Osteochondral Allograft

[A_sure_sky]

I just underwent an Osteochondral Allograft on my left knee.  I saw there haven't been many reports on this type of surgery here lately so I thought I would add my journey. This site has been really helpful in getting to this point so thanks to everyone who has posted here.

First a little background on me. I dislocated my left knee in my early teens and for over six years I dealt with multiple dislocations…it was to the point I didn't trust my knee anymore. Finally I went and had lateral release surgery. That stopped the dislocations so the surgery was a success.  I didn't have any major problems with my knee for a couple decades. A few years ago my knee started to give me problems so I saw an orthopedist who recommended a total knee replacement.  Another year later I sought out another orthopedist who recommended a partial knee replacement. My bone on bone pain had become so frequent that I needed to do something.  After hearing about OATS surgery, and that I was a candidate for it, I decided to go with this route.

Surgery Day: I underwent surgery early in the morning. They put a nerve block on my leg.  The pain was manageable with the medication.  I stayed at the hospital that night and used the CPM machine for many hours to 30 degrees.

Post-op Day 1:  The pain is still bearable thanks to the medication. My nerve block in my leg is over though I didn’t notice a huge increase in the pain.  I still have a little nerve catheter in my thigh just above my knee. I have a hinged brace on my knee and I try to get out of bed to practice using crutches (toe-tap, no weight bearing on my left leg) for the first time after surgery and I pass out for a few seconds (my blood pressure got too low I think).  After resting a few hours I am able to navigate the crutches. Straight leg raises are excruciating but I can get through them. The ROM on my knee brace is set to 60 degrees until my first follow up visit. I spend this night in the hospital as well. I use the CPM machine a lot on this day too.

Post-op Day 2: My vital signs are good and the doctors clear me to go home.  PT clears me to go home after a session with the crutches and practicing going up and down stairs. I decide to go home and my dad takes me on the two-hour drive home. Pain level increases really that evening until I take the pain meds.

Post-op Day 3: I get up several times to use the bathroom.  It is a major pain to use the toilet while on crutches.  Being on crutches and non-weight bearing makes every little journey tiring.  Straight-leg raises are too painful for me to do today. I sound like someone being attacked when I try to do them.  I am very disappointed.  I can do all of the other exercises I am supposed to do. Pain level is bearable with pain meds.

I’ll keep my little recovery journal going for a little while if anyone finds it useful. Let me know if there are questions.

Thanks!

[A_sure_sky]

Day 4: Much better night of sleeping.  Pain level has deceased thankfully. I am able to do all my exercises including the straight-leg raises! Hopefully that was just a temporary set back.  I am able to get my knee to 60 degrees (my limit) without too much discomfort. I am looking forward to being able to get to 90.  I can see when I do my quad sets that my quad isn’t firing like it did yet.  I wonder how long that takes to recover?  I am still feeling my way with the crutches.  Every little journey in my house is tiring. I think I may not be using them as efficiently as I could.

[A_sure_sky]

It has been just over a week now since the surgery.  Pain is really low. I expected much worse, honestly. I can do straight leg extensions with no pain.  I am doubling up my assigned exercises to give my knee and leg more to do.  Stitches should come out next week. My knee still is quite swollen and looks like hell--especially in the back. I can't wait until I can be weight-bearing on my left leg.

[A_sure_sky]

It has been three and a half weeks since the surgery.  I can finally be weight-bearing (locked straight knee brace only) which is a big relief. It is so much is easier to get around now.  I think I will be able to get down to a single crutch very soon.

Pain still is pretty light.  On the down side I still can't get my quad to fire like I want it to do.  I also have a little pain below the knee on the right side when doing quad sets.

I go back to the doctor in just under three weeks to see how the grafts are doing. I worry constantly if they have taken. I don't want to go through this again.

[A_sure_sky]

It has now been six weeks since my surgery. I went back to the doctor this week for a checkup. He said the X-rays show the patella graft looks good for this time period post-surgery. I can get my knee to 105 degrees ROM which apparently is also good at this point. I also can take the brace of my knee at night which is a big relief.

My main tasks over the next six weeks before my next checkup are to rebuild the lost strength in my leg and my hips and to regain my normal walking gait. I am not restricted on limiting my ROM anymore. I have tried walking with the brace unlocked a few times and it feels strange. There is no pain but I don't trust my knee to operate normally. It seems a little unstable but maybe that is because of the lack of strength in my quads? Anyway, I hoped I would regain my normal walking gait pretty quickly but I see now that is something which will be more difficult than I expected.

[Celina1989]

Hi Sky,

Thank you for posting. Although I am not getting an allograft I think recovery for my cartilage (and bone) lesion will be like this (although it is my femur). So I am reading all your posts. I have some experience with my unfortunatly failed microfracture before. Seems that you are doing well. Hopefully continues like this. Wishing you strenght in your recovery! 

[jomann75]

Hi - appreciate your posts as I had the OATS procedure on 5th December so it's good to have sight of other people's experiences. This is my second knee operation in 12 months - I firstly had the microfracture done on my right knee (small osteochondral defect on the medial femoral condyle). This didn't work and in actual fact my knee got progressively worse afterwards. So I got a second opinion and the second surgeon suggested OATS.

The op went well, although much more invasive than a standard arthroscopy - I now have a nice 4 inch scar on my knee! That said, I had much more swelling with the microfracture so I'm pleased with progress so far, albeit 3 weeks in.

Getting used to the different aches/pains is part and parcel of any knee recovery I think - each day is different and as long as you do regular rehab you give yourself every chance of a decent recovery. I am partial weight bearing right now until mid January - can't wait to ditch the crutches.

Good luck with your recovery!

[A_sure_sky]

It's nice to see comments from others. I hope my experiences might help others. Good luck with your surgery/recovery Jomann and Ceiina!

I am now eight weeks out from my surgery. My knee is getting better slowly.  I can now pretty much ditch the crutch and walk without limping if I am wearing the knee brace (fully unlocked) or with a compression wrap around my knee for shorter distances.  Without anything around my knee it feels too weak and I limp and feel unstable. Still, I have progressed a lot from a couple weeks ago when I first could unlock the brace and put weight on my leg/knee. Walking with 10% ROM with crutches felt highly unstable for a while.

I am doing PT a couple times a week.  I have started doing quad sets with a blood restriction cuff on my leg which is supposed to work the quad without weight training (I am not allowed to do that for a while). I have started walking on a Zero-G treadmill for 10-15 minutes at 60 percent of my weight. Those sessions went well so today I used the regular treadmill at my work gym and walked slowly for 10 minutes. That went fine too.

I was kind of concerned for a several days because after doing a set of unweighted leg lifts while locking my bad leg and then doing the lifts with my uninjured leg, I could not get a full bend in my bad knee without pushing it up from below. If I didn't use my hand to help bend my knee  I would feel an unnatural resistance and then get a large popping noise (it didn't hurt, it had almost the sensation of like cracking your knuckles). Anyway, I haven't had that for a few days now so I hope I am past that.

I still don't have full range of motion in the knee yet but it continues to get better. There is still swelling in the knee. I think I may be even starting to build a little muscle back in my quad thanks to the PT. My leg doesn't seem to be quite as feeble looking now (or maybe I have grown more used to it)!

[jomann75]

Hi A_sure_sky,

Seems you are going well, and I fully empathise with the cracking knuckle sounds! When I do certain stretches my operated knee makes all sorts of those sounds at the moment - I expect it’s a mix of scar tissue and the knee getting more movement as the swelling goes down. At times I actually need to stretch to relieve the pressure but it doesn’t feel painful.

I am six weeks lost op and am now on the stationery bike at the gym whilst doing most walking without crutches. I’m just not doing anything silly and resting when the knee swells, which is still most days.

Good luck with continued recovery

[A_sure_sky]

It's been a little over ten weeks now since my surgery.  I haven't used the crutches in several weeks and I only put on the hinged knee brace a couple times (for safety) last weekend when I had to walk a little bit in snow/slush.

On the positive side, I am able to walk longer on a treadmill for up to 20 minutes with a good portion of that time on an incline and at a faster pace than I could a few weeks ago. I think my everyday walking stride is improving too. I don't think I limp much (except the first step) on shorter trips. Longer journeys may have a little degradation in my stride. I always use a wrap or compression sleeve on my knee.

On the negative side, there is some swelling in my foot and calf in addition to my knee.  I wasn't doing a whole lot of icing and elevating my knee for the past few weeks but I have resumed that. I am not sure if the more extended walking has brought that on or not.

I had one twinge of pain from my knee a little over a week ago (the first time really since the surgery) which freaked me out a little but have had nothing like it since then. Hopefully it was only a one-time thing.

Jomann, it is interesting to hear you are on the stationary bike now. I think I am like four weeks ahead of you in the recovery process and I don't think I am allowed to get on the bike until four months after the surgery. I guess different doctors may have different recovery plans...or perhaps the differences could be explained by the size and placement of the transplants? Thanks for the well wishes and continued success in your recovery.

[jomann75]

A_sure_sky,

I would expect the swelling you are experiencing is down to that greater frequency of walking. I definitely found the same when I had my first knee op 12mths ago - as soon as you try to walk normally the joints in that area tend to swell. Like you are doing, elevation and ice is the key.

Does sound like the size of our lesions differ, and probably the location too. For mine, a stationary bike is normal after 6 weeks based on research. Yours is around the patella right? Either way, I think aches and pains are very common as you progress to greater exercise levels. For me, I’m waiting for a few months before deciding if the surgery was successful. So far so good though.

Stay in touch

[A_sure_sky]

Jomann, I think you are right about about the additional walking being the cause of my swelling.  I iced and elevated a lot this weekend and that has helped with the swelling. I'm still trying to find the proper balance of walking enough without overdoing it.

Yes, my transplants are on the back of the patella and the trochlear groove. At least one of the cartilage holes was pretty large. It is great that your recovery allows you to start on the stationary bike now.

I know what you mean about waiting to determine if your surgery was a success. The allograft seems to have cured the bone-on-bone pain I was having so from that standpoint the surgery was successful. There is still such a long way to go in my recovery that it is way to early to say with any certainty what the final result will be (and how long that may last).  Still, I know my knee is getting slowly better and I am meeting post-op milestones so it is seems like it was a good choice.

[A_sure_sky]

I am three plus months out from surgery. Overall, things seem to be mostly OK. My updated X-rays are showing good healing. My doctor seems pleased which makes me pleased. My range of motion is 135 degrees. The medical staff reiterated the need to take things slow as the grafts will be still healing for many more months.  I will able to start on a stationary bike once I reach four months post-op.

The issues I have seem to occur if I do too much walking. I can get sensations of what feels like needles pricking me from under my kneecap. It is kind of painful but it is not constant and goes away after a few hours.  I have tried to be more careful and it seems to be mostly working.

[A_sure_sky]

It has been about five months since my OATS surgery. At this time in in my rehab I should be doing more intensive stationary bike riding.  Unfortunately I do not have a bike at home and because of COVID-19 the gyms at work and near where I live are closed so I am afraid I am falling behind strengthening my leg from this exercise.  I was ramping up on the stationary bike riding for 10 minutes at about 60 rpm (no resistance) before the shutdown without any issues.

Most of the time I don't have much pain in my knee. Sometimes it feels like needles within my knee but that is rarer now.  I am limited in my walking so I try not go over 3000 steps a day.  I overdid it yesterday and I am still feeling the after effects of that a little bit today.

i am continuing seeing a PT twice a week (they are still open thankfully) where they manually work on the loosening up my quad muscles, I do blood restriction therapy while doing exercises, and they give me some additional exercises to finish up with.  These sessions are going OK with no issues.

My surgeon explained to me that what I will need most in this recovery in patience and that certainly is true.  My quad still has a long way to go in terms of building up strength.  I guess that really isn't going to happen until I get the all clear to start doing weight resistance exercises.  Maybe I will the get all the clear when I go back for the follow six month appointment in May.  Hopefully the lockdowns will be over by then.

I wear a sleeve over my knee for all of my waking hours.  I can walk without it but it feels much better to have it on. Progress is slower than I would like but I feel I am progressing so I can't complain...especially with everything else that is going on in the world these days.  Stay safe everyone.

[A_sure_sky]

It has now been seven months since my surgery.  Progress has been slow but steady.  I had my mid-year check up a couple weeks ago and the X-rays are looking good. I am cleared for more walking and to finally lift weights.  Due to the virus I am will be sticking to leg lefts with ankle weights for a little while longer until I build up more strength.

My knee still doesn't feel quite right without a sleeve or a wrap but with it my knee feels just about normal. The doctor told me to spend the next several months building up quad strength (going for repetitions over weight).  I resumed doing some stationary bike work as well.

For anyone thinking about this type of surgery I would say you definitely need a whole lot of patience.  It can be incredibly frustrating at times.  Right now I am feeling cautiously optimistic about it all.  The bone-on-bone pain is gone.  Weird sensations from the knee have lessened as well.  If  I can really build up the quad strength without doing anything stupid I am hopeful that all this will have been worth it.