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Old 03-24-2008, 11:35 AM   #1
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Angry Should I get OATS or other surgery after failed drilling for OCD

Hello everyone,

I wanted to hear from people who have had the various surgeries for OCD after failed drilling or debridement procedures. I suffered my injury playing softball in June of 2006. My ankle was not really that painful at all, but I decided to go to the Dr. after slight pain in December 2006. The Dr. told me to get the microfracture procedure so I listened.

THis very likely was the biggest mistake of my life. My pain is now cronic when I get up from rest untill I guess the blood flows to my ankle. I have already given up on ever playing a sport like basketball again, but the major concern of mine is debilitation to the point I can not walk in the future.

Also, about 2 weeks ago my knee started to bother me right under my knee cap. The pain in the knee is much worse than the ankle and constant

I would like to hear from any of you that have had OATS or another transplant procedure that actually worked.

Thank you,

Mark

 
Old 03-26-2008, 03:54 AM   #2
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Re: Should I get OATS or other surgery after failed drilling for OCD

Hi Mark,
I'm sorry to hear about your problems. I'm curious your age and the extent of area and location on Talus of your surgery?

 
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Old 03-26-2008, 06:56 AM   #3
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Re: Should I get OATS or other surgery after failed drilling for OCD

Hello Skaters Dad,

I am almost 25. I saw my OS yesterday and he told me that I had a 1.5 cm lesion. I am not sure of the location, but my OS told me that my leg bone would have to be broken to have the surgery. I believe it is more towards the side of my talus instead of directly on top.

My OS told me that there was no purpose in me getting a MRI if I did not intend to have surgery any time soon, which I don't think I will because I am in my 2nd year of law school and don't have months to spend healing.

Do you remember how your son's OS diagnosed his injury after his failed drilling. My OS seemed to believe he would have to open me up to see what is going on in my ankle now. Does this seem right? How is your son doing now? How many months has it been since his surgery

Thank you,

Mark

 
Old 03-26-2008, 12:13 PM   #4
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Re: Should I get OATS or other surgery after failed drilling for OCD

Daniel was 13 when he was first seen for ankle pain. A very high level Sports Medicine MD saw him, had it X-Rayed and diagnosed it as tendonitis. Daniel kept skating on it but it was not getting any better and actually getting worst. Since then I have been in discussiuon with another skater who saw him for a sore knee which he diagnosed as tendonitis. This patient had a torn meniscus.

Daniel went to an OS who ordered an MRI and they saw this OCD which was pretty good size on the dome of the Talus near the medial edge. We went to another OS althought the first was very good.

He was casted for 4 weeks to see if it would heal on its own. After 4 weeks they did a nuclear uptake Cat Scan to see if any healing was going on in the area where the OCD lesion was at. Nothing going on so he had a OCD drilling on April 20th, 2006. (Daniel was now a few months older and now 14) They hoped that because of his age that the area would heal itself with the drilling as he was borderline having a solid sub-chondral bone but it didn't work. Daniel went back on the ice in September but you could tell it was not healed. The MRI at 6 months showed it was about the same as before but our OS says it very difficult to tell how much healing has actually taken place. He wanted Daniel to give it a few more months. In January 2007 the OS decided to do the graft using a cadaver donor. First graft was too old we we waited for a second graft, One came in early April and Daniel had the surgery on April 17th?. They took a wedge off the Tibia to get access to the Talus and fixed that with three screws which Daniel never complains about.

It's been 11 months since surgery where a 9mm plug was translanted. Daniel is skating about 2 hours a day and now has a partner so they hope to be in full training this summer and plan on competing again in the Fall, God Willing.

Not sure if this helps but we pulled him out of school post op until about 6 weeks after the surgery because we were afraid he would hurt it but the OS was willing to have Daniel return to school sooner if he wanted too. Of course high school is alot different than law school.

Your pretty young so I think that is great and the cutting through the Tibia - surgical break is not that bad. It heals in 6 or 7 weeks. The culprit is the tiny little Talus that we all take for greated but it like an everready battery and normally just keeps on ticking - until we hurt it - than it's devestating.

I sure hope you get back like you were before.
Take care.
Dennis

 
Old 03-26-2008, 08:09 PM   #5
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Re: Should I get OATS or other surgery after failed drilling for OCD

Dennis,

Firstly, thank you for taking time out to respond. It is great that Daniel is doing well. I think that the key is being young. The younger the better as far as healing is concerned. Also, Daniel sounds like a real competitor. I initially got the drilling because I thought it would get me back to 100%. As I said, it made things a lot worse.

I know I would not have had the surgery if I could go back, but we cannot go back in life, only forward. I am going to try conservative treatment I think for my ankle now because I simply do not have the time for healing and rehab at this point in my life. Also, I am not really that in to high impact sports, and have come to live with the fact that I will never play basketball again (I only played a couple of times a year before).

I guess my main question to you is, how did you OS determine the exact size of the injury before Daniel's second surgery - x-ray, MRI? How did they know 9mm - or did they have the cadaver ready and judged how big the lesion was after opening Daniel's ankle? I am just wondering if I should shell out the cash to go to the Myerson clinic to get them to look at my ankle.

Thanks again and best wishes,

Mark

 
Old 03-27-2008, 03:43 AM   #6
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Re: Should I get OATS or other surgery after failed drilling for OCD

I think that the MRI gave Dr Stroud a good hunch of what he was dealing with, but I don't believe that he knew for sure until he got in the ankle joint. I believe they use an instrument like a dental explorer to determine the softness of the cartilage in the damaged area. Soft meaning the underlying bone was not functional. The instruments that remove the new plug from either a patients knee or hip - or in my son's case, from a donated cadaver bone are apparently kitted with various sizes ready to go once the determination is made visually of what size plug is needed.

My guess is that these instruments are pretty expensive and probably need to be kept pretty sharp so not many surgeons or hospitals probably even have the correct equipment to do these types of cases.

Good Luck in what ever you decide.

 
Old 03-27-2008, 05:52 AM   #7
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Re: Should I get OATS or other surgery after failed drilling for OCD

hate to butt in here but.. why would drilling make your ankle worse? and is this common?
I'm getting drilling in a week..

 
Old 03-27-2008, 07:07 AM   #8
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Re: Should I get OATS or other surgery after failed drilling for OCD

Airjaw, I too had a failed drilling.

I wouldn't be overly concerned... Like any surgical procedure, there is risk of failure, and with a failed surgery you could see your symptoms worse off, better, or unchanged from before the surgery.

Microfracture is generally done as the first surgery anyway, since it is the most conservative of the surgical procedures used to correct/treat this type of injury.

Obviously Mark will have to respond as to why his ankle got worse, but I suspect that following the drilling his cartilage simply did not heal, or only partially healed.

In microfracture they're actually cleaning out the damaged cartilage (removing it), and trying to stimulate regrowth by drilling the bone beneath. I would imagine it's possible for the ankle to get worse if there was no regrowth...since what (damaged) cartilage that was there has been cleaned out.

Last edited by mak06; 03-27-2008 at 07:07 AM.

 
Old 03-27-2008, 07:57 AM   #9
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Re: Should I get OATS or other surgery after failed drilling for OCD

Quote:
Originally Posted by mak06 View Post
Airjaw, I too had a failed drilling.

I wouldn't be overly concerned... Like any surgical procedure, there is risk of failure, and with a failed surgery you could see your symptoms worse off, better, or unchanged from before the surgery.

Microfracture is generally done as the first surgery anyway, since it is the most conservative of the surgical procedures used to correct/treat this type of injury.

Obviously Mark will have to respond as to why his ankle got worse, but I suspect that following the drilling his cartilage simply did not heal, or only partially healed.

In microfracture they're actually cleaning out the damaged cartilage (removing it), and trying to stimulate regrowth by drilling the bone beneath. I would imagine it's possible for the ankle to get worse if there was no regrowth...since what (damaged) cartilage that was there has been cleaned out.
if there's a risk that your ankle get worse though...

does that affect the success rate of the OATS procedure?

 
Old 03-27-2008, 09:09 AM   #10
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Re: Should I get OATS or other surgery after failed drilling for OCD

Hey,

I know you are in Law school but its nearly summer...that would be a great time to have the operation!

I had 3 operations during my undergrad and masters, to be honest... non weightbearing recovery was really fantastic for my grades... you are pretty limited in what you can procrastinate with, and going to lectures is like one great big fun event... even torts at 8am haha

I had my MACI operation (similar to OATS) done once I started working, two operations in such a short time was tough, but not impossible. I'm pretty handy on crutches now =) I really think that the recovery won't be nearly as bad as you think...and mine failed, so if it works it should be even better.

My strongest advice is don't leave it too long to try the OATS operation... my MACI failed as the arthritis was too far gone. Once you get to that point it is fusion or replacement....yeah now that is scary! Especially as most surgeons will tell you you have to be 60 to get a replacement.

But I was very lucky and managed to get a replacement last year at 26 which has worked out wonderfully for me. It's not a real ankle but I cycled across cambodia at christmas and went skiing in January. It rockes! and I did it all all without rocker soled shoes, a walking stick or daily drugs (as was my life in the end before the op).

Anyway... might be good to keep an eye on the ankle and get a second opinion on how long before you really need to have the operation... I would try and see a doctor in the same team as mayerson (will be good and the wait will be less).

Best of luck
kira
P.S. skaters dad, wonderful to hear daniel is doing so well and that he is going to start pair skating soon! he must be thrilled!! =)

 
Old 03-28-2008, 11:47 AM   #11
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Re: Should I get OATS or other surgery after failed drilling for OCD

Quote:
Originally Posted by airjaw View Post
if there's a risk that your ankle get worse though...

does that affect the success rate of the OATS procedure?
Nope. Shouldn't affect success rate of the OATS.

In the OATS they're actually removing a plug of damaged cartilage and the underlying bone.

Regardless of whether OATS is your first or second surgery, they're taking that plug out...

 
Old 03-28-2008, 01:01 PM   #12
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Re: Should I get OATS or other surgery after failed drilling for OCD

Quote:
Originally Posted by mak06 View Post
Nope. Shouldn't affect success rate of the OATS.

In the OATS they're actually removing a plug of damaged cartilage and the underlying bone.

Regardless of whether OATS is your first or second surgery, they're taking that plug out...
ok thanks mak.. that's good to have cleared up
your appointment is soon right?
next week

 
Old 03-30-2008, 08:27 PM   #13
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Re: Should I get OATS or other surgery after failed drilling for OCD

Airjaw - I feel that the drilling procedure is absolutely the right move if you are having significant problems with your ankle. My situation was a sports injury resulting from jumping and coming down on the side of my ankle. Thought it was just a bad sprain and so no medical treatment. I went to the doctors just because I thought the surgery could get me back to 100% - it made things worse. Before surgery I could run a mile on the treadmill with no pain or ice needed - I will never be able to do that again with my current condition. A surgery is a trauma to the ankle - so results will vary as Mak said. The key is to determine what is right for your life and level of pain to make your determination.
In hindsight I would not have gotten the drilling surgery because my ankle was really not that bad. That is exactly why I am not having any further surgeries at this point. I can still walk around wherever I need to go and running is not really a huge part of my life (being a law student and tv and movies and music are). Shall I wish to exercise I can swim or ride a bike.

Anyways thats my situation.

Dennis - thanks again for your held

Kira- I am glad to hear how great you are doing. I do not think I am in near the pain you describe you were in, so that is why I am not risking another possibly failed surgery at this point. I have a very busy life style (perhaps could not get any busier) and I can not afford to not be available for employers this summer as I need to build my resume. Thanks for your advice.

Best wishes,

Mark

 
Old 03-31-2008, 10:45 AM   #14
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Re: Should I get OATS or other surgery after failed drilling for OCD

Quote:
Originally Posted by airjaw View Post
ok thanks mak.. that's good to have cleared up
your appointment is soon right?
next week
No problem.

Yup I have my appointment this Friday (with Dr. Jeng). Hopefully everything will go smoothly and I'll be able to set up my OATS procedure for some time in May.

I agree with Mark's advice, but one thing I would add when deciding whether or not a surgery is right for you is to think ahead as well. It is true that some OCD's don't really require intervention, and may remain stable for long periods of time. With larger lesions though (and depending on the location of the damage) there is the possibility that your cartilage can continue to degrade...especially since there is a lesion. I'm choosing to treat my lesion agressively with the OATS procedure even though I can get through my day with none/almost no pain. My lesion is pretty large, and I don't want it to degrade further to the point where certain surgical options will either be out of the question, or less likely to succeed. Although Kira's example is pretty extreme, her cartilage had degraded to a point where she had said that the MACI procedure was pretty unlikely to succeed.

There still is not too much in the way of truly long terms research/data on these injuries, but the info that is available so far suggests that these surgeries, when they work, are helpful in healing the injury or slowing down the deterioration, at which point there will hopefully be some sort of advancement in tissue regenerative/regrowth techniques.

I think it's important to realize what can happen if you decide to go with surgery, but also if you decide to put off surgery... In my case, I want to treat this aggressively in the hopes that I will stop or slow down the degradation of my cartilage.

 
Old 04-01-2008, 03:29 AM   #15
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Re: Should I get OATS or other surgery after failed drilling for OCD

Guys - hope you don't mind me joining this thread - i am in a similar position to most of you are/have been in that i am currently assessing my options for repair of a medial OCD of the talus in my left ankle.
i am trying to gather as much info as possible and have many q's which i figure are the same q's that you will have been asking your OS. as a very quick background:
April 03 -(age 24) trauma injury to ankle playing soccer
Aug 04 - microfracture performed - v pleased with results - although couldn't get back to competitive football could do plenty of other sports and above although, with minimal discomfort.
Apr 07 - began to feel same pain as prior to microfracture
Jun 07 - had cortisone injection - this relieved a good amount of the pain for a few months (still refrianing from any sporting activity mind)
Oct 07 - under advise of my OS, had 2nd microfracture (remove the fribrocartilage regrowth that had become 'roughed up' and drill to induce bleeding and regrowth again)
To date - 5 months post-op and am not feeling any better than before this 2nd op - same pain, same area (feels slightly worse if anything) saw OS last week who acknowledged op had not been a success this time - this comes as a shock to me and is q hard to understand given the success last time and the banded 85% success rate.
Anyway, i am now at the 'what next' stage and am due to see my OS at beginning of May 08. (i did have one fairly brief discussion with OS last time where he mentioned OATS and HemiCap insert)
Naturally, i am doing my own research so i am armed with q's for our meet next month - my options as i see it:
1 - 3rd microfracture (if it worked 1st time can it work again? am concerned i was wb to early after 2nd microfracture (day 4 - tho this was per OS instruction and same as post 1st op) and didn't give time to heal?
2 - OATs using cartilage from my knee
3 - OATs using donor (tho don't think available to me in UK)
4 - HemiCap implant (this is v new: 12 ankles in the world to date - my OS is leading it's 'trial' in UK (i don't think it has approval in US yet) i do know that it has been around in the knee and shoulder for last c18mths with v good results so far.
5 - delay surgery another 18mths - take a couple of cortisone's (no more than 2 tho) and hope something 'new' and offering better guarentees/results comes along.
any suggestions from the reserach you guys have done and the OS's you have spoken with would be much appreciated. thanks v much for reading. Regards

 
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