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Author Topic: Osteochondral Defect  (Read 1580 times)

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Offline mehghand

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Osteochondral Defect
« on: July 08, 2004, 01:31:34 PM »
Hi, I am 23 and recently had arthroscopic surgery to find out that I have a rather large (2.5x1.5 cm by 1 cm deep) osteochondral defect on the outside and towards the back of my right knee. It's allegedly the largest my orthopedic surgeon has ever seen. His only option offered for me was a cadaver graft. I got a second opinion, who said that I should just leave it and see what happens, as the cadaver graft may not work, leaving me with an even bigger hole and worse off. I'm not old enough to have a total knee replacement.

Just curious to see if anyone has had a similar experience or any of the surgeries to fix such a problem. (although I think my defect is too big for mosaicplasty and/or autograft transfer) and find out what their experiences have been (especially with the cadaver graft). I think the lesion is too large to take a piece of my own bone....

Also - if anyone's dealt with insurance - if I don't do anything, and end up at another job 5 years down the road with new insurance and my knee starts giving me problems again is that considered a pre-existing condition which I'll be stuck paying for?

Any insights, personal stories, or help at all would be greatly appreciated, as I seem to have one doctor set on a course to cut me open and the other too frazzled to know what to make of the situation.

THANK YOU!!!

Offline dm

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Re: Osteochondral Defect
« Reply #1 on: July 09, 2004, 04:19:04 AM »
I am presuming you are in the US. I am dealing with the insurance changeover/preexisting conditions thingy.

I'm on COBRA insurance while I await eligibility for my new employers insurance. I have found from visiting several COBRA related sites,  that if you allow medical coverage to lapse for more than 63 days, the new insurance carrier can deny treatment for preexisting conditions. If you have maintainted medical coverage, and are just changing plans/employers, they cannot exclude the conditions that have been being treated, so far as I've been able to tell. One of my drs warned me of the same thing, when I was discussing my situation with them. Read the definition of a preexistsing condition carefully, it is important. Also note that insurers vary the exclusion period for anywhere from 6-18 months.

I would imagine that if you make sure you have medical coverage over the years, it would not fall into the preexisting conditions clause, providing you follow up with xrays and such as recommended. I would think that if you do nothing and wait and see, your doc would recommend annual MRI or xrays to monitor the conditions.

Have you looked into yet another opinion? couldn't they do a graft from your hip if they had to? 2.54cm = 1 inch, so it's not really too huge, when put into more familiar dimensions -> approx 1inx5/8inx3/8in.

Hope this helps a little.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline JG

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Re: Osteochondral Defect
« Reply #2 on: July 09, 2004, 08:33:06 AM »
I was diagnosed with three very large defects about 2 years ago.  I had two of them fixed using osteochondral allograft plugs (mosaicplasty) last April.  My large defect (trochlea) was very big, it took 13 grafts that were 10-15 mm each.  The smaller defect (medial femoral chondyle (MFC)) took 5 12-16 mm grafts.  The third is on my lateral tibial plateau and cannot be fixed using an grafting type procedures.   I was diagnosed after a simple scope for a lateral release and to investigate a probable defect and small fracture of the MFC.  When I went for my 1 week check up, the PA basically said I need a TKR.  

When I talked to my OS, he said I wasn't really a candidate for any of the cartilage restoring procedures available.  However, he said he would be willing to try a mega-mosaicplasty, but I would have to get  a few "second" opinions first.   He arranged for me to either see in person or talk to 4 of the top cartilage surgeons.  So I did, two said, they might try it, but chances of a decent recovery were 50/50 and two said,  no way, the damage was greater than most TKR candidates.  All said it would be the largest procedure they've every seen.  The one problem I don't have is joint space narrowing nor kissing lesions.  Additionally, I was always very functional.

I just had my one year post-op scope.  He found lots of scar tissue, but the grafts looked really good.  I was a fanatic about following the rehab protocol.  I stayed on crutches for 8 weeks NWB and 4 weeks PWB.  My PT has written most of the the protocols for the cartilage restoration procedures (such as mosaicplasty, OATS, and ACI).  I stuck to the program and have done really well.  I have problems, but I am in better situation than I was 1 or 2 years ago.  My grafts are still not totally healed, that will take another year of so.  But it did buy me time, which is what I hoped for.   Today, I am really active, doing pretty much everything but running, jumping and squatting type activities.  

If you have any questions, let me know.

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 killjoy

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Re: Osteochondral Defect
« Reply #3 on: July 28, 2004, 07:44:14 PM »
I'm currently in much the same position as mehghand - doctor (listed as a guru on this site) has recommended an allograft for a 2.2cm full-thickness chondral defect.

Obviously lots of questions, fears, including how long I may be non-weight bearing afterwards, fear of infection from the allograft, etc.

Thought I'd bump this thread up to see if anyone else has had any of these procedures - OATS, mosaiplasty, etc.  Thanks!!

Also, mehghand, I'd agree with dm on insurance.  There's a relatively new law in the US called HIPPA - the Healthcare Insurance Portability and Accountability Act.  In most cases, when you change from one insurance company to another without a gap of 63 days or more, the new company can't refuse claims on the basis of a pre-existing condition.

Offline killjoy

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Re: Osteochondral Defect
« Reply #4 on: March 13, 2006, 07:36:02 PM »
Thought I would bump this to the top, as I'm still wondering what to do.  If any one has any recommendations for a surgeon in NYC or NJ that specializes in osteochondral defects / grafts, it would be appreciated.  I've visited on doc listed as a knee guru on this site and liked him, but am eager for any additional personal recommendations.  Thanks a lot.