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Old 02-05-2013, 05:59 PM   #1
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Fresh Osteochondral Allograft

Hello Everyone.

I am unfortunately facing some tough decisions in regards to a recent diagnosis, and to be honest I am just overwhelmed! In March of 2012 I had a severe ankle sprain during a volleyball game. I had x rays completed in the ER that evening as the sprain was quite bad and heard some popping when I rolled it. I was advised there were no fractures. I followed up with an appointment with an ortho doc, where he did his own set of x rays and evaluation of my ankle. Again was told no fracture, just a grade 2 or 3 sprain. He started me on physical therapy 2-3 times weekly. My ankle remained painful and swollen, less swollen over time, but never normal. After several return visits, the doc did an MRI this past January 2013. As a result, I was diagnosed with an Osteochondral Lesion of my talus bone accompanied by subchondral cysts. I was referred to one of his colleagues who was more specialized in the ankle Joint.

The new doc started off my visit with, "Your prognosis is not good". He advised he wanted to try micro fracture to help stimulate bone growth, however he advised this would likely be a failure due to the size of my defect. I was told we would likely have to complete a second surgery after 1 year to implant a cadaver bone. Was told I would not be active in sports or running again and that I need to re-evaluate how I will be getting my exercise. I was not happy with what I had been told and I also had a lot to learn.

I scheduled a follow up appointment with an ankle reconstructive specialist and was able to see him the next day. The new doc did his own xrays and CT scan. He advised the micro fracture would not work and that was an unnecessary surgery. This doc is advising me my best and really only option due to the size of my defect, is to have a "Fresh Osteochondral Allograft". This is a donor talus bone taken from another recently deceased person. I have to be put on a list and wait for a match based on size and age. I am very nervous to commit to this surgery as it appears to be a relatively new approach and no longer/lifelong studies to know how viable it is over time. Doc can tell that I have reservations and advised it may be a good idea for me to get a 3rd opinion from another specialist and even provided the name of 2 surgeons nationally who he feels are very reputable. Not sure if I go to see these docs or find others...Not sure where to begin. I have time and I want to use it before diving into something.

I am advised that if this procedure mentioned above does not take, that my only option at that point would be ankle fusion. I don't know that I am ready to accept that risk. I am hoping someone on here will have experienced this procedure before.


I don't know why I can't have the cysts filled/packed with donor bone and something like the De Novo Graft done for the lesion. I have so many questions. I don't think I am ready to commit to having 1/4 of my talus bone removed and replaced with a donor.

Very nervous, upset, and full of questions. I want to play sports and be a runner again, this is so depressing. It's crazy, my ankle is fairly normal right now other than a little pain and some swelling. It's just scary to think I may never have a normal ankle again. Any insight from anyone on here?

 
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Old 04-24-2013, 03:51 PM   #2
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It's been a while since I posted this, and a lot has changed. I had surgery completed yesterday, however ended up not doing the Fresh Osteochondral Allograft. I instead found a surgeon who I felt very confident and comfortable with who performed a bone graft using bone from my iliac crest (hip) to fill in the bone defect. Along with the bone grafting, he used the De Novo cartilage graft over the top. The surgeon also did some ligament tightening to help provide a more stable ankle. I am only 1 day post op, so not much to report on yet, but as I heal and have follow ups with my surgeon, I will be sure to provide updates. I did have a nerve block done which has worn off today and my pain is much more significant, but manageable with pain killers. I apologize for not having specifics, I will work on providing those after my first follow up which will be May 6th. Ultimately i chose this route vs the allograft talus because it left my existing bone in tact while still providing me the chance to restore cartilage in the joint without limiting my future options if I should need. Please feel free to ask any questions, i will be glad to share any of my experience with you.

 
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Old 05-01-2013, 09:27 PM   #3
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Re: Fresh Osteochondral Allograft

keep us updated. I am still waiting to see if my micro drilling worked. Its been three months since my surgery and I am still in a lot of pain when walking. I can't get any exercise.

 
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Old 05-07-2013, 11:07 AM   #4
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Re: Fresh Osteochondral Allograft

I am 2 Weeks Post Op from having the DeNovo procedure. My OCD was more than just a cartilage lesion, my underlying bone had died and I was left with a rather large bone cyst below the lesion. Overall my total defect was approximately 1/4 of my talus. I had a bone graft done, taking bone from my hip (illiac crest), to pack into/fill the bone cyst. On top of the bone graft, the doc then used the DeNovo cartilage graft. My total surgery was 3 hours due to the size of my defect. I had my 2 week follow up yesterday which was my first time to see my ankle since the surgery. Everything looks great, actually ankle looks pretty beat up, but my swelling is down and I appear to be healing well. My biggest surprise was the amount of muscle mass already lost in my right leg, it's only 2 weeks post op and the leg is significantly smaller than the other...PUNY! The doc tightened my ankle (tendon/ligamets ?) in my ankle, so my ankle was very stiff and I had very little range of motion. We did x-rays to see my progress, and it was amazing to see. My x-rays looked like a normal ankle joint! It's still early to know how successful this will be, as it will take a full year to year and a half for the cartilage to fully grow and incorporate. For the first 2 weeks I was in a mummy looking splint and spent the majority of my time laid up with my leg elevated. After a week I was moving around on my crutches a little more and more each day. It's super inconvenient as you have to rely on other people to do the simple things for you. Yesterday was my first time out of the house since the surgery as I tried to keep my leg elevated as much as possible during the first 2 weeks. I now have a hard cast on for the next 3-5 weeks. I am returning to the office starting tomorrow, with the help of others since I am still unable to drive due to this being my right foot. My pain level is minimal, only taking the occasional ibuprofen when needed.

Regards!

 
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Old 05-18-2013, 01:27 PM   #5
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Re: Fresh Osteochondral Allograft

Hi, I think I am 5 days (13May13) out from a similar surgery. After 3 years of ankle pain from a ski accident in 2010 and months and months where I thought physical therapy might be helping I finally had a MRI in Jan13. MRI indicated a 10x10mm osteochondral lesion on the back outside edge of the top of my left ankle talus. The MRI also indicated a 10mm deep bone degradation under the lesion. After a surgery delay due to a broken collarbone (oops!) I could finally use crutches and they operated last monday. I haven't had a follow up with orthopedic surgeon yet so I'm not exactly sure what they did but the nurse told me they ended up orthoscopically scooping a lot of damaged cartilage out as well as some kind of bone cyst then filling in the damaged portion of my talus with a bone graft from my left heal and then applying denovo cartilage before sewing me up. I think the total surgery lasted about 2.5 hours but with general anesthesia I'm not totally sure. They mentioned that they would probably to a nerve block but didn't. Pain isn't too bad as long as I keep my entire leg elevated. I've avoided using any pain meds during the day only needed two Vicodin right before bed on the 2nd, 3rd & 4th night. I'm not quite sure how I will manage 6 weeks of no weight bearing. Anyway I look forward to possibly comparing recoveries.

 
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Old 05-18-2013, 01:54 PM   #6
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MTBKR,

Sounds to me like you had the same thing done, only difference is where hour bone was harvested from, your heel vs my hip. Sounds like you are doing great for being just a few days out. I will be interested in hearing how your recovery goes. I am almost 4 weeks post op and my lower right leg remains in a hard cast that was placed on after two weeks. I haven't had to take pain meds for last few weeks, unless i've been up moving around a lot. At 2 weeks post op, I could tell my leg had already lost a lot of muscle from not being used, scared to see what it will look like when all is said and done.

Keep us updated on your progress, it may feel slow, but it will be worth it in the end!!

FLIN

Last edited by Administrator; 05-18-2013 at 09:29 PM.

 
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Old 05-18-2013, 03:04 PM   #7
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Re: Fresh Osteochondral Allograft

thank you both for your post. I am very interested in hearing how these surgeries go. Good luck.

 
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Old 06-02-2013, 09:13 AM   #8
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Re: Fresh Osteochondral Allograft

I had my 5 week follow up this past Thursday and happy to report that everything appears to be healing on a good course. My cast was removed, woo hooo!!! I can't even begin to explain how much my leg has shrank in size from being in the cast and non-weight bearing, it is absolutely puny. We did another set of x-rays during this visit, and the doc said that everything looks good. We are still waiting to bear any weight until we are sure the the bone graft completely heals as well as my tendons where the doc had tightened them. I tried moving my ankle while out of the cast, very tight and the muscles/tendons still feel a bit tender and weak. I was given an option for either another cast or I could go with a boot, with the condition that I only remove it to shower. I had no problem taking the boot as I couldn't wait to shower without a bag and rubber band on my leg I have now been placed into a boot/aircast and will remain non-weight bearing for another 3 weeks. At my next appointment, in another 3 weeks, we expect that I will be able to begin weight bearing while continuing to wear the boot. I will weight bear while walking in the boot for a 3 week period, then wean myself off the boot to only using a brace. So 6 weeks to go in the boot, and only 3 before I can start trying to walk on the ankle....can't wait! The biggest inconvenience has been the no driving up to this point. Doc said once I am weight bearing ok, I will be able to remove the boot while in the car and use a brace to drive. So I'm likely looking at another 4 weeks before I have my freedom back .

For anyone who has never had a cast on their leg before, it is absolutely amazing what happens to your skin while casted, not to mention the loss of muscle mass. I could not wait to get home and start washing my leg and foot. My skin was so dry and I had a rather large layer of dead skin that was just rolling off once I had a wash rag lightly rubbing over it. Felt so good to get the skin clean and lotioned up (Not the incision site though, that skin is still healing and a bit raw, keeping it dry).

Will give updates after my next follow up, hopefully this guy will be back on two feet and moving towards getting my active lifestyle back!!!

 
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Old 06-02-2013, 10:00 AM   #9
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Re: Fresh Osteochondral Allograft

MTBKR,

How is your recovery going?

 
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Old 06-11-2013, 10:19 AM   #10
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Re: Fresh Osteochondral Allograft

Quote:
Originally Posted by FLIN21 View Post
I had my 5 week follow up this past Thursday and happy to report that everything appears to be healing on a good course. My cast was removed, woo hooo!!! I can't even begin to explain how much my leg has shrank in size from being in the cast and non-weight bearing, it is absolutely puny. We did another set of x-rays during this visit, and the doc said that everything looks good. We are still waiting to bear any weight until we are sure the the bone graft completely heals as well as my tendons where the doc had tightened them. I tried moving my ankle while out of the cast, very tight and the muscles/tendons still feel a bit tender and weak. I was given an option for either another cast or I could go with a boot, with the condition that I only remove it to shower. I had no problem taking the boot as I couldn't wait to shower without a bag and rubber band on my leg I have now been placed into a boot/aircast and will remain non-weight bearing for another 3 weeks. At my next appointment, in another 3 weeks, we expect that I will be able to begin weight bearing while continuing to wear the boot. I will weight bear while walking in the boot for a 3 week period, then wean myself off the boot to only using a brace. So 6 weeks to go in the boot, and only 3 before I can start trying to walk on the ankle....can't wait! The biggest inconvenience has been the no driving up to this point. Doc said once I am weight bearing ok, I will be able to remove the boot while in the car and use a brace to drive. So I'm likely looking at another 4 weeks before I have my freedom back .

For anyone who has never had a cast on their leg before, it is absolutely amazing what happens to your skin while casted, not to mention the loss of muscle mass. I could not wait to get home and start washing my leg and foot. My skin was so dry and I had a rather large layer of dead skin that was just rolling off once I had a wash rag lightly rubbing over it. Felt so good to get the skin clean and lotioned up (Not the incision site though, that skin is still healing and a bit raw, keeping it dry).

Will give updates after my next follow up, hopefully this guy will be back on two feet and moving towards getting my active lifestyle back!!!


How are you making out? Recovery going well?
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17/06/13 Ankle Reconstruction and Achilles Lengthening

 
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Old 06-22-2013, 07:55 AM   #11
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Re: Fresh Osteochondral Allograft

I had my 8 week follow up this past week. At this appointment, we did standing x-rays while I was bearing weight on my ankle, to check the healing of my bone graft in the talus as well as the where my tibia had been cut and screwed back on. This was the first time in over 8 weeks that I had applied weight to my right foot, I was very nervous to step down for the first time. Amazingly, there was no pain!! The muscles were tight and weak, but no pain . The x-rays looked good! During my operation, the doc had to cut one of my tendons in half in order to get full access to my defect. To be sure the tendon was completely healed,the doc "tugged" around on my ankle to be sure it was nice and tight, he said it felt great.

I was fully expecting to be told that I needed to continue to use crutches for the next few days while I work towards walking in the boot, however the doc told me I could toss the crutches and walk freely in my boot, awesome news!!!!!!! After 8 weeks I have developed a Love/HATE relationship with crutches!!!! Anyways, I had this vision in my head that I would stand up with this boot on and just be walking like normal.. hahaha was I wrong! It was not graceful at first but it's getting better, I was just walk with a little "SWAG" in my step . There is some discomfort putting all my weight down and walking, but I associate this mostly to the weakness of my ankle and the ligaments being tight. The doc told me that by starting to walk and put weight on the joint, that I would now be "flushing" fluid around to the cartilage graft on top of my talus, helping to provide nutrients to it and helping it to grow.

The other great news is that I am cleared to start driving again! I have to take my boot off and put on a brace to drive, but that's nothing as long as I am driving myself! I have 6 weeks before I go back for another follow up, in the mean time I will be walking in the boot for the next 3 weeks, then transition to a "velocity" brace for the 3 weeks following that. Doc advised I can start using a stationary bike in 4 weeks once I have been walking in the velocity brace for a week. I am following his instructions, I don't want to mess this up! Until then, I am just thankful to be walking again, driving, standing up when I shower!, carrying my own stuff around, the list goes on and on!!!!

FLIN21

 
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Old 06-22-2013, 10:34 AM   #12
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Re: Fresh Osteochondral Allograft

That's great news. Glad you're doing well and getting your freedom back. Have to admit I am jealous though. Lol. I'm 5 days post op, bed rest , NWB and in cast hell. However, the drugs are good..lol. Perc's and Dilaudid.
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Old 06-26-2013, 09:12 PM   #13
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Re: Fresh Osteochondral Allograft

First time posting here. I joined the forum seeking short term and long term info on talar allograft recovery. I'll make a separate post for that but seeing this relatively new thread, I figured I'd post my story.

Long story short, I broke my left ankle at age 9 in 1975. X-ray was rather cloudy and the diagnosis was severe sprain. Several weeks later I walked 20 miles for a March of Dimes walk-a-thon and barely finished it. Ankle was a real problem for about a year but holding down an active 9yr old boy is not easy. I've always attempted any and all activity and usually paid for it for several days afterward over the next 22 years or so. About 8-10 years ago the pain became chronic and severe. Part of that time I had no insurance or money so surgery was put off. Ankle was continually swollen and very painful but I soldiered on without pain killers. Last May (2012) I had arthroscopic surgery to clean up the lesion. After 12 weeks non-weight bearing I was initially optimistic but during PT one day there was a loud pop and burst of pain followed by the joint becoming worse than prior to the surgery.

On 6-11-13 at age 46 I went ahead with allograft surgery at Sigvard T. Hansen Foot and Ankle Institute in Seattle, WA. It is part of UW. My surgeon was Dr. Michael Brage. The lower part of my tibia had to be removed (medial malleolar osteotomy) for a medial approach to the defect.

My understanding was that he planned to harvest a round "plug" of bone with the cartilage intact from a donor cadaver and cut out a similar sized spot in my talus to implant the allograft. According to pre-op MRI & CT my defect was about 14mm.

I'm 15 days post-op now and so far I'm pretty happy about the surgery. I used the pain pills for about 3-4 days, mostly at night to sleep comfortably. No pain meds at all since. I had a very large and heavy Thompson splint on it for 14 days. Splint and sutures were removed yesterday and apart from the gruesome look of the skin, muscle loss and bruising it looked good. Swelling seems to be much less than with last years surgery. I'm now in a walking boot for convenience and comfort but I have strict orders to remain non-weight bearing until my 6 week appointment. I expect to be non-weigh bearing for 12 weeks though. I am allowed to begin simple range of motion exercise as of yesterday.

Sleeping without that huge splint is a real treat! The joint feels pretty good but ROM is restricted and tight. Most pain seems to coming from the osteotomy site. The constant, never-ending pain that was present prior to surgery was gone on the first day. Pain in general has been minimal but pain prior to surgery was global and off the chart!

As with most people, I'm miserable living life on crutches but they are better than constant pain. Since my defect is in my left ankle, I can still drive and my employer is very accommodating so returning to work will happen 7-8.

I had to travel six hours one way to get to Seattle and a nerve block was offered and accepted for travel. My procedure was treated in an outpatient manner and I was home 12 hours after surgery. If you will be traveling within 24 hours of surgery you will want that nerve block! Better yet, avoid travel!

My primary goal is to lose the pain and be able to tinker around in my shop without dreading the consequences! Ultimately, I'd like to be able walk the deserts of the SW but that may be out of reach. At this point I'll settle for pain free.

I look forward to your recovery stories. If you have any questions about my experience fire away!

 
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Old 06-29-2013, 09:04 AM   #14
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Re: Fresh Osteochondral Allograft

Well I have had 9 days of bearing weight and am nearly 10 Weeks post op, so I wanted to give an update. My first few days of weight bearing in the boot/Aircast was a little awkward as I was learning how to walk with the contraption on my leg and just the plain weakness of my ankle and leg muscles. Each day has gotten better in terms of my ability to walk. The one thing that has increased is my level of discomfort. I associate most of my discomfort with the weakness of my ankle. Most of my pain/discomfort is coming from top of my ankle. The muscles in my foot even seem to get stiff and I find myself trying to stretch them out for relief. During my surgery they had to cut in half my FDL tendon and then reattach the two halfs. The doc told me they over tightened this tendon when putting it back together to help provide stability. My guess is that as I am weight bearing, these muscles and the FDL tendon are all getting stretched back out and strengthening themselves, which I believe to be the likely cause of most of my discomfort. I likely pushed myself too far the first few days, it was so hard to resist being on my feet after having been laid up or crutcing around for the past 2 months. I am taking it easy this weekend and really trying to rest the ankle as much as I can and doing some icing of the joint throughout the day. I talked to the doctor's office yesterday, as I wanted to check in and be sure what I was feeling is considered normal. They advised that it should be getting better each week, but also advised that I would likely go back through a similar experience once I move from the boot to a brace. Once in the brace I will be introducing more motion in the joint, so once again more strengthening and stretching out of everything.

I can't wait until I am able to just hop out of bed and wear nothing on my feet except some flip flops, I live at the beach and it is very hard to see the "Beach Life" happening around me and not being able to fully enjoy my surroundings. I am keeping things in perspective though, I am much better off than I was 9 weeks ago when I was fresh out of surgery, at least I am able to drive now and walk around with my boot on.

I will check back in a few days and provide an update. I am hoping the discomfort will have subsided more and will have gained some strength back!

Regards,

FLIN21

 
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Old 08-06-2013, 09:00 AM   #15
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Re: Fresh Osteochondral Allograft

I had my 14 week post op follow up last Thursday with my surgeon. This was a great appointment! It had been 6 weeks since my last appointment, of which 3 was spent weight bearing in an aircast/boot followed by 3 weeks of wearing a velocity brace. We did the usual x-rays when I first arrived for my appointment and then reviewed them with the doc. The bone is healing extremely well. We compared all of my prior x-rays to the most current and it was awesome to see how well my bone graft has taken, at this point there is no difference between the bone graft and the rest of my talus. Each x-ray showed improved/decreased contrast between where the defect was and the rest of my talus. The doc has released me at this point to begin low impact activities i.e. swimming, eliptical, cycling, etc. This is great news! I will still be wearing an ASO brace for the next few months to keep the joint protected while I am gaining my strength back. I will be restricted from high impact activities (i.e. running and jumping) for the next few months while the DeNovo cartilage graft continues to grow and incorporate itself on top of my bone graft.

In terms of how I am feeling, my ankle feels better every single day. I have no real pain at this point. I have some loss of feeling remaining across the top of foot, but the doc advises that this will come back over time as I continue to heal. The leg muscles are slowing getting stronger and are getting closer to being back to original size. The first few weeks of walking in the brace without a boot was probably the most uncomfortable part of the recovery for me, as the foot and ankle muscles hadn't been used for a while. As i began walking and my foot was being used to walk normally i.e. rolling the weight over the ball of the foot, I experienced a lot of muscle strengthenig pain. I am now to a point where I barely even notice any discomfort in the mornings, I am literally going through my daily activities not even thinking about how my ankle is feeling. It's amazing to look back and see how far I have come and how far on the other side of this I am. :-)

 
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allograft, ankle ocd lesion, ankle sprain, osteochondral lesion of the talus, subchondral cyst



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