to the nerve block and all the medication I was on.  I got discharged the day after with a straight leg brace locked to 0 degrees and some crutches. My next appointment is in a month, and the doctor wants me to work my way up to 40 degrees till then. I'm on pain meds at the moment and it is tolerable - the discomfort of lugging around a huge leg brace is more bothersome.  Didn't do much today except bed-rest...I tried to wiggle my toes often to get the blood circulating which is all i'm capable of doing.  Even simple quad sets cause some discomfort.
« Last Edit: February 17, 2016, 05:49:38 AM by kneedit »

Offline Etbs

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Re: Osteochondral Transplant Allograft Blog
« Reply #1 on: November 22, 2015, 10:11:39 AM »
Hello,

Thank you for starting your blog. I just had an OATs procedure (donor) done Nov 11, and my OS doesn't have me seeing a PT until 2 weeks post op. I've been reading different rehab information and it seems many people start with CPM. I've been trying to do some ROM exercises but my knee right, it feels like I'm pulling at the skin and it burns a little. Have you done any ROM yet? If so, do you get the tightness? My incision is about 5" long and I still have the stiches and tape. Other than the tightness and some random sudden pains, the ROM seems to be getting better. I've worked my way to 35/40 degrees. However, I can't get it to zero. I wasn't given a brace, and I keep resting my leg with the knee slightly bent.

I'll be 6 week NWB. Right now, I'm not in much pain. The first 36 hours were brutal. I wasn't given a block (I had one with a microfracture in 2012) and I didn't think to ask for one before surgery. Anyway, I've been on ibprofren since day 2 and I'm not in much pain at all, except when doing quad sets. My quad is waking up more, and getting stronger each day. I, too, hope to get back to sports.

I hope you recovery fully and quickly! Oh, you mentioned researching doctors. I agree. I was lucky to find one who also happens to work on professional athletes, so I do feel confident with postop info I get. I just don't know why no CPM.

--
OATs (donor) RK November 2015
Micro Fracture RK May 2012
ACL graft (donor) RK June 2008
ACL repair RK May 2005

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #2 on: November 22, 2015, 06:40:54 PM »
Hi Etbs,

My doctor does not have me seeing a PT until after my first post-op visit, which is in 3 weeks (4 weeks from procedure).   I was told I can do quad sets and straight leg raises until then.  As far as ROM goes, my doctor said a CPM would not be necessary....he told me that I could weight bare partially without bending my leg using crutches whenever I walked.  He told me I should work up to 40 degrees flexion by myself by my first visit, using the brace.

I'm gonna ease on the ROM until i get through my first week...the skin still feels very tight like you mentioned and the burning sensation is still there whenever i try to push it too far.

What made you have this procedure?  Injury?

Offline Etbs

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Re: Osteochondral Transplant Allograft Blog
« Reply #3 on: November 22, 2015, 09:23:07 PM »
Hi. Thanks for your response. It's helpful to know the tightness is normal. I probably have been pushing the PT too far, causing the burning.  I was in a ski accident and had a failed microfracture from that, so OATs was the next step.  I have my first PT appointment this Wednesday. Based on a handout from my surgeon, I've been doing assisted heel slides, quad sets, leg extension with a foam roller under my foot. I can't seem to do a leg raise because my quads aren't firing yet. My OS said that can happen for a couple of weeks.


--
OATs (donor) RK November 2015
Micro Fracture RK May 2012
ACL graft (donor) RK June 2008
ACL repair RK May 2005

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #4 on: November 29, 2015, 06:19:39 AM »
11/28/15 - 1.5 Weeks Post-Op: The knee is feeling much better.  I stopped taking the prescribed pain medication around 3 days after surgery and switched to ibuprofen for a day or two afterwards.  The swelling has gone down significantly but still has a long way to go.  I can get myself to 40 degree flexion (heel slides) very easily which is what I was suppose to be working towards for the next 2.5 weeks. I wanted to push the flexion more but was told to hold off on that until later so the allograft can heal in it's place with no stress.  My leg has shrunk considerably especially at the quads/hamstrings, almost x2 as small as my other leg.  I've only been prescribed quad sets, leg lifts, ankle pumps for my at home physical therapy.  It took me a good week before I even attempted a leg lift because there was considerable pain at the surgical sight when I tried to do even a single rep.  Today, I was able to do the 3x10 although it was a struggle. 

The swelling and pain is decreasing each day.  I'm limited to very basic physical therapy exercises and flexion only up to 40 degrees for a full month.  Trying to keep my leg straight and immobilizing till then is testing my patience but so far so good  - i'm optimistic in the future and my ability to play sports at a competitive level again.
« Last Edit: November 29, 2015, 06:32:49 AM by kneedit »

Offline razuzin

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Re: Osteochondral Transplant Allograft Blog
« Reply #5 on: November 30, 2015, 03:20:12 PM »
Hi kneedit,
thanks for posting this.
I'm considering a similar surgery.
Could you provide more detail about the nature of your defect and your current condition. Is your allograft on the weight bearing portion of your knee? How wide and deep to the bone is the graft?
At this time of your recovery are you able to bear weight on your operated leg? Can you walk without crutches? How do you handle daily chores like bathroom, shower, going up/down stairs?

Thanks a lot.

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #6 on: December 04, 2015, 05:27:33 AM »
Hi Razuzin,

I'm assuming the allograft was on the weight bearing portion of my knee - there was considerable pain every single step that made me change my gait.  I'm 2 weeks post op and I will be using one crutch for two more weeks, which was what i was instructed. I can weight bear on my operated leg without the crutch, but VERY gently.  Using the crutch sucks for the first few days but you get use to it and just make it part of your life.  Next thing you know, a month will pass and you will ditch the crutches, begin PT and eventually be fully recovered.  After the first 3 days following the surgery, nothing has been too difficult at all.
« Last Edit: December 04, 2015, 05:37:28 AM by kneedit »

Offline razuzin

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Re: Osteochondral Transplant Allograft Blog
« Reply #7 on: December 04, 2015, 02:10:52 PM »
Thanks for a detailed response kneedit. Wish you a speedy recovery, looks like you're doing pretty well.

I'm seeing two doctors re my condition, both are very experienced surgeon who did many surgeries of this types. It's interesting how different their recovery protocols are: one is very strict about six weeks non-WB and extensive use of CPM machine, another - just one week non-WB, no CPM, start walking and moving around ASAP afterwards.

My defect is in the trochlear groove under patella which is non-WB section, I feel it only when I bend the knee more than 30 degrees e.g. when going up and down stairs. The doctor who suggests minimum NWB takes this into consideration. So far I'm leaning towards that doctor, not surprisingly. :)

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #8 on: December 20, 2015, 08:44:42 AM »
12/20/2015 - 1 Month Post-Op: I had my 1 month post-op appointment today.  The swelling has gone down significantly and there is almost no pain when the leg is at rest.  I took X Rays and the graft has healed well.  I got the okay to start formal physical therapy...I'm restricted to range of motion exercises and closed chain exercises.  It's going to be like this for another month...if all things go according to plan, I can really start pushing it afterwards.  I also got the okay to ditch the crutches which is a relief.  I'm walking with a noticeable limp...but i'm walking.  With an estimated recovery time being 4-6 months, I feel optimistic.  I feel like it'll be another month or two with some good physical therapy before I can tell if this operation was "worth it".  As of now, it's still too early in the recovery process. 
« Last Edit: December 20, 2015, 08:46:43 AM by kneedit »

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #9 on: January 15, 2016, 09:31:21 AM »
1/15/2016 - 2 Month Post-Op: The swelling at this point has almost completely gone down to normal. 
My leg is about 75% of the size it use to be, which is great progress. I am walking with near perfect gait but with discomfort. There still is pain underneath the kneecap, where the graft was placed. I'm a bit worried as I feel that I've hit a plateau in recovery in that things are feeling better very slowly compared to the first month of post-op.  It was at this 2 month mark that I got the okay from my doctor to start open chain exercises, but I think i might delay it a couple more weeks.  My doctor said I should be able to jog at the 3 month mark and ease back into sports at the 4 month mark, making a full recovery at the 6 month mark.  I feel a little behind schedule, but I've read articles and other blogs that recovery can take from 8 month - 1 year.  I have full range of motion and hopefully the pain will go away within the next month or so where I can really start pushing the physical therapy exercises at that point. 

 

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #10 on: February 17, 2016, 06:10:14 AM »
2/16/2016 - 3 Month Post-Op: Went to the orthopedics to get another x-ray....everything seemed to check out fine and the graft has healed well, although you can still a small contrast between bone and graft.  My leg seems to be getting stronger, it's almost 90% of the size of my other leg. My doctor seemed very optimistic.  I've been going to physical therapy and to the gym consistently probably every other day. 

I know it's only 3 months from the surgery, but I am still having pain behind the kneecap, where the graft was placed.  It gets worse as i bend down to squat, or any action where there is more weight placed on the kneecap.  This was the same exact pain I felt pre-operation and it has not really gotten from months 2-3 post op. My gait looks fine but I am still compensating because of this pain and have started to develop some nasty tendinitis on my other knee!   I expressed my concerns to my doctor who assured me that everyone heals at a different pace and that because I got this surgery 1.5 years after my initial injury, it might take a bit longer to heal. I was initially quoted as having a 4-6 month recovery time until sports, but it seems as if it might be 6 months before I can start to walk with no pain at all.  I really hope he's right...I'm starting to believe I might have some alignment/maltracking problems that hopefully won't need surgical intervention. 

If anybody has had the osteochondral allograft procedure on the patella, please contact me as I have some questions on recovery, time of recovery, etc.  I could really use some advice.



« Last Edit: March 08, 2016, 03:43:47 AM by kneedit »

Offline razuzin

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Re: Osteochondral Transplant Allograft Blog
« Reply #11 on: February 17, 2016, 08:22:23 PM »
Thanks for the update kneedit.
I'm wondering where you had the surgery and who was your surgeon.

My surgeon who I plan to do a similar surgery with, Dr. Riley Williams at HSS also doesn't use CPM, just ice machine post-op.
How big was you incision? My OS showed me an approximate size of the incision and it's around 2-3 inches.

Was anything else done during the surgery besides allograft, like cartilage smoothing, shaving?

Wish you a full recovery. Keep us posted.

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #12 on: February 18, 2016, 09:50:03 PM »
Hi Razuzin,

I didn't use CPM or ice machine post-op....my incision is 2.5 inches long.  I woulnd't worry too much about these things...i managed to get full range of motion fairly quickly and the swelling is completely gone without using the CPM or ice machine.  The incision stopped hurting after the first month  or so. 

I only had the allograft inserted...I had prior cartilage smoothing with 2 different procedures before going with the allograft. 

Offline kneedit

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Re: Osteochondral Transplant Allograft Blog
« Reply #13 on: August 12, 2016, 05:40:12 AM »
8-11-16 (8.5 months post-op)

Hello everyone...it's now 8.5 months post-op and I would like to say the past 8 months have been hell. 
My knee still feels the same as it was pre-surgery...2 years of dealing with 3 operations has lead to severe tendinitis due to compensating on my other knee and my Achilles, as well as just being depressed.  I can't stand for too long either...my heel starts to hurt due to all the weight that my knee can't take.

My doctor is baffled that im still experiencing pain and ordered a bone scan.  I talked to 2 more orthopedics who are equally as baffled.  I am going to talk to one more orthopedic, but it looks like objectively, my MRI shows a 'good' knee.  The pain on the other hand is not so good...I really wish there was something wrong so I could at least have another operation.  At this point, the only thing left is an exploratory scope, but i'm not too confident at all that the doctors will find anything.  The MRI shows good cartilage and good bone, so i'm not too sure where the pain is coming from, but it has to be coming from somewhere.  The cartilage is brand new and smooth, so it can't be that...at this point, it has to be the bone right?

I'm just completely confused...i never had prior knee problems with no arthritis and am only 26 yeras old...this was a result of a sports injury so i'm just so frustrated. 

I'm pretty desperate at this point...I think i've seen maybe 6 orthopedics so far, had surgery with 3 of them, and am going to see a 7th soon.  Wish me luck .

Offline mulberrysdream

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Re: Osteochondral Transplant Allograft Blog
« Reply #14 on: August 12, 2016, 06:11:19 AM »
Might I ask who you've seen and who you're seeing?

I'm so sorry to hear about all your struggles :(

I just had surgery #7 two weeks ago, my third with Dr. Laprade out of The Steadman Clinic here in Vail.

I had an OATs done last year which is doing amazing...although my whole knee is full of chondromalcia :/

My next step, based on Laprade's recommendation, is to do a series of BMAC injections...I'm 25 and have severe arthritis as well...and is all the result of two bad surgeries and an extremely misleading surgeon. Feel free to shoot me a message if you want.

Have you consulted with Laprade at all? If not...I can't possibly recommend him enough. I'd give anything to have seen him in the first place.
Right Knee-
MT Menisectomy, Chondroplasty, 10/16
MT Repair, Chondroplasty, Clean out+ BMAC/PRP7/16
Meniscus Transplant & OATs 8/15
Notchplasty,Osteophyte Removal,Prep for MT/OATs 7/15
loose body removal, menisectomy- 4/15
Menisctomy, loose body removal1/14
Lateral Release08
Meniscus Repar 07















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