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Author Topic: DONOR TIMELINE  (Read 2225 times)

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Offline EddyPDX

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DONOR TIMELINE
« on: January 30, 2017, 08:32:54 PM »
Hello everyone!!
  Eddy from Portland OR, USA.  Im 38 and a sponsored Athlete. I just got told I need to go through the OATS procedure. My doctor is affiliated with ARTHREX.  anyway.. my question is.. i have gone through 2 meniscus repair, PRP and Synvisc injections so this is my next step. For those of you in the USA... how long did it took to find the matching donor? How this works?

Thanks for the info!!!

EddyPDX

Offline dal_knee

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Re: DONOR TIMELINE
« Reply #1 on: January 31, 2017, 04:04:19 AM »
Hi
I can't answer your specific question, but am curious about your case specifics.  How large is the defect?  What does MRI report ?  Did you get a second opinion?  Your wording is a bit troublesome in that you feel pressured to undergo this procedure due to being a "sponsored athlete".    An allograft OATS has a pretty low success rate at around 70-75%.  What is your sport?  Basically, you will not hear many anecdotal stories of either autograft (higher success rate) or allograft (from cadaver) OATS bringing patients back to impact activities.  This website has a much larger audience in U.K., where they are extremely conservative in knee surgery recommendations, compared to U.S. docs whose main care-about is just getting the patient in and out of their office, with much less regard to longevity of the surgical intervention.  Another issue in dealing with U.S. docs, is that in their head, the only surgeries that "work" are the ones that they "perform" and have actual experience in.   So, if they don't do it, then it's not a reasonable alternative.   So it's up to you the patient to really consider the alternatives.

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 razuzin

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Re: DONOR TIMELINE
« Reply #2 on: January 31, 2017, 06:53:38 PM »
Hello everyone!!
  Eddy from Portland OR, USA.  Im 38 and a sponsored Athlete. I just got told I need to go through the OATS procedure. My doctor is affiliated with ARTHREX.  anyway.. my question is.. i have gone through 2 meniscus repair, PRP and Synvisc injections so this is my next step. For those of you in the USA... how long did it took to find the matching donor? How this works?

Thanks for the info!!!

EddyPDX
I think it depends on a hospital location.
I was scheduled for this surgery which I later decided not to do. During about 4-5 months period a doctor from one NYC hospital called me 3 times informing me that the donor is available, I kept postponing.
I also had an arrangement with another hospital, they haven't called me over the same time frame.

They have some registry where they enter your desired allograft parameters, incl. some physical dimensions. I a match is available, doctor is notified.
On average, I'd say it takes 3 to 6 months.


Offline razuzin

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Re: DONOR TIMELINE
« Reply #3 on: January 31, 2017, 06:58:40 PM »
dal_knee,
I wouldn't agree it's a low success rate for osteochondral allografts.

I'd say it's one of the highest among more traditional, non-biologics treatments, certainly higher than microfracture.
It's about 80% after 10+ years which is obviously based on past experience. I'd assume that with all the technology improvements it's even higher for the next 10 years.

Offline Vickster

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Re: DONOR TIMELINE
« Reply #4 on: January 31, 2017, 07:36:10 PM »
How would you define success in this context? I was told about 7 years ago that OATS (autograft) was a poor option for me, a then 1.5cm2 defect on my weight bearing lateral femoral condyle with some lateral meniscus missing. Partly due to the location on a curved part of the bone. I was referred then for a MACI which that surgeon refused to do due to mild valgus deformity (which is now probably worse thanks to the more widespread damage and arthritis that has occurred). Nothing was done, the traumatic defect filled with fibrocartilage (DIY microfracture lol), this is now breaking down as weould be expected at around 7 years according to the knee doc
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline dal_knee

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Re: DONOR TIMELINE
« Reply #5 on: February 01, 2017, 12:20:26 AM »

Return to sport is rated at an alarming 5% as referenced in article below. Defect sizes  slightly larger than 2 cm squared.  I think eddy the original poster should comment on what is defined as his success threshold. Vickster brings up a good point in that everyone has a different definition of "success".
https://www.ncbi.nlm.nih.gov/m/pubmed/23841992/
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 razuzin

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Re: DONOR TIMELINE
« Reply #6 on: February 01, 2017, 03:38:18 AM »
Quoting from the study:
METHODS: A retrospective review was conducted of 38 consecutive OATS procedures performed at a single military institution by 1 of 4 sports medicine fellowship-trained orthopaedic surgeons.

Small cohort, single surgeon.

Here is a larger study with better outcomes.

http://www.healio.com/orthopedics/sports-medicine/news/print/orthopedics-today/%7B82ecba66-d0aa-471f-86c8-63a845878682%7D/long-term-osteochondral-allograft-findings-reveal-widespread-use-predictors-of-failure


Most importantly, if main failure predictors are eliminated, such is defect size, older age etc., the chances of success increase a lot.

Offline Vickster

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Re: DONOR TIMELINE
« Reply #7 on: February 01, 2017, 08:18:01 AM »
For your second link, failure rate 11 % for OD which to my knowledge affects mostly kids and teens. The failure rate was over 40% in OA. At 38, given the OP is 38, he's more the latter than former, especially if he's had meniscus surgeries, and Synvisc (indicated in OA primarily).

We need to know what sport he does, swimming and cycling are very different to high impact sports, tennis, football, rugby. How the defect came about, how big it is, where it is, what state is the knee in generally etc

The first study was done at a military institution, on serving military personnel, who were presumably younger too
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline razuzin

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Re: DONOR TIMELINE
« Reply #8 on: February 01, 2017, 02:51:38 PM »
For your second link, failure rate 11 % for OD which to my knowledge affects mostly kids and teens. The failure rate was over 40% in OA. At 38, given the OP is 38, he's more the latter than former, especially if he's had meniscus surgeries, and Synvisc (indicated in OA primarily).

We need to know what sport he does, swimming and cycling are very different to high impact sports, tennis, football, rugby. How the defect came about, how big it is, where it is, what state is the knee in generally etc

The first study was done at a military institution, on serving military personnel, who were presumably younger too
I'd agree that OA, plus possible maltracking are risk factors for this type of surgery.

Still, when looking at the statistics based on past one needs to adjust for recent process improvements not reflected in the past experience. For example, in past allografts from a cadaver were treated by radiation to kill possible infection. It was recently found that it's detrimental to chondrocytes, so it's no longer used. Also storage temperatures varied, they were often frozen at very low temperatures, now the optimal temperature of -4C is a standard.

As I'm considering this surgery as a possibility, I'm seeing two doctors who specialize on it. Both swear that they're seeing very good results, people return to sports etc. Of course, this evidence is pure anecdotal.
Still, keeping this option as my plan B should my knee deteriorate further and no breakthrough procedures in biologics be available.

Offline Barmski

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Re: DONOR TIMELINE
« Reply #9 on: February 26, 2017, 11:57:48 PM »
Hmmmm, very interesting info, at the Steadman Clinic under Laprade, they never mentioned allograft not being anything but the best. I have researched as much most of the people on this site, I am educated, I am asking a lot of the right questions. The Steadman Clinic is one of the best in the world- yeah I see your argument about the doctor thinking his method is the best but this is simply not true, Laprade told me he has experience with ACI and did not like it. He has done microfracture as well. Laprade said the allograft was by the best option and he was not wild about autografts robbing peter to pay paul simple because it still takes away at the body. I used my own stem cells and things are good to far, doing 2 hour a day 5 days a week of leg exercises and starting yoga soon as well as swimming. Allograft just makes sense because its structurally strong from the beginning.