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



Foot & Ankle Problems Message Board

  • OCD Repair Options

  • Post New Thread   Closed Thread
    Thread Tools Search this Thread
    Old 02-26-2008, 02:21 AM   #1
    SkatersDad
    Member
    (male)
     
    SkatersDad's Avatar
     
    Join Date: Jan 2007
    Location: Bloomfield Hills, Michigan
    Posts: 86
    SkatersDad HB User
    OCD Repair Options

    After a failed drilling of a Talus Dome OCD lesion our surgeon opted to use a 9mm donor cadaver allograft plug to repair the OCD damaged area. The results have been very good so far but I'm curious what other options there are for these OCD lesions and how long/what to expect in the recovery process. I'm mainly interested in this information for my child's future needs in the event he needs further surgery but I know other people out there also are trying to find out which options to use to repair these terrible injuries. Drilling, Micro Fracture, Autograft, Allograft, Zenograft, Allo Plastic Graft, and Chrondrocyte Transplant. It appears that age has alot to do with this decision as well as the desired activity level.

    Any input about the various methods used to treat this type of injury would be appreciated, particularly about the long term results of any repair.

     
    Sponsors Lightbulb
       
    Old 02-26-2008, 07:47 AM   #2
    mak06
    Member
    (male)
     
    mak06's Avatar
     
    Join Date: Nov 2007
    Location: Arlington, VA
    Posts: 58
    mak06 HB User
    Re: OCD Repair Options

    Quote:
    Originally Posted by SkatersDad View Post
    After a failed drilling of a Talus Dome OCD lesion our surgeon opted to use a 9mm donor cadaver allograft plug to repair the OCD damaged area. The results have been very good so far but I'm curious what other options there are for these OCD lesions and how long/what to expect in the recovery process. I'm mainly interested in this information for my child's future needs in the event he needs further surgery but I know other people out there also are trying to find out which options to use to repair these terrible injuries. Drilling, Micro Fracture, Autograft, Allograft, Zenograft, Allo Plastic Graft, and Chrondrocyte Transplant. It appears that age has alot to do with this decision as well as the desired activity level.

    Any input about the various methods used to treat this type of injury would be appreciated, particularly about the long term results of any repair.
    SkaterDad, quick question. Since I took have had a failed drilling/debridement, and will most likely be on my way to an OATS procedure I was interested in the longevity of these solutions. I know that the OATS and OBI surgerys still result in inferior cartilage when compared to what we're born with...did your son's surgeon mention how long the OBI plus should last? Had you heard anything about how long an OATS procedure should hold up?

    I'll be seeking a second opinion in a little over a month...but just wanted to see if there were any other answers out there.

    My first surgeon made it seem that if I procede with the OATS a success would be minimal but manageable knee soreness, a patched up ankle lesion and return to a pretty active lifestyle. A success of this procedure he said would delay the (inevitable) arthritis in my ankle, hopefully for 10 to 15 years (unfortunately that still puts me at a pretty young 33 to 38 years old), at which point it will need to be addressed again. In terms of the technology and procedures we have now, it sounds like at that stage I would require a fusion (since it's unlikely I would get a replacement at that age). It does seem like there are cartilage regrowth techniques in testing phases now, and hopefully we can turn to these in the future to further delay a fusion or replacement...

    SkaterDad, did your son's doctor mention what the long term follow up would look like, or how long these surgeries should delay a subsequent surgery?

     
    Old 02-26-2008, 08:42 AM   #3
    SkatersDad
    Member
    (male)
     
    SkatersDad's Avatar
     
    Join Date: Jan 2007
    Location: Bloomfield Hills, Michigan
    Posts: 86
    SkatersDad HB User
    Re: OCD Repair Options

    Mak06,
    I have not heard that the OATs is an inferior type of cartilage to the synthetic plug. In OATS they are transplanting good hyaline cartilage and bone into a damaged area from a healty joint. If it heals and gets incorporated the articular surface should be almost as good as before the injury less minor scar tissue surrounding the area. Someone correct me if I'm wrong, but my son had an allograft from a donor cadaver which is also a transplant using good hyaline cartilage and it should heal fine. He is pretty active so it must have helped him or he wouldn't be skating two hours a day.

     
    Old 02-26-2008, 09:45 AM   #4
    mirchanon
    Inactive
    (male)
     
    Join Date: Nov 2007
    Location: VA
    Posts: 57
    mirchanon HB User
    Re: OCD Repair Options

    Quote:
    Originally Posted by mak06 View Post
    SkaterDad, quick question. Since I took have had a failed drilling/debridement, and will most likely be on my way to an OATS procedure I was interested in the longevity of these solutions.
    mak, any insight as to why your drilling failed? i'm about to get drilling done. I know you are about my age (23, 24) and Dr Jeng said that for young people our chances of success are greater.

    also.. I thought drilling provided hyaline cartilage as well. what would OATS do that drilling didn't?

     
    Old 02-26-2008, 11:40 AM   #5
    mak06
    Member
    (male)
     
    mak06's Avatar
     
    Join Date: Nov 2007
    Location: Arlington, VA
    Posts: 58
    mak06 HB User
    Re: OCD Repair Options

    Has anyone had their lesion treated with ACI? From the research I've done, it looks like a 3rd generation of ACI technique is currently in testing...but even the past techniques seem effective.

    From what I understand, in ACI they culture your own cartilage cells and re-transplant then into the defect in a biomatrix.

    Does anyone know what the OATS procedure is generally suggested after a failed drilling/debridement. Why is it that the ACI procedure is not recommended?

     
    Old 02-26-2008, 12:01 PM   #6
    SkatersDad
    Member
    (male)
     
    SkatersDad's Avatar
     
    Join Date: Jan 2007
    Location: Bloomfield Hills, Michigan
    Posts: 86
    SkatersDad HB User
    Re: OCD Repair Options

    From what I was told, if the Allograft that my son received from a donor doesn't get rejected than he should be good to go for 40 / 50 years. It's very well incorporated now with one edge that is a bit high. It's been almost 10 months. Doctor said after 24 months it should be completly integrated into Daniel's Talus and very doubtful he would have any further problem at that point. He is pushing it pretty hard but does avoid high impact - like running. He does power skating and ice dance 2 hours a day but its not impact like running. More of a torque - side loading type of movement than the jar you get from pounding your ankle during running..

     
    Old 02-26-2008, 01:44 PM   #7
    mak06
    Member
    (male)
     
    mak06's Avatar
     
    Join Date: Nov 2007
    Location: Arlington, VA
    Posts: 58
    mak06 HB User
    Re: OCD Repair Options

    Wow! 40 to 50 years!! That's great news...by then there should be vast advancements in cartilage/tissue engineering.

    If I even get half of that time out of an OATS procedure I'll be very happy! Hopefully I'll find out soon.

     
    Old 02-27-2008, 12:39 PM   #8
    Calrunner
    Member
    (female)
     
    Join Date: Jun 2007
    Location: SoCal
    Posts: 89
    Calrunner HB User
    Re: OCD Repair Options

    That's interesting, SkatersDad. I am now able to run with minimal pain (completed a 50K a couple of weeks ago!), but ended up with a lot of pain after a couple of days of skiing last week. I would think the ski boot would lock my ankle in place, but found the pressure of digging the edges of my skis into the snow unbearable. Yet, I can run?!?! (My ankle is now doing lots of painful popping.)

    Maybe it's because I don't ski often, so it was just a new type of torque in the ankle? Or maybe the boot held my ankle in a position directly over the OCD? Needless to say, I was suprised to have problems with skiing when running was going so well.

    Glad to hear Daniel is doing well. I'm still cautiously optimistic that my drilling/debridement is successful, and that I won't be faced with the "what's next?" question.

     
    Old 02-27-2008, 03:41 PM   #9
    mazzie46
    Member
    (female)
     
    mazzie46's Avatar
     
    Join Date: Aug 2007
    Location: UK
    Posts: 67
    mazzie46 HB User
    Re: OCD Repair Options

    Hey Mak

    Just a thought or two for you to help make your own mind up maybe;

    In any surgical procedure you have more chance of success the more experienced the surgeon is with that exact procedure. (Thats medical fact) Practise makes perfect as they say.

    Also, Myerson is at the top of this game! I would bet he has done this procedure more than anyone alive.

    Consider the extra wait for Myerson, with the extra wait of a whole extra surgery and recovery with a not so competent OS??

    You need to be happy with your decision that you have done the very best for your own recovery.

    Best of luck!!

    Mazzie

     
    Old 02-28-2008, 12:49 AM   #10
    DaveG1
    Newbie
    (male)
     
    DaveG1's Avatar
     
    Join Date: Dec 2007
    Location: perth, WA , Australia
    Posts: 5
    DaveG1 HB User
    Re: OCD Repair Options

    Hi, I've reviewed this web site a few times and found some interesting content.
    In summary, I have a large sub chondral cyst 15mm x 10mm from mylast MRI scan in the Talar Dome region. I had a microfrcture 2 years ago (NHS) which made matters massivley worse. Before the operation I had a grade 1 OCD. I now I have a grade 5 OCD.

    I am working in Australia now and have seen some of the Foot & Ankle specialists over here. My options are as follows;

    1) Do NOTHING and wait for cartilage technology to improve
    2) OATS operation
    3) ACI operation. Surgeon has performed 30 of those in the ankle and claims a 70% success rate. This is his preferance.
    4) Retrograde drilling - surgeon is NOT keen as I dont think he has done this operation before.


    They don't do the Allograft operation or the OBI procedure in Australia.
    The reason the ACI operation is NOT done in the US is that it doesnt have FDA approval. The knee however does have FDA approval so hopefully wont be too long away.

    Anyway I will get another MRI scan in 2 months time and then will have a tough decision to make.

    Yours in hope

    PS. I use an electronic device called 'E-cell' which I find very good for pain relief.

     
    Old 02-28-2008, 08:11 AM   #11
    mak06
    Member
    (male)
     
    mak06's Avatar
     
    Join Date: Nov 2007
    Location: Arlington, VA
    Posts: 58
    mak06 HB User
    Re: OCD Repair Options

    Quote:
    Originally Posted by mazzie46 View Post
    Hey Mak

    Just a thought or two for you to help make your own mind up maybe;

    In any surgical procedure you have more chance of success the more experienced the surgeon is with that exact procedure. (Thats medical fact) Practise makes perfect as they say.

    Also, Myerson is at the top of this game! I would bet he has done this procedure more than anyone alive.

    Consider the extra wait for Myerson, with the extra wait of a whole extra surgery and recovery with a not so competent OS??

    You need to be happy with your decision that you have done the very best for your own recovery.

    Best of luck!!

    Mazzie
    Thanks Mazzie, that's all definitely true, and I will probably reserve judgement until after I see Dr. Jeng.

    I guess I'm just assuming there will be a long wait for Myerson, and most likely I'll have the surgery performed by one of his associates (who are no doubt very experienced as well). Just wondering if people thought it would be foolish to wait and allow the cartilage to degenerate when I could get the surgery done by another OS I trust and feel is competent (although perhaps not quite as experienced). I know practice makes perfect though, just wondering if anyone else thought that the OATS procedure sounds like a simple one (technically speaking)...just wasn't sure if the amount of extra experience the Myerson clinic has makes any real difference with this type of straight forward surgery...

     
    Old 02-28-2008, 08:27 AM   #12
    akirka
    Veteran
    (female)
     
    Join Date: Oct 2006
    Location: Bitterroot Valley, Montana
    Posts: 373
    akirka HB User
    Re: OCD Repair Options

    Hi Mak,

    Everything I've been told about OATS is that you need to go to a very experienced surgeon. My Dr. here in MT is an excellent surgeon but she wouldn't touch me with a ten foot pole. I would want to go to someone who has done this at least 20 times ...... it sounds like a simple, straight forward procedure but it must not be. For my Dr. in MT to be very intimidated by it communiicates you want the best you can get (within reason). I'm not going to go to Myerson when I live on the opposite side of the country, but there are a handleful of gurus in the west that make it feasible for me. And I have to travel post-op long distances for various appt.s so that's a consideration in who you pick. My Dr.'s say waiting months is not going to drastically degrade your injury - it could stay the same for years (mine didn't change over a years time). So I wouldn't worry about that. One of my big concerns is that I didn't want a cast in the dead of summer with it being so hot. Cold air/weather feels good on a swollen, hot foot. But with going to school, I see your point wanting to get this done. Are there any other OATS Dr.'s you can go to in your area?

    Abby

     
    Old 02-29-2008, 02:52 AM   #13
    SkatersDad
    Member
    (male)
     
    SkatersDad's Avatar
     
    Join Date: Jan 2007
    Location: Bloomfield Hills, Michigan
    Posts: 86
    SkatersDad HB User
    Re: OCD Repair Options

    Heinselrunner - I'm curious if you use an orthotic when running but did not use it skiing. I recall that if a person has some pronation than for every degree of pronation the talus dome gets pushed forward an little bit which starts top-loading the talus dome. Their is an Athletic Trainer in Ft Myers, FL who took care of Garrison Hearst when he had avascular neurosis that told me this and how important it was to wear orthotics. Sound like your doing great!

    Our OS used to be partners with Myerson and moved back home to Michigan and he treats alot of athletes. The OS in Ann Arbor used to be a resident with Myerson. I imagine that most of these Gurus, have new docs going through fellowships so its getting easier to find a doc that does these. It appears to me that the instruments for this type of surgery are very specific to the treatment and I'm not certain if all have them. Daniel's when you look at the MRI started out very flush but about a month later one side of the plug was a bit uneven so my guess is that the press fit of the plug into the socket allows for some deviation.

    The Gurus also do alot of sponsored program research which allows them to teach, do more surgery and experiment but the flip side is that you may be getting something that is pushing the envelope and not proven yet.

     
    Old 02-29-2008, 05:35 AM   #14
    demogoat
    Senior Member
    (female)
     
    demogoat's Avatar
     
    Join Date: Feb 2008
    Location: New Hampshire
    Posts: 107
    demogoat HB User
    Re: OCD Repair Options

    Hey Mak,

    Just want to throw out one more thought to make your decision even more complicated. If you are waiting and are symptomatic, while it is unlikely you will damage your cartilage any further, other parts of your body may start to compensate for the injury. I am in that boat right now. I can't clear my own schedule for surgery until mid May and my knee and other ankle are getting very sore due to my limping on the bad ankle. My OS wanted to operate 3 weeks ago but with 3 kids (ages 3, 5, and 7) I have to try to maximize all available resources.

    Good luck!

     
    Old 02-29-2008, 08:57 AM   #15
    mak06
    Member
    (male)
     
    mak06's Avatar
     
    Join Date: Nov 2007
    Location: Arlington, VA
    Posts: 58
    mak06 HB User
    Re: OCD Repair Options

    Hey Demogoat...thanks for the reply. I know what you mean!! My right knee (same side as injured ankle) is flaring up!! At first I was worried about an ipsilater OATS procedure b/c my knee is already kinda sore...hopefully it's just irritated in there an no real damage though.

    Akirka, you said that the lesion could stay unchanged for years if I'm not working out hard/doing high impact...I guess I'm just a little worried because this is a NEW lesion! It wasn't there 1 year ago and this one is large! Also...within the last year I've only been on my ankle about 10 months because of the past surgery...and most of my time on it was faaar from high impact strenuous activity!

     
    Closed Thread

    Related Topics
    Thread Thread Starter Board Replies Last Post
    groin hernia repair mtmt Hernia 70 01-27-2013 05:34 PM
    TVH with cystocele and rectocele repair shejac08 Women's Health 36 08-27-2009 04:42 AM
    Newbie here - OATS repair 2ScrewedUp Foot & Ankle Problems 2 06-22-2009 01:32 PM
    Rectocele Repair Long-term Results bkdinsc Women's Health 3 11-28-2008 01:04 AM
    Ankle sprain after ligament repair kehorner Foot & Ankle Problems 2 01-05-2006 10:02 PM
    Incisional hernia repair West Coast Girl Hernia 2 06-18-2005 11:45 AM




    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    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




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 01:08 PM.





    © 2022 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!