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Old 01-26-2009, 04:57 PM   #1
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Wink Ankle OATS after 2 surgeries? Or live with it?

Hi all,
I am a new member to the board, but I have to say, I've used it as a resource for the last 13 months religiously, and I am so thankful to all those who have posted information...it has been far more valuable to me than anything in terms of gaining information since this all began. I will try not to get longwinded, but in short, I have been an avid equestrian my entire life. I've sprained my ankle several times, never broken, and in Sept 2007, I started to have throbbing pain and instability in my ankle. Went to a renowned OS in Charlotte, NC and ended up having a 1 cm lesion in my ankle and a torn tendon. To complicate matters, I am severely flat-footed and my knee caps are too small/crooked, and I had a torn meniscus as well, so in Dec 2007 I had a microfracture and reconstruction to the rt ankle and a rt knee lateral release, meniscectomy, and "cleaning up" of the rt knee.

Ok, so I do the PT and recovery thing, and I'm back up to snuff by the summer. I continue to have good and bad days on the ankle (the knee is fine by now though). I'm doing well enough to do my summer job of teaching riding lessons in a deep sand arena and riding 6 horses a day. By September, when I'm back in school teaching, my ankle is starting to feel like that same old pain again, and now the left knee hurts. To cut the story short, I saw my OS, who said that I had a chondral flap in the ankle that was acting like a hangnail and creating this pain (by this time, I'd already tried cortisone shots in the rt ankle and left knee with zero help). So, in Dec of 2008, I have another arthroscopy on the ankle--he says my regrown fibrocartilage looks good, but that I had a chondral flap and lots of "plakia (sp??)" and scar tissue that was causing my pain and that I should be good to go. As a side note, I asked about OATS and he said he did not think it was a "slam dunk" at this point, and that he thought the less invasive surgery was good to try first. I also had to have a lateral release and "clean up" of my LEFT knee on Jan 15 of this year...so I'm getting more than tired of surgery at this point, plus I'm out of sick days at work!!

So...after all that exhausting history, here's my problem. It's been a month since my ankle surgery, and I feel absolutely NO relief to my ankle. None. Zippo. I'm weight bearing and all, but since I'm off my left leg due to the knee surgery, I'm having to go around in a wheelchair because my right ankle is so painful and unstable I can't use crutches for more than a few ft at a time.

Here's my question: Has anyone been through a similar procedure, and if so, is this normal? Did your ankle get any stronger/less painful? I'm going to PT for both tomorrow and hope my therapist has some good solutions, but at 22 years old, I just feel like it's ridiculous to have spent 50 grand on surgeries and feel like my ankle is no better than it was 13 months ago. Do you think I should try a different OS? Or should I go on to the OATS? I am very hesitant about the OATS b/c I keep hearing that the "lifespan" on the grafts is about 4-6 years, and I don't want to set myself up for having to have "maintenance' surgeries every few years. Any thoughts/ideas/experiences??

I am so grateful to ANYONE who can reply...I'm the only person in my family to have gone through this and so we're all at a bit of a loss with how complicated these ankle procedures can be. I just want to be able to teach and ride my horses without pain, and I feel like that's not so much to ask for someone as young as me, who has been active and healthy all her life. Thanks so much for your time and answers!!!!!!!

 
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Old 01-27-2009, 12:01 PM   #2
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Re: Ankle OATS after 2 surgeries? Or live with it?

You might be eligible for drilling in lieu of OATS. I had microfracture surgery, debridement and scar tissue removal in June 2007. I'm an ultramarathon runner, and whereas I'm back up and running, I'm starting to have some more of those sudden, jarring bolts of pain in the ankle again. My lesion is currently 8mm, so until it gets to 1cm, they won't even consider OATS on me. So, my next step will likely be drilling -- or to just suffer until I can't take it any more!

 
Old 01-27-2009, 04:10 PM   #3
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Re: Ankle OATS after 2 surgeries? Or live with it?

I had OATS surgery on an 18mm lesion 1 year ago. One reason I decided to go ahead with OATS was my age. After 45, they start to hesitate using that surgery and I'm 40. You're 22 yrs. old and that's really young. So you had drilling already that healed well but left some scar tissue and a chondral flap? So when you had the arthroscopy did the surgeon remove scar tissue and the flap? The bad news is even with successful OATS or drilling, you're going to to always have some pain in your ankle. It shouldn't be so bad you're using a wheelchair though! (Or even limping around) What does your ankle OS say? You're only a month out from the clean-up arthroscopy. I would give it more time to heal before getting too discouraged. That's hard to say after all your surgeries - ahhh! It might be good to get a second opinion from another Dr. just to see what he thinks. Your current Dr. is right that OATS is not a "slam dunk". However, the data on the 4-6 year life span of the graft I don't think is correct. They don't really know how long these grafts last - it depends on recovery and activity level later. My OS is hoping for 10-20 years and the medical data now looks good for people 7-8 years out. They just don't have enough info yet to build the statistics. So when your 40 and your graft may last til your 60 - that's good. When your 22, 20 years is not very long. We all look forward to a day when they have a better solution for these injuries! I think it's coming soon! From talking to people on this board I have found that recovery is a lot harder when you have other issues besides a lesion. If you had reconstruction for severe flat feet I'm sure that can bring in a lot more issues. You have to be walking (mechanically) a lot differently since your ankle and both knees have been operated on. Hopefully PT can help you re-adjust to a very different gait. These ankle surgeries are WAY more complex than I ever knew so I'm glad we can help each other on this board. Hope this helps!

Abby

PS: Never heard of 'maintenance' surgeries after OATS. If it fails, you're looking at a 2nd OATS or ankle fusion/ankle replacement. You don't want OATS to fail for sure!

Last edited by akirka; 01-27-2009 at 04:16 PM. Reason: addition

 
Old 01-28-2009, 02:58 PM   #4
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Re: Ankle OATS after 2 surgeries? Or live with it?

Thanks Heinselrunner and Abby for your replies! I went to PT yesterday and he sort of echoed what y'all said....I am going to kind of have to re-learn how to walk properly. He said that hopefully my ankle is just giving me a fit because I've had to rely on it while my left knee is recovering (I've had to use crutches for short stints places not wheelchair accessible...it's amazing how much you notice how people create handicap inaccessible areas when you have these problems!). I still worry since I've been in the wheelchair so much, but he said that if I am still having issues in a couple weeks after I'm more stable on the left leg (and it can bear the brunt of more weight to help save the right ankle), that I should probably call my OS. I told him at my post op appt that I was still hurting, and he said that was normal, but that was also 2-3 weeks ago, and he just said to email him in March and let him know how I was doing. Hopefully I won't need to contact him sooner than that and all this will be okay...or at least better...by then.

Abby, good to hear a more promising time-span on the OATS---in a way, I feel like I'm way too young to even be considering the OATS, but at the same time, if I can get 20 years pain-free, it's quite tempting, even if I would need an ankle replacement at 40-something. It was also interesting to hear that your OS didn't mention the "maintenance" surgeries...makes me wonder a little bit.

Heinselrunner, it's great to hear that you are back to running! I used to run, but I haven't been able to in a couple years now. How long did it take for you to start running again? My biggest passion is my horseback riding, which I do competitively, and so my most important goal is to be able to ride and compete pain-free without worrying about hurting my ankle while doing so. My current OS says I can ride in 4 weeks, but I don't see how I can do that with the pain I'm having--even if my knee wasn't an issue.

Here's a question for y'all...does your ankle ever hurt at rest? Or is it only weight bearing? Mine only hurts weight bearing, 90% of the time as the foot goes to push off the ground, 10% simple weight bearing. I tell ya though, today is cold and rainy, and it HURTS to crutch around!

 
Old 01-28-2009, 07:35 PM   #5
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Need talus ocd advice

Hello! My name is liz, I'm new on here and unsure of how to start a new thread. I've been reading your posts and find them quite helpful. I'm wondering if anyone knows of a good os in Texas for OCD lesions of the talus. Thanks in advance!

 
Old 01-29-2009, 12:30 PM   #6
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Re: Ankle OATS after 2 surgeries? Or live with it?

I had my surgery just 2 weeks before my 40th birthday, and it took me about 8 months to get back up and running. I progressed very slowly, with lots of "hills & valleys". (Between 3-6 months I was certain the surgery had failed, but things got better after that. My PT was GREAT!) Some days the ankle felt okay, and some days not. I enjoyed about 6 months of relatively pain-free running, but now the pain is getting worse again. Like you, it hurts mostly during push-off, or any time I cut or shift my weight suddenly. Then, it's a sharp jolt of take-your-breath-away pain. I have general achiness even when I'm not weightbearing, particularly after a long run. (i.e. I ran a 50 mile race two weekends ago. During the race, I had 2 major ankle pain episodes, but each time I was able to work thru it and continue on. After the race, I was in a lot of pain for about 1 week. I even noticed my right hip and knee were painful, no doubt from trying to accomodate my painful right ankle.) With lots of ice and rest, I'm doing better now, and hope to run a little this weekend. Ironically, I do better on rugged terrain than I do on concrete, so I avoid the streets.

I'm not familiar with the torque on the ankle during horseback riding. Hopefully your OCD is in a location that can be fixed and still allow you to compete. I KNOW how hard it is when you're not able to follow your passion! At 22 years young, you should certainly find a dr. who understands OCDs, their treatments, and the long-term nature of the recovery process. Before my microfx surgery, I had 2 drs. tell me I'd never run again. My persistence paid off!

I hope you find your cure!

Last edited by Calrunner; 01-29-2009 at 12:32 PM.

 
Old 01-29-2009, 04:13 PM   #7
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Re: Ankle OATS after 2 surgeries? Or live with it?

Thanks so much for the posts...I look forward every day to see what people have written so I can learn more!! I really appreciate hearing from others, it really supports me more than I ever could have imagined.

Liz, I am so sorry you are going through this as well...unfortunately I am in NC so I can't help you out with an OS in TX...but I would recommend either researching large ortho groups that specialize in sports, like maybe find out who treats the Cowboys, or go through a university. My OS group treats the Panthers and the NC dance company and I've been very pleased, despite my continuing ankle issues.

Heinselrunner....WOW! You are so inspirational and hope-inspiring...that after all you've been through, running 50 miles blows my mind! I don't know how you worked through the ankle pain during your marathon. Does your ankle not just give out with you? I don't know if it's just that my muscles are weak from lack of use or guarding, but when I go out to feed my horse, by the time I'm on the way back, my ankle becomes so painful that I either have to rely on my super weak and swollen left knee or stop because my right ankle pain is either too great or it gives out. I have to walk on gravel, and I wonder if that has anything to do with it. I actually can understand running better on rough terrain, because if your ankle muscles are stable, then surely running out in the woods or on a trail is better than the unrelenting surface of cement or asphalt! I wonder if that's what set me off--standing/walking on tile floors in a classroom all day.

The torque riding is quite a lot on the ankles, but I am considering giving up jumping---which puts tremendous pressure on the ankles (the average weight rider landing after a 4 ft fence plus the force of gravity weighs 400 lbs...all of that in the ankle joint); if I give jumping up, I can lengthen my stirrups enough to take a lot of pressure off the joints. BUT...if it means I can continue to ride, I'll certainly give jumping up.

Thanks again for the posts...I'll keep everyone updated, and I'd love to hear more from y'all.

One more BIG question---what is the difference between OATS and ACI and Mosaicplasty? Which is the best method, which is newest, which do people have experience with? I found the ACI today researching, and it sounds really incredible and less scary than bone grafting, so I'm definitely curious about it---but I don't know if it's FDA approved in the US. Anyone know??

 
Old 01-29-2009, 06:14 PM   #8
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Re: Ankle OATS after 2 surgeries? Or live with it?

Hello everyone,
OATS means osteoarticular transfer system procedure. There are a few different kinds. Autograft (ACT) meaning coming from your own body allograft is from another source whether it be cadaviar or synthetic. (sorry for spelling errors)
Mosaicplasty uses a small tool to take small dowels of bone and cartilage from usually the knee and fills in the missing peices of bone and cartilage. It ends up with a mosaic look.
The ACI uses a arthroscopy method to take a piece of cartilage usually from the knee then they send it to a lab and grow and culture it with your own cells then they use the lab grown stuff and implant it into the ankle. It requires 2 surgeries.
There is also oats that uses a wedge from the tibia.
Each one is a bit different and is better used for different size lesions and issues with bone or cartilage.
Manybest wishes
Diane

 
Old 01-29-2009, 06:19 PM   #9
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Re: Ankle OATS after 2 surgeries? Or live with it?

Sorry I just saw your second question. I believe all of the procedures are FDA approved HOWEVER, Most of them are considered experimental by insurance. That is the big hurdle unless of course you have a stuffed mattress. All I can say is "experimental" is the insurance way out of paying.
Diane

 
Old 03-11-2009, 06:42 AM   #10
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Re: Ankle OATS after 2 surgeries? Or live with it?

Hi all,
Sorry it's been so long since I've posted...
I'm almost 3 months post-op on my ankle, and while it's certainly better than it was while I was recovering for my left knee, it's still painful. I can walk, but I still walk with a limp and have pain upon pushing off of the foot during walking. There are times when I have pain (usually once a day for a very limited amount of time), but I can never predict when it will be or for long. After the short pain free period, I am right back to hurting again. My OS said that my slow recovery was expected b/c it was my second ankle surgery...however, my insurance is maxed out until July 1, so if I need to have another operation, I must have it BEFORE July so I can afford it! Has anyone else still had daily pain after 3 months of a surgery where all he did was debridement and scar tisssue removal? It still feels like that same old pain as before, even though he said my fibrocartilage looked good when he scoped it 3 months ago. Would love to hear feedback...he seems to think that it's no big deal; I just need to know definitively that I will become pain free at some point after this operation because I'm on a timeline with being able to get the OATS if I'm going to get it; insurance rates are going sky high after July and will not be able to afford it then. Ideas and thoughts?? Thanks!

 
Old 04-29-2009, 01:39 PM   #11
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Re: Ankle OATS after 2 surgeries? Or live with it?

Hello! I'm a 37 year old male who underwent OATS Knee to Ankle back in Feb 08. The lesion was 1.1cm at the front left lateral portion of my talus. The recover was torture. At this point I take supplements to help with some residual pain. Lately I've been fairly pain free most times-save for morning ankle stiffness and mild pain. I've tried running recently-just two miles-and I can do it relatively pain free. When I get home it aches somewhat. Is this normal? Have you been told about the possibility of ankle replacement after OATS?

 
Old 04-29-2009, 01:55 PM   #12
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Re: Ankle OATS after 2 surgeries? Or live with it?

Bezerka,
Hi I had my OATS in Feb 08 also. I still have trouble with pain. The weather is a big factor. I also have trouble with my other ankle so I think that is some of the reason why I don't even attempt running. My fantasy is double ankle replacement. Someday.............

 
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