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Old 02-12-2007, 12:52 PM   #1
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sevesteve HB User
Osteochondral Lesion Transplant after "Failed" drilling

I have "talked" to several of you on this site re our shared osteochondral defect/lesion issues. I find that very helpful and the information I receive useful. Here's my question:

Already am quite certain that debridement/drilling done in early October has had little/no effect on the pain I experience when performing any type of medium to high impact activity (low impact is "ok", but never pain "free"). After the go ahead from my OS to test it by playing some basketball and doing some light running (15 minutes of jogging on treadmill one day, followed by 20 minutes of full court basketball a few days later) it's NO better than it was previously...in fact it's as sore (b-ball was four days ago...hurts more today than any of the previous three days...you all know how that is!) as it's ever been and I definitely won't be doing any more running/basketball, which is really a bummer for me.

I am seriously considering the OATS or some other transplant procedure and have researched to the extent information is available. I'll likely have a more experienced OS do the next surgery (Cleveland or Baltimore...I live in Michigan) and both have told me chance of improvement with the next surgery is quite high (75 to 85%) . Sounds pretty good and encouraging to me but my odds of improvment from the debridement/drilling were supposedly 50 to 75% (bad luck on my part!!) and so not feeling at all confident about likelihood that going further will help.

Have any of you had similiar "failure"/disappointing results with drilling and subsequently had significant improvement from some type of cartilage replacement treatment? If so , what type did you have, how long after your drilling surgery did you wait, and how long after the transplant did you "know" that you had in fact improved (and I'm not talking about a marginal amount of pain relief but sufficient enough to have made you very happy!!).

Figure I may be chasing a pipe dream and although I'd roll the dice even for 50/50 odds (if I "knew" that's in fact what they were, but I know medicine does not work that way), wanting to know if anyone out there has had similar experience.

Thanks...Steve

 
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Old 02-13-2007, 06:00 AM   #2
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Re: Osteochondral Lesion Transplant after "Failed" drilling

My first attempt also was a partial failure. Some of my "spots" are filling with fibrocartilage, but the 2 big ones are refusing to heal. {I had surgery in 7/06}I still have pain each day, especially as the day wears on but it is not as severe as before surgery. After doing anything more than walking around the house I feel just as bad as before surgery but at least I can walk. I was going to get bone grafts transplanted (via donor) but we have elected to try the drilling one more time. My OS is top-flight and thinks I have a 50/50 shot at this giving me relief. The transplant is a biggie of an operation compared to drilling/picking and with a longer recovery. I can always go back and try it if the re-drilling does not work.

At first I really wanted to just go ahead and get the grafts but have decided that I ought to try this one more time. After all, what have I got to loose? He (my OS) told me he feels repeat drilling works 1/2 the time and grafts about 3/4 of the time. Re-drilling with yet another failure has no impact on future graft transplant surgery. The caveat was that after a graft you cannot go back and re-do a drilling on the same area. For me I wanted to do anything other than a fusion for as long as possible - in order to buy me time for those joint replacements to get better perfected.

I do know that regardless of either surgery I will always have some limitations and pain with certain activities. I am looking to be able to get back to "normal" life and sports with no/little pain. After all with the scars I have aquired my days as a future foot model are shot (hee hee).

Whatever you end up deciding I wish you the best of luck and results you want. I went back and forth over my choices for a weeks on end. I may regret my choice or I may be satisfied; time will tell as they say.

jane

 
Old 02-13-2007, 11:46 AM   #3
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Jane,

Sounds like you made a very sensible decision to me. I haven't really considered the re-drilling as it hasn't been suggested by either surgeon I have seen. I am getting a "third" opinon from a renowned specialist in Maryland, so am hopeful he is more "direct" with his information and recommendations.

As you undoubtedly know, the decision of "what's next" when you have had little healing/pain relief to date and not having a clear cut path (I'd almost rather be told I have little no chance for improvement, if that were in fact the case) can really wear on you. Each step (literally) you take is a reminder and although I know many others deal with more pain and life threatening injuries and illnesses than what I have, I know mine stands no chance of getting any better unless I do something (time and rest don't heal this, just reduce the pain, but that stinks!!). Problem is, (as you know), their is no clear cut "something" and no guarantee you'll have any benefit. I suspect repeated surgeries could in fact make things worse than doing nothing at all.

When will you be having the redrilling procedure?? What has your OS said will be your recovery time (mine initial was 6 weeks non-weight bearing, with 4 to 5 weeks therapy therafter) and what will be your therapy requirements this time?

Finally, how long aftet your previous drilling procedure did you "know" from feel that it hadn't worked to extent you hoped? Did doc take any film to verify changes (mine hasn't). My revelation of no improvement was truly the first real step I took (I was actually in non-weight bearing for 7.5 weeks as it turned out). Therapy for me mostly was a huge downer because I could tell almost from the onset that the distinguishable pain I'm sure you know well was "back". Never really had much confidence or hope after returning to weight bearing that surgery did a darn thing, so as you have, am dealing with the realities and dissappointments yet keeping the hope and faith.

Good luck. Thanks for letting me know where you are at with yours. Will be nice hearing back from you.

PS...if your foot/ankle ever truly heals, it will be a gorgeous site indeed.....it will look/feel like the most perfect foot in the whole world!!

Steve

 
Old 02-16-2007, 02:05 PM   #4
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Hi Steve & Jane
I had Mosaicplasty (cartilage / bone transplant) in September 06. When my ankle locked up that June, I really went from gingerly treating my ankle to not walking without crutches. I was off and on crutches from then until my surgery. After surgery I was fiberglass casted for 7 weeks (NWB) and then in the boot for 10 weeks. I was told at 7 weeks that I could start to bare weight, that was a joke, my anke was nasty, swollen, discolored and just looked angry. By 9 weeks I had mastered balancing weight like for showering or standing at the stove to cook. At 10 1/2 weeks I took my first unassisted steps from the counter to the fridge, it was ugly but I was smiling - it was wonderful to me. The ankle was still pretty sore and sensative at that point. I started getting range of motion back at about 2 1/2 months Post Op, I lost all the muscle tone in my leg from the surgery and being imobile all those months prior. At 3 1/2 months I ditched the crutches completely - even donated them to my OS for his work in less developed countries. The only drawback I have had from this surgery is I developed PF the day I took those first steps, I really thought I had broken something and I even thought maybe they left some surgical equip. in my foot.... but nope its just PF. I have NONE of the pain I had prior to surgery, I am walking, wearing shoes (sneakers) and working hard at building my leg / ankle back up as I am still in PT.
Overall I am smiling, this was the roughest thing I have ever done and there were days I didnt' want to go on, the pain was incredible but now I look at my ankle and I smile, its wonderful that it moves...I dodged Fusion again! My OS said that it will take a year for me to see the benefit of this surgery and he'd like to see me take it easy for awhile. I figure I've taken it easy for 12 yrs whats one more and if it means I can get back into the things I once loved, then its worth it but if I only get the abiltiy to walk pain free than I can live with that too. I have been in pain for the past 13 yrs and this the first time my ankle doesn't grind and so far no locking either! . I have an area on the leg that is numb with nerve damage but that is to be expected, I had nerve damage from the surgery 12 yrs ago and that was just arthoscopic not open like this one.
I guess I kinda take each day as an adventure and we'll see what it brings, anything past walking pain free is a bonus and I'll take it.
I wish you the best.

Jane, I am glad to hear that you can have redrilling in lieu of the transplant. I am still working that issue out with BCBS and so far I think I am loosing but I haven't given up yet. When will you be having your surgery?

All my best to you both.
Carol

 
Old 02-17-2007, 08:21 AM   #5
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Carol,

That is great news about your progress. 13 years of pain is a long, long time. To be relatively pain free 7 months after surgery, with all you have been through, must be incredibly uplifting. I think I can really understand how happy you must feel.

I will learn this next week from another outstanding OS in Baltimore what his opinion is of my chances for improvement with another surgery...and which type. I like you will eagerly give 8 months to a year of my life in pain (post surgery), rehab then strengthening to get relatively pain free and to be able to do some of the things we all take for granted prior to being injured or diseased.

I was extremely dissappointed and discouraged in finding out recently that mine is not much, if any, improved after my first surgery. Hearing your success is very positive for me and gives me added hope and motivation to not live with it the way it is and to continue to be proactive instead of just "lving with it".

Hope your progress continues and after the year (late summer) post op your ankle is better than you could have even hoped. I and others with similar condition know you deserve it and what you have endured in getting to this place. Keep us posted on how things are going for you.

Cordially,

Steve

 
Old 02-21-2007, 07:18 AM   #6
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Hi Steve
Just wondering how you made out in Baltimore? Hope you got some good news. Keep us posted.
Carol

 
Old 02-22-2007, 03:47 AM   #7
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Hi Steve and also hi to Carol
This is Daniel's Dad and my son is pretty much in the same situation as Steve. Steve, We are in Bloomfield Hiills and had thought about going out to Baltimore also, but have decided to stick with our OS here. My son really likes him and he has done a fair amount of these. My son's problem is on the medial posterior aspect of the Talar Dome and the drilling was partially sucessful, but still pain. With Daniel, he is talking about opening up the ankle, fliping over the end of the Tibia and doing an allograph on the dome, then putting the tibia back togetger with a couple of screws. It sounds dreadful but Daniel asks everyday how much longer before he can have the surgery. OS says it takes 2 to 6 months to get a good size match allograph.
The whole injury is simple amazing to us as we cannot figure out what caused it in the first place.
Take Care and keep us posted

Last edited by SkatersDad; 02-22-2007 at 03:48 AM.

 
Old 02-22-2007, 07:04 AM   #8
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Skaters Dad,

Sorry to hear about Daniel's injury, especially at a young age. Here's hoping with his age (I'm assuming teens), health and an expert OS that the surgery is successful and he can get back to doing what he loves, pain free.

I can tell you as someone who has been into sports my whole life and never really had any serious sports-related injuries prior to this, it's a huge bummer. The pain Daniel is experiencing (if like mine) is unlike any other....bone on bone is an aching, deep-feeling pain that is with you every step you take. It worsens when more active, which must be very wearing on your son and I'm sure is why he wants to get on with the surgery. Even at a relatively young age, I'd bet the thought for him of living with that pain, especially as it would limit his activity as a skater and beyond, has been very discouraging and even depressing.

I'd encourage you to go the whole distance with whatever treatment options you and the specialists indicate. I "lived" with mine for 7+ years, seeing a podiatrist (totally undiagnosed) early on and a general OS 3 years into (partially diagnosed, but not experienced with fixing ankle osteochondral injuries), and kept hoping it would get better and that I could "live with it". It didn't and likely wouldn't for anyone else...it's an insidious thing and only inactivity reduces/eliminates the pain. The problem is, once you go back to "using it", whether one month or six months later, it isn't really any better or healed...it rather quickly flairs up and gets back to/worsens from previous.

I find it interesting how different skilled OS's recommend different surgical remedies. Microplasty, OATS (autograph, allograph, cell growth), MOSAIC, and now synthetic plugs that serve as "scaffolds" are all being used successfully. I'm sure you have done extensive research and have learned all of these techniques. My drilling OS was a foot/ankle specialist in western MI who has offered to do the OATS, but I kind of lost confidence and have chosen instead to go to whom I believe is an outstanding specialist in Cleveland, and now getting a second opinion for a renowned Baltimore doc.

I do know that none of the procedures have a 100% success rate (unfortunately, not like mending a broken ankle, arm or many other athletic/trauma injuries). But with your sons age, health and the best doc you can find (or at least a very good one, who has significant experience with this....sounds like you have that in Bloomfield Hills), he has a strong chance for significant improvement.

My injury is lateral anterior and definitely caused by a severe ankle sprain (or series of ankle sprains) from playing basketball. One bad landing on the hard court has led to this, but I guess that's the case for most injuries whether sports-related or not.

Good luck and let us know how things progress. The allograh is something I haven't seriously considered, so I'm interested in keeping up with how things go for you.

Best regards,
Steve

Last edited by moderator2; 02-22-2007 at 07:10 AM.

 
Old 02-22-2007, 07:45 AM   #9
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Hi SkatersDad
I am glad to hear you have an OS whom you trust for this procedure. It is a difficult one no doubt for both the OS and the patient. Recovery is long but I can say that I am glad that I did it. Like your son I have no idea what caused my lession but mine was on the floor of the talus and they did break the tibula and put it back together with two screws.
When I had come to terms to having this done, my OS said his average was about 3 months for an allograft to become available. I hadn't even gotten around to getting my life in order when the call came in three weeks later that a suitable bone was located. I was scared and relieved and surgery was the following week. I was scrambing to get things in order with my job, the house, the pets etc,.

If your definately thinking allograft then please check with your insurance, you may have read on other posts that Blue Cross refused to pay for this stating it was experimental. The cost of one fresh talus bone was $6,800.00 with shipping. I have a home equity loan on my ankle! I filed claims with BCBS and the first two they denied stating that the codes were wrong, using the same code the third time they responded with payment of $245.80 stating this was considered final. I have since filed a level one appeal and await their response again. I have one appeal left and I have to choose to sue them in civil court or go thru their appeal before a medical review board. I can tell you I found lawyers who will gladly sue the hospital or your doctor but none of them want to take on the insurance company.

I can say that I have a 7K ankle and I am glad I do cause I can walk virtually pain free and the pain I had before surgery is gone.

I wish you and your son all the best, he will need your support during this surgery as its difficult.

Take care and keep us posted.
Carol

 
Old 02-22-2007, 08:36 AM   #10
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Lightbulb Re: Osteochondral Lesion Transplant after "Failed" drilling

Hey Michiganders--

Have you tried the Henry Ford Center for Athletic Medicine in Detroit? How about different foot and ankle specialists? My OS is Christopher Zingas, board certified orthopod and a fellow of the American Orthopaedic Foot and Ankle Society. I just love him--he's truly an amazing guy, and so humble--if he can't fix it, he will send you to someone who can. Who are your docs?

Karyn

 
Old 02-24-2007, 08:13 AM   #11
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sevesteve HB User
Re: Osteochondral Lesion Transplant after "Failed" drilling

Karyn,

A foot and ankle specialist (also in AOFAS) in western MI performed my debridement/drilling in October '06. Because I have lost some confidence in him, I will abstain from mentioning his name.

Realizing that drilling was not successful, I began search for OS in/outside Michigan, with objective being finding "the best" or at least a highly reputable doc with significant experience with OCD repair.

In that regard, I saw Dr. Bryan Donley at Cleveland Clinic in January and really liked him and believe he is extremely talented and experienced. He would likely be my next surgeon either performing an OATS or using a synthetic scaffolding ("plug") in the lesion. He is recommending the synthetic mainly because he has had success using it and it eliminates the possible morbidity from the knee extraction.

After researching this further, my concern was that the synthetic very likely does not result in true hyaline cartilage forming at surface of joint, whereas an OATS transplants bone and hylaline cartilage in one piece, and the ankle site as result does have some hyaline cartilage (instead of all fibrocartilage).

I then consulted with an OS in Baltimore, Mark Myerson, who uses the synthetic plug rather extensively to get his opinion on its use in my case versus the transplant. I expect to hear back from Dr. Myerson next week.

I do know that Dr. Donley in the last several years has treated Peter Forsberg (All-Star NHL player) and Dr. Myerson performed ankle surgery on Terrell Owens (All-Star NFL player) in late 2005. So these guys are being used by athletes whose careers depend on their ankle health so I figure they are top-notched.

My approach has become totally proactive after relying too much on a Podiatrist, general OS and even the foot/ankle doc previously mentioned. I want my next surgery hopefully to be my last so I'm not restricting my options geographically. I want to find, within reason, the most skilled doc with the most specific experience that I can. If I like him/her, that's a bonus!!

Keep us posted on how goes with your Detroit OS and your condition and best of luck to you!

Steve
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Old 02-25-2007, 05:05 AM   #12
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Hi all-

Had surgery on Feb. 16th. Stayed in hospital 2 days because I had some complications. Home in a boot, leg in a bandage and I do dorsiflexion and plantarflexion exercise to mold growth and help achilles. I am not 100% sure what was done. I do know he did some picking and drilling, spur removal, achilles lengthening and scar tissue removal. I had some bleeding and "surprises" in my foot, thus the surgery took exactly twice as long as scheduled. A nurse told my husband so he wouldn't get worried. Then... the anesthesia wouldn't wear off so I didn't wake up for 12+ hours. Needless to say he was worried about me and not in a listening mode. My OS gave him some of the basics but told him to bring the photos with me this Friday. I am dying to know what went on and to see what it looks like!

So far the leg/calf is really bugging me and so is the end of my tibia (think I had another osteotomy). I can feel that familiar postop ankle drilling pain and toes #3 and 4 are numb on top. Foot will not tolerate being down at all. Already tired of being non-weight bearing again.

Before surgery he told me what he planned to do and I can tell he did it. Told me I would be 4 weeks NWB (already cheating but trying really hard to be good) then PWB, PT etc. Same old song like last time but without the lateral stuff (tendon and ligaments) yet with the added factor of the achilles lengthening (Ouch!).

Not on computer much as it is tough to manage right now. Will let you all know when I know.

jane

 
Old 02-25-2007, 07:16 AM   #13
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sevesteve HB User
Re: Osteochondral Lesion Transplant after "Failed" drilling

Jane,
Sounds like your surgery was quite an ordeal and I understand your anxiety. Any unexplained "surprise" after what you have been through, on top of the post-op pain and discomfort, would be a real test of patience. It's the "unknown" outcome that makes this condition so darn difficult. You know you can get through the post-op pain, immobility and PT, but what you really want to know (and only time will tell...at leasts that's what I have learned) is if the friggin ankle is fixed!!

Even though I'm sure it's difficult to access your computer, keep visiting and we'll keep showing our support. The "support group" aspect of this website is what is really cool...your situation is not identical to any others, but all of us know the difficulties you are facing and the courage and motivation you possess to make it better. Some folks, I'm sure, would just learn to live with it...but not you!! No, it's not life threatening, just severely life limiting.

Let us know how your Friday appointment goes. Here's hoping the news is positive and keeps you excited about the outcome. Hang in there, Jane!!
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Old 03-01-2007, 01:09 AM   #14
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Hello everyone,
This is Daniel's Dad again. FYI, Daniel is 14 and was a competitive figure skater who also did alot of ballet and tap dance over the last 8 or 9 years. His OS at Wm Beaumont Hospital is Christopher Stroud MD. He did a fellowship in Sports Medicine and another in Foot and Ankle. He was parners with Mark Myerson in Baltimore before moving back home to Michigan a couple of years ago. He performed the debridement and drilling last april which was about 20% successful although I believe Daniel's ankle condition has deteriorated a little recently. Daniel can skate a little about 20 minutes and then has to get off. A few double jumps off his good ankle but none on his left, which is his take off foot. (He would normally land most jumps on his right leg). Currently, no ballet or tap but does ballroom OK.

We are waiting for a donor allograph (about a month now) They told us 2 to 6 months to get a good size match. Dr. Stroud does not want to get an autograph from any of Daniel's other joints because he says Daniel is just too young to do that and he has had faily good results with Allograph. We will keep you posted of Daniel's Surgery.
Take care
Dennis

 
Old 03-01-2007, 09:46 AM   #15
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Re: Osteochondral Lesion Transplant after "Failed" drilling

Hi SkatersDad
I wish your son the best, 14 is a young age to go thru this surgery. I am glad to see he has you for support, it will be important no doubt. I am hoping and praying that this will bring the relief he needs to return to those things that he loves.
I am 5 months post op and was just released from therapy. My ankle scores a 66 out of 80 but we never anticipated more than 70 as I never had full ROM prior to surgery. Overall I am pleased since my ankle moves and that was my goal.
I will be returning to work next week and I am both excited and nervous. I know my employer will not be giving me any slack at all and I am not 100% yet but can't bear to stare at the walls here no more. It will be a true test if I make it thru the 12 hr days that are required.

Steve and Jane, My prayers are with you both as well. Jane I hope your feeling better and behave.... keep off that foot and let it heal!

All my best to everyone!
Carol

 
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