Ankle microfracture / drilling, brostrom, biocartelige

[1168phil]

This forum has really helped me come to an understanding of my ankle, and hopefully I can pay it forward. Late June of 2012 I stepped on a guy's foot while playing basketball (just running down the court, not landing from a jump). After many a misdiagnosis and tons of different treatments 17 months later, I'm left with surgery or live with the pain. I have opted for surgery as I can't continue to play basketball as I am now. The surgeon is doing a microdrilling, aided with biocartelige and bone marrow to be extracted from my heel, to fix my 10x6x7mm OCD. I am also having a Brostrom procedure concurrently to reconstruct my outer ligament. This is my first time having surgery so to say I'm nervous is quite an understatement. The surgeon thinks I can return to work (at the library) 10 days later as long as I remain NWB. I'm 28, was in great shape before the injury but not any longer. 10 days sounds VERY optimistic from what I've read online. If anyone who comes across this post has any advice, opinions, words of wisdom, questions, please don't hesitate. My surgery is on Wednesday, Nov 20 of 2013 and I plan to update throughout for those who may be interested.

[umtum]

hi Phil,

your story sounds so similar to mine.  I was diagnosed with ocd earlier this year when I was 28 about the same size as yours.  Happened due to basketball injury.  I'm guessing your lesion is on the lateral side like mine.  In march I had microfracture surgery.  After 6 months i was still in pain (actually worse than before).  My doc kept saying to wait it out and it was normal.  However, I knew something was wrong and my doc was a total douche bag.  ANywho, I went to see another doctor and ended up having the Denovo + ligaments done just 2 months ago from today.  So far, the recovery from denovo has been much better than with microfracture.  I can walk without that horrible ocd pain anymore.  It does flare up and becomes painful at times.  I'm hoping that's from the ligaments.  Hopefully things will get better in couple more months. Hard to say if it was a success right now.

Don't be afraid of doing microfracture b/c of my failure story.  Honestly i think my doctor screwed up the surgery.  My personal opinion is Denovo seems much less invasive and recover is better.  However, there are atheletes that have returned from ankle microfracture to play sports again (Andrew Bogut, Gary O'neil).  I think i went to school after 5 or 6 days after microfracture.  It wasn't too bad as long as you can put your leg up on the chair so that all the blood is not rushing down.  Since your doing ligaments too it may be more challenging. 

My advice would be to be patient with your recovery.  Somedays you may feel good and think you're ahead of schedule so you push it and then you end up paying for it later so BE PATIENT.  Don't push to hard.  Be gradual in your recovery.  There's a lot of ups and downs.  You'll experience pain.  Not only physically but mentally and emotionally.  I was devastated that I couldn't play bball anymore let alone even go outside for a walk.  It still haunt me to this day.  When you have negative energy try meditating to calm your mind and body.  Be around ppl that care about you. It can get real difficult if your by yourself. GLUCK and let me know how it goes =]

[1168phil]

Thanks for the post. I was hesitant about microfracture from the get go, but the surgeon I am seeing is one of the pioneers in using denovo and for whatever reason said denovo wasn't right for me. I trust he has my best interests, seeing as he'd make more money if I used denovo. He instead is using my own bone marrow from my heel and something called biocartelige, which sounds similar to denovo only "frozen" I guess like astronaut ice cream.

I was also hesitant because my OCD seems much less bothersome than other people have had. For the most part it is calm, but I have some days worse than others. It really only bothers me after exercise, which is why I quit. But the surgeon said in a year I'd be back to basketball and I can't stand being so sedentary and gaining weight after playing in 3 highly competitive basketball leagues at a time.

Hopefully your recovery and denovo work out great for you. I will post my progress with the biocartelige as I've yet to come across anyone who has used it. I hope it works, because I'm not sure my nerves can take prepping for another surgery.

[umtum]

So your doctor has performed Denovo before? I wonder why he didn't explain what the reason for not recommending denovo. B/c I brought it up to my first doc who did the microfracture and he knew about it and just said "that's something we're hoping for the future." Basically he was stuck to his old ways and didn't want to admit that he doesn't know how to do a denovo or he's never done one.  I guess the only reason I can think of why your doctor told you that is b/c Mfx is still considered the first line of treatment for OCD b/c there's not conclusive research on denovo yet.  Also, you're doctor wouldn't make more money by doing a denovo.  The money for the denovo cells goes to the denovo company not the doctor.  Just make sure you have a good honest, knowledgable doc who will take care of you.  My first one who did the mfx was such an idiot. 

I think you'll do well if your in good hands.  So far I'm doing pretty good and it's been 8 weeks.  GLuck Phil! Wish you a fast and smooth recovery. 

[1168phil]

My surgeon is one of 8-16 (I can't remember how many) docs who participated in the case study using denovo. After re-reading my exam review, the dr seems to think that denovo is a bit overkill since my OCD (although fairly large) isn't a prime candidate as there is still a flap of cartelige covering it as opposed to a "hole" lacking cartelige. At least that's what I gather. The stuff he is going to use, Biocarelige, seems comparable to denovo in that it is stem cells taken from cadavers but it seems to be applied in a very different way. Maybe that's the difference. I'll ask tomorrow if I'm not too terrified and can remember, as I'd like that to be option #2 if this fails

[umtum]

Which side is your lesion on? Also, do you have continual swelling around your ankle joint? inflammation?

I don't really understand why it's an overkill b/c MFx is more invasive I think (since you have to drill the bone)... I also had a flap that was covering... I think my first MFx doc may have drill under then flap and try to push down the cartilage b/c when my denovo doc when in my ankle he said that he couldn't tell where the mfx was done and there was a flap... He assumed that he did mfx underneath it... but who really knows... i don't think you should ever be afraid to ask your doc any questions... this is your life at stake... b/c of my first doc I suffered for 6 months... you have every right to know any doubts or concerns you have... it's his job to educate you and have you understand exactly what he is doing... you could ask him about the exact reason why he thinks it won't work... you can tell him about me (we seem to have the exact same diagnosis) and my recovery at 8 weeks... Gluck on surgery!

[1168phil]

Thanks! Headed to the hosptial now, I'll post an update when I feel up to it.

It's not so much being afraid to ask the dr. about why not denovo as much as I trust his decision. If it were simply mfx then I'd be going elsewhere. This is actually the third surgeon I'd met with, and the only one who offered to do anything additional to the ocd (using biocartelige and my own stem cells from my heel). He was also the only one who said I'll be back to playing basketball 100% in a year, so I feel okay with his decisions.

I do appreciate your concern, and I am going to ask about the specifics of why no denovo (if I remember... I get forgetful while nervous) just so I know.

Good luck with your recovery, and I'll let you know how things go.

[1168phil]

I just wanted to post an update 20 hours later. Surgery went well, although my OCD was a bit larger than anticipated. I think i the MRI said 10mm but doc said it was certainly bigger than 1cm. Everything looked good though.

My nerves were better than I thought they'd be as I arrived, which was good. The stuff they gave me for nerves did an ok job, and the anti nausea medicine helped too I believe. The 2 nerve blocks being shot in weren't too bad, and were lifesavers for my 2 hours car trip home.

I did fine with the anesthesia, I knew where I was, what happened, no sick feelings. Definitely groggy though. I was in the OR for about an hour, and in recovery for 30 minutes that I don't remember at all (but the nurse said I was telling him about some crazy stuff) and was in recovery for about an hour that I do remember... So an hour and a half after total. I honestly did better with this than the light sedation I had for wisdom teeth removal.

For the next 2 weeks I'm to just lie in bed, take it easy, and elevate w ice. My splint/dressing has a coil wrapped inside for this ice machine they sent me home with, so every 20 minutes I just hook up some wires to my leg and it ices for me. At least I'm guessing, cuz I'm still numb from the knee down.

Umtum, to answer your earlier question, my injury was on the outside of my ankle (lateral?). Both my OCD and ATFL ligament.

I'll post again once the block wears off, or if anyone has questions. Thanks everyone for your support. This forum really is a great community.

[mhop]

happy healing and hang in there.  the first 2 weeks were the hardest for me - being in pain and also being so sedentary - but it seems to get progressively better every day.

[ocdnetadmin]

Goodluck Phil. Keep us updated. I'm also similar age and similar injury event (basketball, someone's foot) with similar size OCD.

[1168phil]

Just wanted to give a quick update as its been a while. Got my surgical splint removed after 2 weeks, and getting the hard cast on was a nightmare. I think it was more due to the inattentive nurse than anything. Im back to work with the help of a knee scooter, but cannot wait to be done with it. Had to be put back on anti inflammitory meds due to a swollen big toe, but aside from that just keeping elevated. My toes still turn deep purple instantly when down, even 4 weeks out. I hear that lasts a while though. I should be in a walking boot come Xmas eve... all xrays look good for my ligament reconstruction but the OCD drilling will take a while to know how it went. Doc says based on the surgery I should be 100% back to competitive basketball by next winter/spring.
The healing does get better every day, but the boredom gets worse. I've never looked forward to work as much as I have recently (and I hate my job). I'll post again if anything interesting happens, or when I am PWB. Does anyone have any tips for finding a physical therapist? The only time I've used one it was terrible, 90% of the time was me just waiting for the therapist to finish with other patients while I sat on the table bored... And I later found out they specialized in shoulders... Thanks all

[ocdnetadmin]

Thanks for the update Phil. If you can get back to competitive basketball that would be amazing. I miss the sport everyday.. I will stay tuned to your progress. IF it goes well I might consider denovo myself.

[1168phil]

Update on healing... I am now in the weight bearing phase of healing. Not sure if my experience is typical, but the transition to walking in my boot has been mostly painless. I was able to quickly go to full weight within 2 weeks, never having pain. I will say, however, that I was not very swollen at all after being in a hard cast, but now that I am walking my swelling has become tremendous. The area over my microfx and brostrom have become lumpy and hard, not squishy like I'm used to with swelling. I've dialed back my full weight bearing, particularly at work, until I see my physical therapist for the first time. I was warned of swelling, but the lumps have put me off a bit on my progress and I'd rather play it safe for now. My surgeon is 2 hours away or I'd have them take a quick peek. All other things seem to be going well, scars are healing and the random pains deep in my ankle have gone away. It's VERY early but I feel good about things thus far. I'll update as therapy progresses through the month

[ocdnetadmin]

Thanks for the update Phil. Maybe you can call your surgeon? He probably wouldn't mind.. mine discussed my progress via phone a few weeks after my operation.

[MJDO64]

Glad to hear your progress Phil and will keep tabs on your recovery.  I too hope you can reclaim your active life once again.  My surgeon says him and other colleagues debate on when a Denovo patient should begin impact activities after procedure.  He's telling me no running until a year out and no cutting/high impact/yoga exercise 9-12 months postop.  Some of his other colleagues were allowing running 6 months postop.  Was not very happy to hear how long i'll be out of commission once again, but will have to settle for biking/swimming once I get the green light.

Jan 31, 2014 going in for Denovo for my failed incomplete allograft/OATS lft ankle from 3 yrs ago and possible lateral ligament repair (laxity is small but causing instability and pain). Allograft didn't completely take and cartilage lifted this last year, which in turned causing fluid being forced into incomplete graft and produced a cyst as well. Osteotomy screws being removed  also.  Did your insurance cover scooter and ice machine?  I've been seeing these used as I read upon others stories.

MJ
50 yr Female