It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Foot & Ankle Problems Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 10-12-2011, 04:56 PM   #1
Newbie
(male)
 
Join Date: Oct 2011
Location: Portland OR USA
Posts: 2
skateboardankle HB User
Yes or No: Ankle Surgery using Denovo NT?

I'm 25 and active with moderate non-restrictive pain.
2/25/10 Sprained Ankle
4/8/10 X-ray no findings.
9/24/11 MRI
10/17/11 Surgery Consultation
10/25/11 Surgery Scheduled w/ Podiatrist using Denovo NT

Findings from the MRI "moderate sized chronic osteochondral lesion of lateral dome measuring 10 x 9mm" "Mild amount of bone marrow edema within the medial malleolus of uncertain etiology"

I met with a Podiatrist and he was pretty adamant about surgery as my only option to fixing the problem. He has only done one other "D" procedure and the person is still recovering.

I am nervous about the surgery. My insurance runs out in May. I have a north american tour scheduled for Dec 1st which goes until Feb 3rd. I don't know enough about the recovery process. Any guidance or input would be greatly appreciated.

 
Old 10-13-2011, 05:50 AM   #2
Senior Member
(female)
 
Join Date: Oct 2008
Location: Shorewood IL USA
Posts: 206
dizzizzi99 HB Userdizzizzi99 HB Userdizzizzi99 HB Userdizzizzi99 HB Userdizzizzi99 HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

It does (unfortunatly) appear that surgery is the only option for this condition. Also the recovery is very long even at your age. It is usually well over 4 months for OATS however I am not sure exactly what they do for the D procedure. You need to call insurance right away. They do not normally cover this. Don't just get a preapproval that does not mean anything. You need to ask for predetermination. This could take several weeks. (very expensive if not covered) I would also be tempted to look at other docs. Only one other surgery experience would be my issue. However, this is a bit of a new procedure so it may be hard to find other docs who have done it. There are people on this board who have had it done maybe they will reply. Best of luck to you and yes recovery is possible so stay positive. But hound that insurance!

Last edited by dizzizzi99; 10-13-2011 at 06:01 AM. Reason: did not want to quote

 
Sponsors Lightbulb
   
Old 10-13-2011, 09:58 AM   #3
Newbie
(male)
 
Join Date: Oct 2011
Location: Portland OR USA
Posts: 2
skateboardankle HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

Thank you. I will get on top of the insurance company asap. Any insight on why it is an open surgery vs. Arthroscopic?

 
Old 10-13-2011, 10:40 AM   #4
Senior Member
(female)
 
Join Date: Oct 2008
Location: Shorewood IL USA
Posts: 206
dizzizzi99 HB Userdizzizzi99 HB Userdizzizzi99 HB Userdizzizzi99 HB Userdizzizzi99 HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

I believe there is a graft put into the area. Go down to the bottom of the page and look at the related posts and click on the "overview of treaments" thread by livesnear the store this man has done alot of reaserch for you make sure you go to the first pages (posts) of the thread.
Because you will be opened up the recovery is alot longer, However I do not think the success rate for a lesion of your size is very good using the arthroscopic methods. I do not have any data to back that, just what I have seen on the boards since I have been on (08?)(my opinion not a medical backed one) I am not sure if there is a way to research that. The mentioned thread is a great way for you to find your options. There are a few, it may also pay to go get a second opinion. Get any insurance predetermination in writing.

 
Old 10-13-2011, 10:42 AM   #5
Senior Member
(male)
 
Join Date: Sep 2011
Location: Los Angeles
Posts: 106
j9879 HB Userj9879 HB Userj9879 HB Userj9879 HB Userj9879 HB Userj9879 HB Userj9879 HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

DeNovo NT is a relatively new product (approx 2 years) You will be hard to find many physician that have done a lot of them. The good thing about using the DeNovo NT is that technique isn't much different from treating a typical OCD lesion of the talus. It is usually done through a small incision and does not require cutting any bone, but this is depended on the exact location and how difficult it is to reach. It isn't done arthroscopically because it is hard to get the cartilage and place it correctly through such a small incision. Also, the area needs to be dry to apply it, which is virtually impossible to achieve via arthroscope.

The procedure is done by cleaning up the OCD lesion then applying the DeNovo NT to the lesion. Essentially recreating the cartilage in that area. It is made of juvenile hyaline cartilage and has shown very good results since cartilage has been almost impossible to make normal again after an injury. The recovery time will usually be 6 weeks of non-weight bearing followed by protected weight bearing for up to another 4 weeks. The cartilage needs time to incorporate without being displaced or sheered off. That is the reason for the non-weight bearing. When compared to an OATS, it is a much less technically demanding procedure, usually does not require cutting the bone, and has shown better results.

The other poster is correct. Many insurances do not cover the procedure since it is relatively new. Before contacting the insurance company you need to contact the Zimmer representative. They can give you the information needed to make sure you are asking the insurance company the appropriate questions. Some insurance companies won't know what you are talking about if you don't use the appropriate medical language and/or codes.

 
Old 10-13-2011, 08:32 PM   #6
Senior Member
(female)
 
2ScrewedUp's Avatar
 
Join Date: Jun 2009
Location: Cincinnati, Ohio, USA
Posts: 109
2ScrewedUp HB User2ScrewedUp HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

I had OATS done 2009. I can't stress enough 2nd/3rd opinions. Google OS (orthopaedic) docs in your area, see if they're in insurance. Google docs background, etc.-type in Dr. John Jones patient reviews or medical history, etc. Look for sites w/patient ratings & any listings about medical license (AMA) etc. Call docs: Have they done "D" procedure or OATS. How many? Success rate & if there's any patients you can talk to. How they'd do procedure (I had an OS & a DPM w/2 different ways to operate), schedule a meeting, bring questions/notebook & any x-rays/MRI's you've had. If you have a DPM ask for OS recommendations. It's your ankle/your choice. I based my decision on experience/medical knowledge of OCD's, bio/medical background & bedside manner/how they answered questions, responded to me. OS #1 had credentials but no bedside manner/was rushing me for decision. OS #2 had credentials (he specialized in OCD of Talus which is what drew me to him) & had Incredible bedside manner! He explained procedures/drew pictures, made sure I understood all along, asked me what questions I had & actually listened & answered questions. He has since treated a fractured knuckle & my bad knee. I had 2 1/2 months to do research, find OS, schedule surgery & did research on before/during/after surgery. Call me "OCD" pardon the pun w/research, but this was major surgery & new to me. Best of luck to you and Happy Healing.
__________________
2ScrewedUp

Last edited by 2ScrewedUp; 10-13-2011 at 08:35 PM.

 
Old 10-14-2011, 11:24 AM   #7
Senior Member
(male)
 
Join Date: May 2011
Location: Orange County, California, USA
Posts: 214
LivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

You can probably find the instructions online, which I believe involves making a foil mold of your OCD, setting minced cartilage in fibrin gel, then gluing it in place with fibrin glue. As j9879 said, they need the spot to be dry and enough access to make the mold and glue it in. If your pod hasn't done Denovo many times, at least make sure he's done talus grafts more than 10 times.

If you can still walk and doctor is in a hurry to operate, usually not the best sign. Or are you the one in a hurry? Is your tour Dec 1st 2011 or 2012, and is it like playing the drums in a band or skateboarding? If it's Dec 2011 and skateboarding, I advise you to miss the start no matter what surgery you have. Yeah it's possible if you have surgery next week (if no osteotemy) and be skating by Dec 1st, but you'd probably still have a weak ankle and risk of re-injuring the ankle and wrecking the expensive new DeNovo NT graft.

If your tour is skateboarding, do it next year instead. If it's your one and only chance to become the next Tony Hawk, you could could try tour first, surgery in February, but you risk making the OCD bigger.

Like 2screwdup said, get a 2nd opinion, maybe a 3rd, before you let anyone cut into your ankle. I got 4 opinions total before my OCD surgery.

Edit: I will try to attach a photo of this product installed in a knee (patella).

Quote:
Originally Posted by j9879 View Post
The good thing about using the DeNovo NT is that technique isn't much different from treating a typical OCD lesion of the talus. It is usually done through a small incision and does not require cutting any bone, but this is depended on the exact location and how difficult it is to reach. It isn't done arthroscopically because it is hard to get the cartilage and place it correctly through such a small incision. Also, the area needs to be dry to apply it, which is virtually impossible to achieve via arthroscope.

Last edited by LivesNearStore; 10-14-2011 at 11:31 AM.

 
Old 10-14-2011, 11:33 AM   #8
Senior Member
(male)
 
Join Date: May 2011
Location: Orange County, California, USA
Posts: 214
LivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

Trying to attach photo of Denovo NT glued into a patella (knee, not ankle) defect.

WARNING, medical photo, not bloody, but not for the squeamish.
Attached Images
File Type: jpg DeNovoNT_Patella.JPG (42.0 KB, 17 views)

Last edited by LivesNearStore; 10-14-2011 at 11:33 AM.

 
Old 10-25-2011, 04:54 AM   #9
Member
(male)
 
Join Date: Oct 2011
Location: Danvers MA
Posts: 55
JimJJr HB UserJimJJr HB UserJimJJr HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

I've had 3 microfractures of a lesion similar to yours. Started the same size as yours, but mine has grown to 25mm and is considered large. I just and mean JUST booked my DeNovo procedure for December. It sounds promising, and I don't want a plud that large removed from my knee...

 
Old 10-30-2011, 08:52 AM   #10
Senior Member
(male)
 
Join Date: May 2011
Location: Orange County, California, USA
Posts: 214
LivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB UserLivesNearStore HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

Here's some commentary I should have added with the photo. It's "book knowledge" since I have not had DeNovo or OATS myself.

The idea is that juvenile cartilage contains younger, more "aggressive" chondrocytes that will rebuild new articular (hyaline) cartilage, which is more durable than the fibrocartilage which is typically generated by a microfracture procedure. Mincing it helps release the chondrocytes from their normal cellular matrix and makes it easy to mold them into the correct shape. If all goes well, the "bits in jelly" you see in the photo above turns into new, solid cartilage. Don't know what happens if you have bone cysts underneath, my *guess* is it fills the cyst with new cartilage too.

What I've read is that traditional allo/autografts transfer mature articular cartilage but with mature chondrocytes, which are good at maintaining cartilage but not at rebuilding new cartilage. Autograft means a hole in your knee (or tibia) so becomes harder to do as the OCD gets bigger. Allograft kills some of the chondrocytes when the donor tissue is processed.

I believe there is some evidence that DeNovo produces higher quality replacement cartilage than microfracture. Haven't heard any evidence that it's better cartilage than what you get with OATS, but you avoid the donor hole and perhaps in some cases you avoid the need for a malleolar osteotemy, which should simplify recovery. Maybe Denovo also has a lower risk of rejection than allograft--I don't know. Perhaps J9879 knows and can comment.

 
Old 07-12-2012, 11:35 AM   #11
Newbie
(female)
 
Join Date: Mar 2012
Location: Richmond, VA
Posts: 6
Sari001 HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

I just ha d Denovo surgery 4 weeks ago on my 1st MPT joint. So far, all seems to be healing well and my foot feels better now thn it did before surgery! Did you go through with the surgery? My suggestion would be to stay away from Podiatrists and find an Orthopedic surgeon who is a "pioneer" in this area. I am 25 and a runner and am hoping to get back to running next year.

 
Old 07-12-2012, 11:55 AM   #12
Member
(male)
 
Join Date: Oct 2011
Location: Danvers MA
Posts: 55
JimJJr HB UserJimJJr HB UserJimJJr HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

Quote:
Originally Posted by skateboardankle View Post
I'm 25 and active with moderate non-restrictive pain.
2/25/10 Sprained Ankle
4/8/10 X-ray no findings.
9/24/11 MRI
10/17/11 Surgery Consultation
10/25/11 Surgery Scheduled w/ Podiatrist using Denovo NT

Findings from the MRI "moderate sized chronic osteochondral lesion of lateral dome measuring 10 x 9mm" "Mild amount of bone marrow edema within the medial malleolus of uncertain etiology"

I met with a Podiatrist and he was pretty adamant about surgery as my only option to fixing the problem. He has only done one other "D" procedure and the person is still recovering.

I am nervous about the surgery. My insurance runs out in May. I have a north american tour scheduled for Dec 1st which goes until Feb 3rd. I don't know enough about the recovery process. Any guidance or input would be greatly appreciated.
It's funny I got this email today WHILE I was at my 6 month follow up for e DeNovo procedure. best decision I ever made. I haven't felt this good in 7 years. I've regained my body back to 185 lbs, down 50 lbs. ride a bike for more than 20 miles 4x wk. I too recommend this be done by an OS, and not a podiatrist. I couldn't be happier I did the DeNovo

 
Old 07-12-2012, 11:59 AM   #13
Member
(male)
 
Join Date: Oct 2011
Location: Danvers MA
Posts: 55
JimJJr HB UserJimJJr HB UserJimJJr HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

Quote:
Originally Posted by Sari001 View Post
I just ha d Denovo surgery 4 weeks ago on my 1st MPT joint. So far, all seems to be healing well and my foot feels better now thn it did before surgery! Did you go through with the surgery? My suggestion would be to stay away from Podiatrists and find an Orthopedic surgeon who is a "pioneer" in this area. I am 25 and a runner and am hoping to get back to running next year.
Best thing in the world. Today was my 6 month follow up from ankle OCD.. AWESOME. I am pain free for the first time in 7 years, and I mountain bike 100 miles a week now! I noticed too, how much better I felt almost right away. Temper that with following the dr's orders and let it fully integrate into your bones before beating on it! I know it's hard when you feel so good for the first time in so long...

 
The Following User Says Thank You to JimJJr For This Useful Post:
Sari001 (07-20-2012)
Old 07-20-2012, 08:57 AM   #14
Newbie
(female)
 
Join Date: Mar 2012
Location: Richmond, VA
Posts: 6
Sari001 HB User
Smile Re: Yes or No: Ankle Surgery using Denovo NT?

Quote:
Originally Posted by JimJJr View Post
Best thing in the world. Today was my 6 month follow up from ankle OCD.. AWESOME. I am pain free for the first time in 7 years, and I mountain bike 100 miles a week now! I noticed too, how much better I felt almost right away. Temper that with following the dr's orders and let it fully integrate into your bones before beating on it! I know it's hard when you feel so good for the first time in so long...

You are so right! Short term pain for long term gain! Just a few more months and hopefully I can also dive right back into an active and pain free life!!!

 
Old 07-21-2012, 11:44 PM   #15
Member
(female)
 
Join Date: Jul 2012
Location: NY, NY, USA
Posts: 72
pclare HB Userpclare HB Userpclare HB Userpclare HB Userpclare HB User
Re: Yes or No: Ankle Surgery using Denovo NT?

I'm very curious to see the long-term outcomes of this procedure. I sure hope it works and lasts, because after several microfractures and an OATS, I'm pretty much out of other options.

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Sprained R ankle while recovering from L ankle surgery let me walk Foot & Ankle Problems 5 10-28-2011 04:50 AM
Dreading the fate of my ocd ankle: oats Brit215 Foot & Ankle Problems 141 07-03-2011 07:28 PM
Overview of ankle OCD treatment options LivesNearStore Foot & Ankle Problems 1 06-13-2011 02:18 AM
Ankle surgery (Brostrom) if you are single or living alone singlemom1 Foot & Ankle Problems 0 03-31-2011 09:25 AM
Ankle OCD in my 13 year old daughter 5englishes Foot & Ankle Problems 10 03-30-2011 11:54 AM

Tags
"d" procedure, ankle, cartilage transplant, ocd



Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added








TOP THANKED CONTRIBUTORS



roxygirl1 (187), Zerk (133), Titchou (129), Missyluke (121), Hollywood48 (119), ginger62 (97), LadyKanner (97), LisaBdot (83), AdkLizard46 (55), janewhite1 (52)

Site Wide Totals

teteri66 (1166), MSJayhawk (1000), Apollo123 (898), Titchou (833), janewhite1 (823), Gabriel (758), ladybud (747), sammy64 (668), midwest1 (665), BlueSkies14 (610)



All times are GMT -7. The time now is 06:30 PM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!