Saw my doc yesterday... good and bad results
The results of the Brostrum x3 and tendon repair x2 are really good, the Os Trigonum excision caused a lot of scar tissue in rearfoot and I formed a moderately large calcification in almost the same spot (rear of talus). Most of the osteochondral defects (microfracture/picking, drilling, etc) seemed to work fairly well and show improvemnt. Tibial defect is also doing ok.

The bad part is two of the largest defects on talus are not healing as they should so they need to be worked on again. The bone had been showing signs of further softening/AVN but it has stopped getting worse (but not gotten better). There is a lot of scar tissue in the joint itself. I also have impingment in rearfoot from that chunk of scar tissue wrapping around achilles and other tendons. He will cut away as much as possible and excise calcification. This should help me get some dorsiflexion. He will remove scar tissue and clean up the cartilage in joint, re-pick and re-drill the defects that aren't healing. If he thinks that wont work then he will go ahead and do OATS with donor/cadaver grafts. This means I also get a tibial osteotomy - ouch. He will fill the joint with steroids and lubricating fluid (like Synvisc) just before closure.

If all he has to do do is the scar tissue and re-drilling, etc it will be via a scope procedure with maybe an additional incision. That means outpatient and PWB right away. If he ends up doing the transplant I will have open procedure, stay in hospital and be NWB for 6 wks, etc

Surgery is scheduled for 2/19/07. I find out which procedure he did once I awaken from surgery. You can bet those sheets in recovery will be ripped off as soon as I wake up :p He will give me more steroid injections on 1/22 so my trip to Forida (1/23- 1/30) will be less painful {what a thoughtful guy}

Now I am torn between excited to get it over with and half scared out of my mind that this won't work. A part of me hopes he ends up doing the transplant so I won't have to worry about the re-do work failing a second time, thus meaning a trip #3 for the OATS. Does that sound weird? The thought of starting over, recovery wise is frustrating but I'll get through it - it isn't like I don't know what I'll be doing in rehab - ha ha

jane

Hey Jane,

I'm sorry to hear the bad news of your large defects not healing. You know, I have had no surgery as yet for my OCD, but the doctors I have spoken to say they just won't go the route of drilling/microfracture on large lesions because they don't have much success and end up doing a second surgery. So for me, they have recommended skipping the drilling and just going straight to the OATS procedure. So I understand why you hope that the transfer is done, because surgery #3 would be unthinkable! Ahhhhh!

The osteotomy sounds so painful from the others on this board who've had it done, it is scary for sure!! But my Dr. says, It's just bone ... it will heal fine. It's a lot better than what we've done to our cartilage. Still, that's your leg bone and the thought of it is rather barbaric! Easy for them to say!

Are your large lesions on the lateral or medial side? I've read that medial lesions almost always have to have an osteotomy, but lateral only 50% or less of the time.

Good luck and hang in there!!

Abby :)

HI Abby-
I had lesions on both sides but the ones that are giving me fits now are on the medial (1 anterior and 1 posterior) side. The lateral defects are healing as they should. I see my OS on 2/2 for my pre-op physical, etc. I am not sure how to bring this subject up without sounding like a hypochondriac nutjob who is a surgery freak. I am conflicted because when he said I needed surgery #1 and then #2 he described the medial defects as "huge craters" - now he said they are only moderate. 7 weeks ago (when he said I need 2nd operation) he said my only option was to do a transplant/graft (allograft- OATS plug with donor bone). {I had already let him know fusion was out of the picture for the forseeable future and he is ok with that}This last visit he talked about redoing the the scope/drilling, but maybe having to convert to the transplant via OATS with donor bone. I am confused and just wanting this thing done and settled.

I can't get over this feeling of wanting the "bigger" operation just so I can get on with my life. My husband thinks I am slightly nutty "You can always get the transplant later if this procedure fails again" Yeah right, he isn't the one who is spending all his time with braces, crutches and pain for the last year... It doesn't help that I can't find any info on redoing microfracture & drilling vs. grafts.

Ah, life... I guess all will work out in the long run and I am just borrowing trouble.:rolleyes:
jane

Jane,

Yikes! You know why you can't find any info on redoing micro-fracture and re-drilling, because most doctors don't do that. When I had my surgery, Plan A was the drilling routine, Plan B was cartilage transplant, Plan C fusion (OMG Not!). There was no mention of a "re-do". Bless your doctor for wanting to go the conservative route, but ask him what he really thinks the success rate is and go one step further, if this was his wife, sister, whatever, what would he really do.

Wishing you the best. ~Ellen

Jane
I hear you about wanting the bigger surgery, sometimes we just want it once and done and that is where I was at. I was offered three choices, Distraction, Mosaicplasty or Fusion. My Doc wouldn't tell me which one was the best for me, instead he spent an hour and half with my husband and me discussing what each surgery would hope to achieve for me along with their success, failure rate, pro's, con's etc., When I asked him what would he do if this was his ankle? He replied that he had good ankles and he didn't have to make this decision and that kinda frustrated me, I was looking to him for advice and he said he wouldn't offer advice only education and that some patients only get one choice and there is no decision to be made but since he was offering me three choices, I had to make the decision.
I choose mosaicplasty and we talked 7 days after surgery and he was explaining to me the pictures they took of my ankle in surgery and he looked at me and said before you ask... you made the right decision, more than you could imagine. So I have a much better respect for him and I now appreciate that he was allowing me to make the decision and I even went against what my hubby wanted, he wanted me to have distraction cause I would recover faster. but I was thinking get it done and over with... Just fix it... get rid of that pain and I can tell you now that I am 3 1/2 months post op that my ankle even though its very sore, it makes me smile as it moves with a smoothness I can't ever recall, I can walk and it feels bette than it did before, no more grinding! This was an amazing surgery for me, would I do it again? ... NO... not a chance, I am hoping this is it... I admire those of you who have done numerous surgeries to come to this one now.... I don't know how you do it cause I know I don't have the courage, the finaces or the will to do this ever again.
Wishing you all the best.
Carol

Jane,

I kind of know what you are going through, I think. My OS told me at initial appointment last April that my choices were clean/drill or grafting. She said success rate was close to same (she indicated 50% get good to great results, 25% get some improvement, and 25% little/no improvement) for each, and although I made decision, she thought drilling was best way to go ("can always try grafting later").

I put off having surgery until October for sheduling reasons. Then in recovery, OS tells me/wife that damage was quite extensive (removed fragment, spurs and treated lesion) and that her hope was I'd get 50% in pain reduction. That's a different assessment than 75% chance of improvement! I sucked it up and religiously followed NWB/motion exercises for the 8 months on crutches.

Eight weeks post-op appointment, OS said she would not recommend grafting at my age (my foot hurt like hell the first time I walked on it in her office)...now I was only six months older than my initial appointment so "change in treatment options", I'm thinking, must have something to do with severity of damage. Still was hoping that would be moot point and that benefit would be good.

Now 6 weeks post op and ankle is better than first 4 weeks, but still not at all where I need to get active on it and still more painful from daily exertion as it was in entire period from April to surgery. So naturally I am thinking drilling may not have helped and now looking ahead to other options.

I have an appt with OS in two weeks (will be 8 weeks post-op) to hopefully get complete recap on what she found during surgery, where should I be on pain/use (too soon to judge??), how long to wait before final assessment, what my options are with her services, and if other experienced docs may have a different opinion.

So I know in just 14 weeks the roller coaster feeling it sounds like you have been on for quite a while longer. Just want to get the thing as good as it can be (with some confidence) and then leave the surgery/recovery behind and get on with our lives. Hard for others (spouses included) to understand this myriad of thoughts and feelings!!

Hang in there!!

Steve

Jane,
I'm sorry you have to go thru this again. I know what you mean about doing the major and only having one surgery. as you know, with the last surgery I had (the one that landed me in hospital for 11 days) it was just take out all the flesh on the top and bottom of the foot, leave it open and put a vacpac on it. We had looked at other options, such as the hypobaric chamber and some lesser surgeries. we decided to do it big and do it right. well, it was super painful and a long recovery, but I know it was the right way to go. Yes, a lesser surgery may work, but may is thekey word. I know I would go for the one that will work, not the ones that may. no you are not a surgery addict. Sometimes it seems that once they start surgery on the feet we end up having more that planned. but you know,, surgery never has a guarantee. each one of us heal and repair at our own speed. sometimes it works and sometimes it doesn't. when it doesn't, I think to go with the big guns and not have to keep having more and more. You notice I say that after have about 7 surgeries lol..i guess I don't always take my own advice.
good luck and keep us posted.
mary
:angel:

Hey Carol,

You sound so positive in your last message! I'm so glad that your foot is doing much better and you feel a big improvement. I can't wait until you start telling us about your recent hiking and biking adventures!

You know, the interesting thing about my doctor is that he has a small talar lesion himself. He has chosen to do nothing because it bothers him only after playing a rough game of basketball or running on concrete. But he's an ankle specialist and it made me think, "Whoa, if my own doctor is being conservative, maybe I shouldn't do anything!" However, I think the people on this board all suffer much more pain than he does. He said the fact I drove 7 hours to see him communicates that the injury probably bothers me too much to live with it. So in a way, he gave me advise to go ahead. It was fun to question him: I would say, "Can you do a jumping jack"?, "Can you run?" and he answered yes to most the things I can't do anymore. So that was a good comparison and honest conversation.

Jane, I think you're wise for wanting to have the big surgery and get it over with. Every surgery has risks, so why have 2 surgeries when you can go through just one. I'm not married, but if I so, I'd have my husband peeling grapes into my mouth and giving me daily shiatzu massages for all you guys have gone through!

So I was going to go ahead with OATs next month but I've been hit with a wave of weddings and new babies and reunions in my family so I will postpone until the fall when I don't need to travel so much ......

Good luck to you all!!

Abby :)

to everyone-

You have no idea how much calmer and better I feel after reading all of your replies! :angel: I was beginning to think I was an obsessive wimp for wanting the "big guns" - now I know I am semi-normal (ahem, at least in ankle terms...)

On 3/2 I see him one last time for the pre surgery visit. I am going to plead my case and let him know I am expecting a heck of a good reason to do anything other than the grafts. I am telling him I am tired of this, I know there are no guarantees, but I want to "go for it" and just get the graft/transplant done instead of trying the drilling again. Time to get back to my life! After all, doctor's aren't the ones who have to gimp about all the time, thinking how they will get daily things done.

Thank you a million times over for letting me know I am not crazy or alone~
jane;)

Hi Everyone,

I was on the old site and it looks like a lot of you moved over to this site. Anyway, my quick story is I am 28, athletic and had ankle surgery. It was only very minor pain and after drilling it is a 100 times worse now. A year later I still can't wear regular shoes and walking is still painful.

I have seen a million drs like the rest of you and Dr. Myerson in Balt. wants me to do either drilling again or OBI plug. The drs in NY say, OATS procedure with my knee. I am scared to do the OATS/OBI since once you do that drilling is not an option.

Has anyone actually done a second dilling where they have gotten better afterwards? Has anyone done drilling and gotten worse like myself? Some days I think to do nothing because I am scared of being worse than I am even now.

Has anyone gone to Hospital for Special Surgery and liked their dr there?

I would appreciate any advise as the pain is there every waking moment!

David

Hi David,

I am 26, I had a cartilage replacement called a MACI, from what I can gather it is similar to oats. They removed cartilage, grew it in a lab then replaced my old damaged cartilage. I was advanced arthritis and it failed. My advice is get the cartilage done sooner rather than later as it will increase the chances of success. If a superdoc like mayerson is suggesting it, then go for it as the window of opportunity may be smaller than you think (I deteriorated rapidly over 6 months).

Also not to scare you, but if it fails and there is still substantial pain you will probably be told to get a fusion due to your age and being in the US. I was shocked to find that this was the next step, it is a whole new ballgame, alleograph, fusion or replacement. This is not a fun conversation. I ended up going to europe and getting an ankle replacement by a superdoc, and it is fantastic, I have my life back, can't run but do most other things, but no pain, no meds etc, so don't get to daunted, but don't hold off too long.

kira

Hi Kira,

Thanks for the advise. I can not believe they did ankle replacement on a 25 year old. I was told they do not do that until 40.

It is not really my cartilage so much as it is my talus bone with holes on it.

Just trying to keep my head up right now.

Thanks for writing me.

David

Hi David, I am new to this website and am not the most internet literate. However I want to tell you and eveyone that it has been a god send to both my daughter and myself, to know that we are not alone in this maze of OCD. My daughter who is 41 years of age had a microfracture, drilling and removal of a loose fragment at HSS by Dr. Kennedy in january 2007. Unfortunately the defect did not fill in with fibrocartilage, and she is now scheduled for an OAT's procedure by Dr. Kennedy on September 23, 2007. I thought from one of your replys to someone that you had surgery at HSS. Is that so, or did your surgery take place somewhere else. We would be most gratefull to hear from you or anyone else who has been to HSS and any comments on the surgeons. Have also had a second opinion from Dr. Raiken in Philadelphia but did not get too much out of it. I know zippo about all of this, and I do want to thank everone who has contributed to this website for helping me to gain more knowledge and insite into what is truly an unusual circumstance, and one that I know all of you would rather not have. Again, many thanks, and I hope everyone gets better quickly and has a good result. Hoping to hear from you. Thanks, Pat:confused:

Hi Pat,

I had my surgery at HSS awith Dr. Kennedy. I am looking to have the OATS done there in Dec this year, but with a different dr. Please let me know how the surgery went and I am very curious and scared myself as I hate living with pain every morning.

David

Hi, this is Carla, "aircolbert"'s daughter. btw, i'm 45 not 41!
I am 5 days post-op with the OATS procedure, done by Dr K at HSS. He said the surgery went well (though he also said that about the debridement!). First, before I go into what I've experienced thus far, I was wondering why you are going with a different doctor for the OATs?
So, here's what I can tell you about the OATS versus the debridement /microdrilling....it hurts alot more. You have alot less mobility. Now, I am somewhat of a wimp when it comes to upper arm strength, but I don't see how anyone can use crutches after this surgery. First, my knee won't bend, due to pain and due to all the dressings, so how can I raise it up enought to use crutches? Second, my mind is so fuzzy with pain killers that I don't think I'd trust myself. However, I am overweight, and as I said, not very strong or athletic. My mom, who is a former nurse, had the doctors write prescriptions for a few things that, at the time, seemed unnecessary, and now seem like a godsend. 1. a transport chair--like a wheelchair, but narrower so it goes through doorways easier. a wheelchair would be better, but wouldn't fit in the house, (to get around, my husband holds my leg while my mom pushes it--now we have ordered a leg holder thingee and I can't wait for it to come in )2) a commode--again, the bathrooms are small and hard to maneuver in, especially with an outstretched leg, plus girls are different, 3)a bath chair, actually I had that for the last surgery, and 4) pain meds and an anti-anxiety med for the night before. As I mentioned elsewhere, get your pain meds before the surgery so that the day of you aren't scrambling. The amount of pain between the first surgery and the second is considerable, but not horrendous. The knee hurts more than i thought it would. I'm icing that whenever I do the game ready ice machine for my ankle. The first 4 days I took percocet every 4 hours and was glad to do so. I slept most of the first day, which was a blessing. once the popliteal block wears off, you really know it. I had quite a few spasms the first few nights, but they have calmed down. Now I'm on vicodin, and still taking it regularly. As a comparison, I think I took a total of 4 percocet and 4 vicodin the entire recovery of the first surgery.
Dr K assures me that the recovery once I'm in PT is going to go faster than the first time, because this time we don't need to be so careful of protecting the cartilage. I'll keep you posted on that one!
I'm going to sign off now, as I'm getting abit tired, but will answer any questions of course, and will post more as I think of it. Thanks to everyone on the Boards who shared their experiences and made me realize I wasn't alone with this weird condition.
Carla

Hi David,
Sorry I didn't reply before I went to Laos and Vietnam on holiday (hehe usually wouldn't post that but am I so happy I can actually do cool stuff again!)

Yeah I had a bunch of surgeons etc tell me I was too young for an ankle replacement, but I am stubborn and after doing research totally disagreed with them...I got my OS to agree to refer me to two superdocs (created the STAR and HINTEGRA implants) both said yes I was a candidate...and I don't care if it only lasts a year it is just awesome.

Do you have subchondral cysts? because I did and that was one of the reasons both superdocs said more conservative methods of treatement were now out of the picture... just curious...

anyway all the best
Kira =)

I had the OATS surgery on my left talus in November 05, to replace damaged cartlidge, dead bone and damaged done by another hospital through the drilling or the bone (sorry I only know the word for it in German!!) which resulted in a cyst. Sure the first few day were a little painful, I wasn't allowed to bear weight for the first 6 weeks, and then only gradually for the next 6 weeks, the crutch thing gets easier as the weeks pass, before you can bend your knee, try flexing your hip so you leg is forward, a little awkward but less chance of bumping your foot on the ground. I was also overweight due a 12-18 month period of inactivity due to the damage in my ankle. I used little or no pain meds the whole time, only physio. I was out and about rock climbing (with Dr's permission) by summer 06. I have occasional stiffness and pain, but not enough to affect anything I need to do. The screws were removed from my tibia in November last year, and I was up and about as normal within a couple of days. I would recomend this surgery, it's made my life a whole heap easier.

Carla,

I am glad to hear your surgery went well. I just found your mom's email and your detailed email of your surgery and it looks like I am about 9 months or so behind you.

I just had my curretage and drilling on 10/3 for my OCD of the talus and just got my bandages/stitches/splint removed today. I can start PT but just up and down and am NWB for another 5 weeks.

Honestly, my fear is needing what you just had. My doctor has given me a 75 percent chance of the drilling working but honestly after reading this board I have found very few success stories on the drilling as many have needed the OATS procedure after all. I am keeping my fingers crossed and hope to be in the minority!

How is your recovery going? Dr K I've heard is a great OS .. my brother had surgery with Dr. Levine a few years ago and he was the first person I went to, but he no longer takes insurance, so I had my procedure with a great OS at Glen Cove Hospital on LI.

Can I ask how they knew that you needed the second procedure? Was it based on how much pain you were still in after the drilling? I asked my OS today how we know if this procedure was successful and he said that it will take at least 6-8 months before we would know and it would be based on how I feel and then I assume confirmed with a CT or MRI to see if it filled in. I guess at that point its just deciding if I can live with the pain?

Any insight you can provide would be great as we sound like we are in a pretty similar situation .. I too am entering my 40s (40 next month) and have also gained 40 lbs during the last 9 months of inactivity with this issues, so can sympathize with many of your comments above.

Thanks and I hope you are doing better in your recovery!
Kim

Wow, 40 must be the magic number for OCDs. I hit 40 about a week after my surgery.

Can I ask how big your OCD was? Just curious. Mine was 6mm x 4mm, and my dr. gave me an 85% chance of success. I'm now 4.5 months post op, and still working on getting comfortable with high impact activities. Hopefully within another couple of months....

Kim,
To answer your question about how i knew the drilling/microfracture didn't work--after 6 months I still had pain and swelling. I had good days and bad, but basically could not walk more than one mile without pain. And sometimes it was no more than 1/4 mile.Sometimes it was just an aching pain/discomfort, and other times there was a stabbing pain. I felt that I couldn't plan my life, because I never knew if I was going to be able to handle activity--like shopping, or traveling. I couldn't imagine standing in line at an airport, or walking over cobblestones in Europe. So, although my OS discharged me after 5 months, I called him again and explained about my pain. He finally ordered an MRI and said that it looked like not enough cartilage filled in.
Now, my defect was about 8mmx10mm. When he went in to open my up for the OATs, he said that some cartilage did regrow, but not enough.

I'm doing better now--not on any pain meds anymore, 18 days after surgery. The cast and stitches were removed on monday, and a new fiberglass cast (purple!) was put on instead. It's alot lighter, so I could finally use the crutches, but not the roll-about yet, as my knee isn't bending enough.
Interestingly, when I had the first surgery, I didn't get PT until about 8 weeks after! After 4 weeks nwb (no cast though), he gave me an injection a week into my ankle to help the synovial fluid (I know you have needles, but it wasn't bad). I did pwb slowly and did up and down flexes of my foot at home. When the doc saw me limping, he finally said, oh I guess you need PT!! I think he didn't want the PT to be too aggressive. I think I should have had PT earlier because my dorsiflexion never seemed to get back to normal. But the strength and ROM except for the dorsiflecxion was good.
I'd love to post a photo of the ankle stitches for people's info--but don't see anything that says "manage attachments" on this page.
I'll keep you and everyone up to date. Thanks! Carla

Great, another reason to love turning 40! ;)

My OCD is 7mm x 5mm so slightly bigger than yours, so I am guessing the slight decrease in the percentage level of success.

How long did it take before you were walking again normally without pain? My fear is that I've been walking like "Quasi Moto" for so long now that I will never walk normally.

Right now, 11 days post op I can wiggle my toes a little bit. My OS told me to start PT next week and to start moving my foot up and down only and I try, but it is just not moving yet, although when the OS was moving it yesterday the first few moments were stiff but then didn't hurt much.

Can you give me some insight as to your post-op movements experience?

I was NWB on crutches for 3-4 weeks after surgery, but was advised by my OS to do some light point & flex of my foot several times a day. After the 4 weeks was up, I went to about 50% weight bearing for another 3 weeks. At 6-7 weeks, I weaned off the crutches and started PT. It took me about 1-2 weeks to feel like I was walking "normally" -- my PT was awesome, and it helped SOOO much! Still, if I overdid it, I would revert to a limping walk. On occassion, I still limp, but not as bad as I used to.

My OS says it takes 6-8 months for the fibrocartilage to grow to reach the maximum benefit. Right now, the jury's still out as to whether or not it worked. For day-to-day living, it's tolerable, (as long as I wear grandma shoes and limit time on my feet) but for my active lifestyle, I'm just not sure.

Good luck to you! Keep us posted on your progress.

Hello Everyone Again,

I am constantly on again and off again this site. I still read up on how everyone is doing and always brings me some encouragement.

I plan to go for my OATS procedure/redrilling if they can come Dec. I have been waiting for my job to slow down and give me the chance I need to really get this done right. I have not worn regular shoes or exercised in 12 months. Walking is painful and for a super ex-active person like myself, this is a nightmare.

Dr. K totally messed up my ankle and it is 20 times worse now. I have no idea who i want to do the oats procedure. I went to see Dr. Myerson in Baltimore a few times, but it scares me that he uses an OBI plug rather than your knee. Although, from the sound of things, knees are not any better.

What were people's symptoms like before Oats? Could anyone not walk well and can now run? I hope to one day be able to run again or play sports.

I am leaning toward this Dr. Sheskier who is the NY Rangers ankle specialist. Has anyone had any experience with him?

The more info the more grateful I would be to anyone. Always looking for suggestions.

My last question, is did anyone redrill and work better the second time. Has anyone been drilled and it got worse. I am only 28 and it kills me not to play sports as it is my life!

Hope everyone a quick and speedy recovery.

Thanks,
David