The OATS procedure, an abbreviation for osteoarticular transfer system, is a surgical procedure used to treat focal cartilage defects. Although, the administrative assistant told me it will be ANOTHER 3 months from now, & Im not having that so Ill be calling the insurance company to get thing prior authed. Hi! He said the OCA revision surgery would be a salvage procedure to buy me a few more years until Im a little older for a replacement. Our hip preservation service offers arthroscopic hip labral repair and hip osteoplasty. Biopsy shows type II collagen. This is not always the case. In Technique B, healing is initiated by allogeneic chondrocytes reimplanted beneath a periosteal patch. After that I will be able to add 25% of my weight each week. My doctor decided to do MACI on patella and trochlea because he said it is difficult to get the right contour with the articulating surfaces especially since mine was bipolar or kissing lesions. Tested Concept, Grade 4 lesion of the medial femoral condyle, Varus mechanical axis on standing full length radiograph, Concomitant anteromedial tibial tubercle transfer osteotomy (Fulkerson's), Osteochondral Plug Allograft Transfer of the Knee, Type in at least one full word to see suggestions list, 2018 Orthopaedic Summit Evolving Techniques, Dehydrated Human Amnion/Chorion Membrane (dHACM) Allograft Is Solving So Many Problems In My Osteoarthritic Patients - Listen Up! Biopsy shows type I collagen. Grafts in Technique C are transferred to an antibiotic solution to kill microorganisms and stored at 4C until use. Im also going to make tons of freezer meals for easy cooking. 5-10% of people > 40 years old have high grade chondral lesions; location. I thought I would give a more detailed description of what my next knee surgery will be. My doctor is fixing them two different ways. A biopsy of the repair site at 3 months will reveal more Type I collagen in Technique B than in Technique C. Technique C is a 2-stage procedure. In the OATS procedure, the plugs are usually larger, and therefore only one or two plugs are needed to fill the area of cartilage damage. Walking, gardening and bending down to pick up your kids are activities we take for granted until theyre no longer second nature. In Technique C, healing is initiated by mesenchymal stem cell migration from subchondral bone. My three areas of damage (circled in red above) are: 2.5 cm x 2.2 cm defect on the lateral femoral trochlea (slightly larger than the size of a quarter), 2 cm x 2 cm on the medial femoral condyle (slightly smaller than the size of a quarter), and 1.5 cm x 1.5 cm defect on my patella (knee cap). Biopsy shows mixture of type I and II collagen. OATS is one technique of several used to treat this problem; the type of procedure is called a mosaicplasty. MACI vs MFX at 5 years 128 of 140 patients Continued Superior KOOS Pain Scores and Function Scores for MACI Group Long Term OATS vs MFX Randomized Controlled Trial 20 OATS, 20 MFX Lysholm: 1yr, 5yr, 10yr, 15yr Both groups improved at all time points The Facebook group is called MACI support group. OCA stands for osteochondral allograft transplant surgery. Combination of autologous chondrocyte implantation (ACI) and osteochondral autograft transfer system (OATS) for surgical repair of larger cartilage defects of the knee joint. The first step was done in May where my doctor performed a knee scope and took a small biopsy of my articular cartilage. I tried looking but couldnt find it. That was the size of my trochlea defect which is slightly larger than a quarter. Please take a look at the rest of my blog to see my recovery from this surgery. In my opinion not the best option because there will be areas between the small plugs of no cartilage. Of note, he is to be TOUCHDOWN WEIGHTBEARING for the next 6 weeks. Tested Concept, (SBQ07SM.32) I have had to give up all forms of exercise (biking & swimming even cause me pain) & it has been difficult to do household chores. A 35-year-old man presents with mechanical knee pain after a fall. Following a medial femoral condyle osteochondral autograft mosaicplasty, which of the following statements best describes the fixation of the graft? My surgeon will cut the matrix to fit my defects and glue it in. Sites are re-opening to serve patients with respiratory vs. non-respiratory symptoms; see location/service updates. (LogOut/ OATS protocol. All of the following are acceptable scenarios for the use of autologous chondrocyte implantation (ACI) in the patellofemoral joint EXCEPT: Im doing ok. Slightly frustrated with the recovery since my symptoms havent improved at all. (OBQ13.152) Community Virtual Carevisits available 24/7. Overtime the bone and cartilage will grow into the damaged area to resolve joint pain. Hang in there! (LogOut/ You are almost through the worst of it. Im 7.5 months post-op (lost track of weeks by now). (OBQ13.203) That means I will be on crutches until week 10. They will take a plug the size of my defect from a fresh tissue donor (cadaver bone) and put it into my defect. It was definitely a difficult decision for me to make, but in the end I trusted my surgeon and his past experience with patients and that he saw better outcomes using MACI for patella & trochlea vs OCA. Thats when I will have the second surgery. He said it takes up to 18 months for the grafts to completely fill in and harden. Its nice to hear about your confidence in your doctor. They grow the cells in a matrix, like a very thin sponge, as seen below. Tested Concept. MACI, or Matrix-Induced Chondrocyte Implantation, is a two-step procedure where new cartilage cells are grown and implanted within the existing damaged cartilage. Tested Concept, Anterior (Maquet) tibial tubercle osteotomy, Anteromedial (Fulkerson) tibial tubercle osteotomy, Medial opening wedge high tibial osteotomy, Lateral closing wedge high tibial osteotomy, (OBQ10.257) Communitys Center for Joint Health provides procedures for preservation of both hips and knees. Let's Cope with Bullying Together. Many believe that when it comes to joint pain you have only one solution: joint replacement. The OATS procedure, or Osteochondral Autograft Transfer System, is often referred to as a mosaicplasty. Im going to be as prepared as possible and have everything set up in my bedroom. A 32-year-old female is referred to you for definitive treatment of a symptomatic focal chondral defect on her medial femoral condyle. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. anterior aspect of lateral femoral chondyle and posterolateral tibial plateau Although the procedure still remains a 2-stage procedure, the use of the matrix reduces operative time and morbidity and theoretically allows for more even chondrocyte distribution within the defect. But Im so thankful for tissue donors to give people like me another chance to live life pain free and better than what it was before. TTO stands for tibial tubercle osteotomy. Joint Preservation: An Alternative to Joint Replacement, How to Talk to Your Doctor About Joint Pain, Combating Shoulder Pain in Contact Sports. A review illustrated by a case report. These areas of exposed bone are extremely painful. They have all said the first week or two you wont want to leave your bed because the pain is so bad. (LogOut/ Is a 2.5 cm central full-thickness patella defect considered small enough for OATS? His surgeon considers treatment with Technique B and Technique C, which are shown in Figures B and C, respectively. Once the cells have matured they are placed within a membrane for transfer, and are glued into place. This will result in pain relief and for the damaged tissue to heal. - Kris J. Alden, MD, PhD (OSET 2018), Pro: The Autologous Cartilage Tissue Implant - Thomas M. DeBerdino, MD (OSET 2018), Mini-Panel: I Didnt Realize The Cartilage Lesion Was >2cm But <5cm - Solving The Problem! Our knee preservation service offers the OATS and MACI procedures. How many weeks post-MACI are you? Question for you: Why did your surgeon decide to do a MACI on your patella defect rather than aOCA? Since the medial femoral condyle already had microfracture done (little holes poked into the bone) in August 2017 he has to do a procedure called OCA transplant. He is also to start a continuous passive motion machine from 30-70 degrees and advance 10 degrees for goal 0-120 degrees. OATS - MOSAICPLASTY No disease transmission Good chondrocyte survival Reliable bony union Limited donor size Graft size MACI vs MFX 137 pts with FU @ 2years KOOS scales MACI was clinically and statistically better for treating symptomatic cartilage defects than MFX OATS - MOSAICPLASTY. Then the matrix will heal into my bone and provide my bones the cartilage and protection it needs. MACI was superior to microfracture (KOOS response rates 97% vs. 77%), while a positive trend was seen for the individual components of the co- primary efficacy parameter for both pain and function. Change), https://www.facebook.com/groups/130981344407971/?ref=share. This is what my knee will look like on x-ray after the TTO surgery:This will help realign my knee cap so it wont put as much pressure on the defect areas. A diminished immune response to transplanted chondrocytes is seen in Technique C because the dense cartilage matrix acts as a barrier that limits antigen exposure. With the patella not being very thick, and the shape of the patella, it makes it more difficult to get the transplant graft in there and getting a nice smooth surface with no clefts or divots. I still have not received an estimated date for the next surgery, but Im really hoping for August 15th. chronic ACL tear. Biopsy shows type I collagen. See COVID-19 testing information. So if anyone wants to come deliver food to me in bed, that would be great . Once my cells have grown to an appropriate size (enough for both my trochlea and patella defects) they will be ready to be implanted back into my knee. When this procedure is performed, plugs of cartilage and bone are taken from a healthy, non-weight bearing area of the joint and moved to replace a damaged area. When is fill-in expected to occur? a recipient socket is drilled at the site of the defect, a single or multiple small cylinders of normal articular cartilagewith underlying bone are cored out from lesser weight bearingareas (periphery of trochlea or notch), size constraints and donor site morbidity limit usage of this technique, matching the size and radius of curvature of cartilage defect is difficult, fixation strength of graft initially decreases with initial healing response, weight bearing should be delayed 3 months, include autologous tissue, cost-effectiveness, single-stage, may be performed arthroscopically, goal is to replace cartilage defect withlive chondrocytes in mature matrix alongwith underlying bone, fresh, refrigerated grafts are used which retain chondrocyte viability, may be performed as a bulk graft (fixed with screws) or shell (dowels) grafts, match the size and radius of curvature of articular cartilage with donor tissue, an osteochondral dowel of the appropriate size is cored out of the donor, include ability to address larger defects, can correct significant bone loss, useful in revision of other techniques, limited availability and high cost of donor tissue, live allograft tissue carries potential risk of infection, Autologous chondrocyte implantation (ACI), cell therapy with goal of forming autologous "hyaline-like" cartilage, arthroscopic harvest ofcartilage from a lesser weight bearing area, in the lab, chondrocytes are released from matrix and are expanded in culture, defect is prepared, and chondrocytes are then injected under a periosteal patch sewn over the defect during a second surgery, may provide better histologic tissue than marrow stimulation, long term results comparable to microfracture in most series, include regeneration of autologous tissue,can address larger defects, must have full-thickness cartilage margins around the defect, prolonged protection necessary to allow for maturation, only elevate 1 cm or else risk of skin necrosis, cells are cultured and embedded in a matrix or scaffold, matrix is secured with fibrin glue or sutures, only FDA approved cell therapy for cartilage in the USA, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Concussions (Mild Traumatic Brain Injury), include ability to perform without suturing, may be performed arthroscopically. 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