OsteochondralDefect.net Community
Osteochondral Defect Discussion => Ankle => Topic started by: BLT on February 02, 2015, 12:18:44 AM
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Hey I thought I'd go ahead and start a thread to track the progress of my surgery here in case anyone is interested. Since there is not much personal info about this type of surgery, I wanted to do my part to contribute.
My OCD started back in 2006 when I had a terrible ankle sprain. On November 11th of 2010, I went in for MF surgery, and initially recovered very well. In March of 2011, I returned to traveling. I went to Taipei and was able to walk all over the city without any major ankle issues (occasional inflammation occurred, but it was expected and easily forgotten). In September of 2011, I was able to go back and do some jogging, the Beach Body Insanity workout, as well as running a 5K. Unfortunately around June of 2012 the pain returned. My only guess is that the scar cartilage formed from the MF surgery didn't hold up to my activities. After several months of pain, I started using ankle braces to help with alleviating the pain, but it was only a partial fix. The pain was always on the back of my mind and started to affect my day to day confidence. My mental bandwidth was slowly dominated by thoughts of this pain.
I finally decided to bite the bullet, so on January 14th of 2015 I had the surgery. My insurance didn't cover the "Denovo related" parts of the surgery so I had to pay that out of my pocket, which was approximately $11,000. I'm not rich, but the possibility of having my left ankle back was worth the cost. Thank you VISA and MasterCard with 0% APR. Luckily my visits and equipment for recovery are completely covered by insurance.
It's now Feb 1 and I am about 2.5 weeks post-op. I'm still not weight bearing and won't be until 6 weeks post-op. But I feel like the recovery is going well. I can feel my ankle is less and less swollen by the day. I'm also no longer in a cast, and instead am using a splinter cast. It's essentially a partial cast that only covers the back of my calf and extends out to my toes to keep my ankle in a 90 degree position. I take off the cast about four times a day to do simple vertical flexing motion (no horizontal). The flexibility is improving each day. I'm also improving on my crutching ability. I decided not to pick up anything special for moving around. As for cleaning myself, I feel good knowing I am not using more water than needed for my towel baths.
At this point my mind has completely hung onto hope and optimism for the results since I've essentially shut the door on the past pain.
Thoughts? Suggestions? Comments? Please share!
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Good luck and please let us know your progress
Where did you have the denovo procedure performed?
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Good luck and please let us know your progress
Where did you have the denovo procedure performed?
The procedure was performed at the Southern California Orthopedic Institute (SCOI). Dr. Richard D. Ferkel performed the surgery.
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Hey, sounds like we've got pretty much the same story. Former athlete, OCD in 2010, microfracture in 2012. I was back to full activity and feeling 100%, then after about 3 months I was back to pain that was worse than ever. I had DeNovo done a little over 7 weeks ago. I have 1 more week non-weight bearing then will be in a boot until 3/16. Best of luck! Let me know if you have any questions about recovery.
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BLT and Name:
How large were your lesions? They weren't on both sides of the ankle, were they? I have large lesions 15mm on both my talus and tibia. Doctors tell me my prognosis is not good, especially due to the tibial lesion. I'm obsessing over mine, and sometimes get really down...I'm still way too young for TAR or fusion. The only good news is I'm not really in pain from daily activities but it's hard to get around the likelihood that I won't ever be active again...
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Initially before my first surgery I think mine was 12x9. It grew by the time I had my third surgery and I'm almost sure it was up to 15. I had only one lesion.. Here is my MRI: http://imgur.com/a/fZZg5. I'm confident that this last surgery will work, but like you I have been obsessing over it for the past two years. Stay confident!
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BLT and Name:
How large were your lesions? They weren't on both sides of the ankle, were they? I have large lesions 15mm on both my talus and tibia. Doctors tell me my prognosis is not good, especially due to the tibial lesion. I'm obsessing over mine, and sometimes get really down...I'm still way too young for TAR or fusion. The only good news is I'm not really in pain from daily activities but it's hard to get around the likelihood that I won't ever be active again...
Unfortunately I forgot. The doctor told me but I didn't have a pen to write it all down. He said it wasn't small, but not horribly big either. He was confident a Denovo surgery was sufficient enough to fix me up. It is only the left side of my ankle, and neither is it a kissing lesion. When I saw the video of him pouring the Denovo into the lesion, seemed like he did a thorough job.
I'd keep asking more doctors if you are down, specifically one that is world renowned for these cutting edge procedures. But sometimes the best surgeon for a specific procedure thinks everyone should get that procedure. I just wouldn't give up so easily.
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Hey, sounds like we've got pretty much the same story. Former athlete, OCD in 2010, microfracture in 2012. I was back to full activity and feeling 100%, then after about 3 months I was back to pain that was worse than ever. I had DeNovo done a little over 7 weeks ago. I have 1 more week non-weight bearing then will be in a boot until 3/16. Best of luck! Let me know if you have any questions about recovery.
Ha! Sort of, but not really - I'm not really an athlete. But I've become more physically active since I've learned what it feels like to no longer have that option. So if I understand correctly, you are NWB for 8 weeks? For me it's 6 weeks, but on the visit he may choose not to have me weight bearing yet (in which case I would hope he extends my disability timeframe). For now all I'm really doing is keeping the weight off and a few times each day I take off the splinter (like a half cast) to flex my ankle up and down ONLY. During the last visit he felt my ankle was getting too stiff and wanted me to work it a bit. The nice thing about this is that I can actually feel the healing progress.
However, I'm still ultra conservative. There's been one too many surgeries on this ankle and I want this to be the last one. My goal in the short term is to let this ankle heal to it's best potential and not let anything disrupt it. I will only go back to my weight lifting routine after Dr. Ferkel absolutely signs off on it. Luckily I'm not much of an avid runner, so I don't miss it at all.
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It's now Feb 16th, and I'm exactly 10 days away from being cleared for limited weight bearing. Since my last update, my routine hasn't changed too much, but my vertical range of motion is very good. I've been lucky enough to not fall from using crutches and I've gotten enough help from family members throughout each day. I still feel swelling, approximately a 4 or 5 on a scale of 1 to 10, if I do not keep my foot elevated. My only fear at this point is if the Denovo didn't adhere to my lesion. Although I suspect this isn't an issue because of the hard cast on my foot for the first two weeks; hopefully it was more than enough time to keep any cartilage from floating out of the lesion. But then again this is possibly just my head playing with me.
My appointment is on the 26th, and I think that's when most people here would be interested in what happens, and to what extent am I allowed to walk. To be continued...
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Good luck with your appointment. We are anxiously awaiting to hear your results.
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Ha! Sort of, but not really - I'm not really an athlete. But I've become more physically active since I've learned what it feels like to no longer have that option. So if I understand correctly, you are NWB for 8 weeks? For me it's 6 weeks, but on the visit he may choose not to have me weight bearing yet (in which case I would hope he extends my disability timeframe). For now all I'm really doing is keeping the weight off and a few times each day I take off the splinter (like a half cast) to flex my ankle up and down ONLY. During the last visit he felt my ankle was getting too stiff and wanted me to work it a bit. The nice thing about this is that I can actually feel the healing progress.
Correct, 8 weeks. Then 4 weeks in a boot. We're being ultra conservative, but I also had more done than the DeNovo (tendinitis/tarsal tunnel release). Good to hear you're coming along.
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Alright guys, I had my visit today with Dr. Ferkel. Just an FYI - Dr. Ferkel will take forever because he spends a good amount of time with each patient. Expect to wait anywhere between 1 to 1.5 hours beyond the original appointment time. The only exception is if you're his first patient, in which case he'll be on time. Plan accordingly.
Nothing too dramatic happened today. My splinter was swapped out for a walking boot that goes all the way up just below the knee caps. I will be limited weight bearing for two weeks with crutches. During the first week I will use two crutches to assist when weight bearing on the left ankle. On the second week I use only one crutch. Starting on the third, I stop the crutches all together and simply walk with the boot until the next visit, which is another four weeks from now.
Originally I was optimistic and hoped I could stop the crutches all together, but it's still too painful, and honestly I've forgotten how to walk. It makes sense that I continue with the crutches. So it'll be a total of 8 weeks post op before I'm free of crutches. In my perspective, since I've experienced this recovery process before from MF surgery, a huge portion of my life returns when the crutches are done with, and that'll make me very happy. Because from there I can comfortably go out and do many daily activities, I just can't exercise yet other than physical therapy. Physical therapy will start in a little over a week.
Please post any questions or comments you may have!
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Just another quick update - limited weight bearing has made it much easier to get around in the house. I feel safe using my foot in a boot to balance myself when standing (the weight is still mostly on my right foot). A small part of my life has at least come back. I can move around in the kitchen to get things much easier.
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Congrats.
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I've got another two days before I'm ordered to stop using crutches all together. I have to say, I cant' wait. Since starting physical therapy this past Monday, after each session it's much easier to notice improvement. I remember on the first day of using one crutch it was so difficult and painful in areas of my foot that were still swollen; luckily the pain wasn't in the ankle.
Since Monday it's been much easier. I had to learn the technique for using only one crutch, and I noticed initially I was doing it wrong because my right neck was starting to become sore. The key thing was to keep my body straight. I have a bad habit of slouching so it was quite an adjustment initially. My PT has been extra conservative, he felt with so much "trauma" to my ankle being conservative would be best. But he's really good with his hands, so even just the "massage" he gives me already improves my range of motion.
Another interesting tidbit is he is very familiar with Dr. Ferkel's work because he has had several patients from him. He feels he's probably one of the best ones to go to for ankle surgery, and that SCOI (Southern California Orthopedic Institute) is one of the best organizations for orthopedic surgeons. It made me feel much more comfortable hearing him say that. He also said that MF surgery is typically not successful, and especially for young folks because we have expectations of being very active again after healing. The activeness breaks the fibro cartilage and then the pain returns (as we have discussed several times on this forum). He says typically MF would be best for older folks who intend to do very little or no high impact activities to their ankle. So there probably is a time and place for MF, but he doesn't recommend it for young folks that intend to do high ankle impact activities. Unfortunately Denovo is new to him, so he didn't have much comment on it.
But it looks like I'll be using the boot until March 26th.
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I actually saw the PA for Dr. Ferkel instead, and I moved up the appointment to March 25th. As expected, I am off the boot and using an ankle brace. For anyone that is curious, they were going to give me this brace, which I had been using prior to the surgery:
http://www.achillesmed.com/ankle-braces/aso-ankle-brace.html
However, I decided to use the old one that Ventura Orthopedics gave to me, which is slightly taller maybe a little bulkier. But the ASO brace does work extremely well.
Overall, my ankle is getting better each day. The joint itself isn't hurting, which makes me very hopeful. But surrounding areas and incision areas are still sore, swollen, and tight, which is expected. But it feels so great to be walking again and not limping around in the boot. Now I limp without the boot, LOL! I keep a spare single crutch in my car in case I suddenly go somewhere that might require me to walk longer, in which case I can use the crutch to decrease the weight put on my ankle.
Again, everything feels hopeful but the journey is far from over. The PA told me I statistically need to wait at least a year post surgery to really know how good it'll be. In the meantime, all I can do is keep up with physical therapy and continue to strengthen my ankle. Also, I am enjoying the use of my handicap placard for at least another month. Sometimes in the mess of all this, the small positive things can ease the pain.
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Glad to hear you're doing well! I had surgery 12/22 and am having what sounds like the same experience as you. I got my boot off 3/16, and was without it for a week and a half, but developed tendinitis in the upper part of my foot so I had to go back in the boot for a week. Like you said though, the joint itself feels great which is hopeful, but I've been having pain in the surrounding areas just because of my foot and leg being so weak.
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Each day I can feel an incremental improvement, so overall the results are less dramatic. Whereas at first the improvements from the day after surgery were practically exponential in the first few weeks, now it's working at a slower and linear pace.
Just an FYI, I decided to use the ASO ankle braces instead because overall it felt more comfortable compared to the ones I had from Ventura Orthopedics.
My day to day routine has practically come back, minus the exercise routine I had before. It's been replaced with PT twice a week. I no longer carry the crutch in my car as I am comfortable walking without it. I still don't make any trips where I know for sure the walking will be far. I'm still limping, but I can easily make adjustments for resting because all I really do is run errands like grocery shopping. It feels great to at least be at this point in the healing process - I can do most of what I need to do without asking anyone for help. I'm not really sure what else to say, but I'm hoping you guys can post questions so I can further continue this discussion!
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3 months post-op update:
Generally speaking, things seem to be healing as scheduled. In the surgical spots scar tissue is causing some point, but it's NOTHING compared to the pain that was in the lesion. I suspect it'll go away in time. My next appointment is on April 30th.
When I'm outside I wear the soft brace, and at home I don't wear anything at all. I'm only walking with a slight limp at home, and there's still some limping when I walk outside with the brace and sneakers. Minus the strength training I did before, my life is almost back to what it was. So far it's been a blessing and I am feeling optimistic (as we all should do our best to be). I'm taking it easy and not pushing anything until I get clearance from the surgeon. If my MF surgery from 2010 is an indication of how I will recover now, I expect to be walking almost normally without a limp by end of this month. Crossing fingers!
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Do you think you will ever be walking without the brace? What other types of activities are you performing, i.e. biking swimming etc?
Glad to hear you are walking around even with a limp.
My next appointment is April 28, 2015. I am hoping the OS says partial weight bearing and can get rid of the boot. Will see then. That is almost 8 weeks post op.
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I'm positive I'll be out of the brace. I'm not performing any sports-like activity. I do biking for about 15 minutes during each physical therapy session, and plus some other things. But outside of PT, I only walk and go up/down stairs. No sandals, sneakers only. Each day is an incremental improvement. I can definitely feel more strength today compared to a week ago.
When you're partial weight bearing, the boot will still stay...but at least you can put pressure on it. It really makes a world of a difference, especially when going up/down the stairs because you won't be hopping anymore.
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3 months post-op update:
Generally speaking, things seem to be healing as scheduled. In the surgical spots scar tissue is causing some point, but it's NOTHING compared to the pain that was in the lesion. I suspect it'll go away in time. My next appointment is on April 30th.
When I'm outside I wear the soft brace, and at home I don't wear anything at all. I'm only walking with a slight limp at home, and there's still some limping when I walk outside with the brace and sneakers. Minus the strength training I did before, my life is almost back to what it was. So far it's been a blessing and I am feeling optimistic (as we all should do our best to be). I'm taking it easy and not pushing anything until I get clearance from the surgeon. If my MF surgery from 2010 is an indication of how I will recover now, I expect to be walking almost normally without a limp by end of this month. Crossing fingers!
Congrats! Glad to hear you're doing well and progressing towards walking without a limp. I have accepted that as long as my calf isn't 100% strength I'll be walking with a limp, because my leg/foot aren't strong enough to push off of the ground. Even at 4 months I still have a slight limp and the bones in my foot hurt from taking the brunt of the force while walking, so don't set your sights too high. Recovery is slow.
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April 30th update:
Hi Everyone! I visited Dr. Ferkel yesterday and things are healing on scheduled as expected. As far as the ankle brace goes, I only need to wear it as needed. I can stop using it during physical therapy, which is a big plus because there were limitations as to what I could do while the brace was on. He also said to use it if I think I will be doing a bit of walking. But it's really subjective - I have to decide when I need it and don't need it. I also brought up the pain near one of the incisions. He said it's from the surgery itself and will go away. The pain has lessened each day, so he's probably right.
On an interesting note, I mentioned this web site to him and he plans to take a look. He did echo one word of caution, and I think he's right despite what his intentions might be. Sometimes we give medical advice, even in subtle ways and not realize it. A simple example is, "Denovo didn't work for me, so I don't think you should try it, " and vice versa. Success and failure stories should not influence an absolute decision, but instead should always educate us and push us to seek out more information from the trained professionals. But what I've found to be really useful on these forums is the referral of doctors, and I'm even more glad that Dr. Ferkel has been mentioned as one of the best surgeons for this Denovo procedure.
Anyhow, when I go out for the day I still wear the brace mostly for protection and support. I'll see where I stand next week and decide whether to continue wearing it or stop. There will come a point where the brace needs to come off to aid with recovery.
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Congratulations on the progress. I started weight bearing and you are correct about the bones in the foot taking the brunt. It almost feels like they are being crushed. Each day is getting better
You are also correct on the advise portion. It is great to see what others are experiencing and what they have gone through. It is also a great place to voice your own concerns and advances as well as setbacks. It keeps me from complaining or appearing to be negative to my wife, who has been great through this whole thing.
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It's been about 20 days since my last update, so here's what's been going on:
I'm completely out of the ankle braces (hurrah!!!), and wearing both shoes and sandals. I haven't gone on long walks, but any walking from my daily routine is fine. I still feel residual pain from the surgery towards the outside areas of my ankle, but no pain in the original area of the OCD. I barely limp. Yes, this is very promising! But in the bigger picture, I'm still taking it easy. I don't plan to start doing more until another few months (no earlier than September). I want this to last and heal properly.
All in all, Dr. Ferkel has done a great job for me. My physical therapist is helping me as much as possible and I'm slowly getting back to full physical condition, so that I can return to weight lifting.
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My last post must have been really boring :-)
And quite honestly, it's a good thing. I had another follow up appointment with Dr. Ferkel today, and all he said was things are progressing well. Which is true. Some of the surrounding residual pain I told him about last time has decreased, but not completely gone yet. His response was there's no real way to gauge how these small parts of pain will heal, but what he knows for sure it's total healing time is one year. He suggested I keep doing physical therapy twice a week until I'm able to get back to my regular activities. As for weight lifting, he suggested another 3 to 4 months before starting it again (which is consistent with what he's said before).
But again, this pain I'm talking about is not the kind of pain that will stop me from walking. It's the kind that my brain will eventually "phase out" as I keep walking. So yes, I'm so grateful for what I've gotten back so far. As of what I see today, Dr. Ferkel has done a terrific job for me. No more acute catching pain that makes me want to trip and fall!!! When I'm ready, I really want to start jumping in joy with all that has happened so far. But again...patience with the healing since this is my third time around.
Since I am part of his study, I spent about 10 minutes in the office filling out a case study questionnaire. There hasn't been any mention of an MRI, but I think that's supposed to be at the very minimum six months out before it's done.
I'm not saying Denovo is the answer for everyone, but give it serious consideration as an option when you talk to your orthopedic. This stuff seriously works.
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BLT, thanks for sharing your experience. I have left ankle injury too so i'm paying particular attention to your denovo progress.
Does the weight-training hiatus pertain to leg-workouts only or is it any kind of weight-lifting?
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This has been an interesting read. I had been doing fairly well after a steroid shot and hadn't been reading the board much. I don't do any physical activity to try to keep it under control. I dribbled the basketball a bit on flat concrete and tried to keep it away from my son for about 3 min last week and that was all it took. No running or pivoting was done. You description of the acute Catching pain is so familiar. People freak out when it happens to me it can happen while I walking, standing still or sitting. It takes me nearly down. I will be Getting an MRI soon, as I really want to know what is going on.
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Glad to hear it is going well. Just be careful. It can be very tempting to rush into something that is to much so maybe no jumping yet. I really like hearing such positive comments. Again good luck with the healing
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BLT, thanks for sharing your experience. I have left ankle injury too so i'm paying particular attention to your denovo progress.
Does the weight-training hiatus pertain to leg-workouts only or is it any kind of weight-lifting?
In terms of weight training, nothing that puts pressure on the ankles. This means I could do bench pressing and other upper body workouts as long as I am sitting down. However, I'm choosing to sit out and not doing anything at the gym because too much of my time is already devoted to physical therapy, so it's hard to find extra time to hit the gym with my busy schedule. In addition I have a specific routine that requires squatting on the power rack. Since I am not allowed to perform squats, it throws off the other workouts in the routine.
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Glad to hear it is going well. Just be careful. It can be very tempting to rush into something that is to much so maybe no jumping yet. I really like hearing such positive comments. Again good luck with the healing
Thank you. And I echo the carefulness. I'm only doing what physical therapy tells me to do. Outside of PT I'm keeping it simple.
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I'm about seven months post op now. Boy does it feel great!! The residual pain I was referring to isn't gone yet, and Dr. Ferkel isn't completely sure what it is. However, he did notice that my flat foot was agitating that area, so I'm now wearing custom fit orthotics; which I should have been wearing anyways regardless of whether I had this surgery or not. The pain is starting to subside. Occasionally I feel pain right when I get up from sitting at least 30 minutes, but there's been major improvement since I started wearing the orthotics.
Pain in the OCD area is still non-existent! Physical therapy is going really well. My ankle feels stronger as I am now doing exercises that focus more precisely on the ankle. I've gone back to the gym and have started my workout routine, but with very minimal weights. The bike doesn't hurt my ankle. The only thing I haven't done is run, but I'm waiting until January 2016 before I start that. Right now everything is next to no impact on the feet. But overall, how is it going? EXCELLENT! I can't express how grateful I am for feeling today. Denovo does f*cking work!!!
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Awesome news! What exactly is your residual pain you are feeling? I am still having pain in the tendons surrounding my Achilles and down to my lower inner ankle at 8 months post op. I feel pain in that area, kind of like it pinching, on the outside of my ankle when I walk and on the inside when I go up on my toes.
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Awesome news! What exactly is your residual pain you are feeling? I am still having pain in the tendons surrounding my Achilles and down to my lower inner ankle at 8 months post op. I feel pain in that area, kind of like it pinching, on the outside of my ankle when I walk and on the inside when I go up on my toes.
It's funny - I can never give a clear description of this pain. I have no clue if it has anything to do with the tendons. Here's my elementary way of describing it - it feels like a small rock is sitting right underneath the skin where the cuboid bone is. It hurts when I sit for a while and then get up. The pain lasts for less than a minute. Afterwards as I continue walking its non-existent until I sit down for a period of time and get up again.
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I've got another two days before I'm ordered to stop using crutches all together. I have to say, I cant' wait. Since starting physical therapy this past Monday, after each session it's much easier to notice improvement. I remember on the first day of using one crutch it was so difficult and painful in areas of my foot that were still swollen; luckily the pain wasn't in the ankle.
Since Monday it's been much easier. I had to learn the technique for using only one crutch, and I noticed initially I was doing it wrong because my right neck was starting to become sore. The key thing was to keep my body straight. I have a bad habit of slouching so it was quite an adjustment initially. My PT has been extra conservative, he felt with so much "trauma" to my ankle being conservative would be best. But he's really good with his hands, so even just the "massage" he gives me already improves my range of motion.
Another interesting tidbit is he is very familiar with Dr. Ferkel's work because he has had several patients from him. He feels he's probably one of the best ones to go to for ankle surgery, and that SCOI (Southern California Orthopedic Institute) is one of the best organizations for orthopedic surgeons. It made me feel much more comfortable hearing him say that. He also said that MF surgery is typically not successful, and especially for young folks because we have expectations of being very active again after healing. The activeness breaks the fibro cartilage and then the pain returns (as we have discussed several times on this forum). He says typically MF would be best for older folks who intend to do very little or no high impact activities to their ankle. So there probably is a time and place for MF, but he doesn't recommend it for young folks that intend to do high ankle impact activities. Unfortunately Denovo is new to him, so he didn't have much comment on it.
But it looks like I'll be using the boot until March 26th.
Ferkel must have learned that in the last 15 years, because he didn't hesitate to microfracture me back in 2000 when I was an active 16 year old. Sure enough, I started feeling the pain about 10 years later. That makes me a little mad.
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10 years ago MF was the suggested protocol Even now many insurance companies will not pay for DeNovo and will only pay for MF. Unfortunately my insurance company is one of those.
I do plan on being very active again. The only thing I probably will not do is complete a full iron man something I had planned on doing well into my 60s. The marathon is hard on the feet and I am sure on the ankle also.
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I've got another two days before I'm ordered to stop using crutches all together. I have to say, I cant' wait. Since starting physical therapy this past Monday, after each session it's much easier to notice improvement. I remember on the first day of using one crutch it was so difficult and painful in areas of my foot that were still swollen; luckily the pain wasn't in the ankle.
Since Monday it's been much easier. I had to learn the technique for using only one crutch, and I noticed initially I was doing it wrong because my right neck was starting to become sore. The key thing was to keep my body straight. I have a bad habit of slouching so it was quite an adjustment initially. My PT has been extra conservative, he felt with so much "trauma" to my ankle being conservative would be best. But he's really good with his hands, so even just the "massage" he gives me already improves my range of motion.
Another interesting tidbit is he is very familiar with Dr. Ferkel's work because he has had several patients from him. He feels he's probably one of the best ones to go to for ankle surgery, and that SCOI (Southern California Orthopedic Institute) is one of the best organizations for orthopedic surgeons. It made me feel much more comfortable hearing him say that. He also said that MF surgery is typically not successful, and especially for young folks because we have expectations of being very active again after healing. The activeness breaks the fibro cartilage and then the pain returns (as we have discussed several times on this forum). He says typically MF would be best for older folks who intend to do very little or no high impact activities to their ankle. So there probably is a time and place for MF, but he doesn't recommend it for young folks that intend to do high ankle impact activities. Unfortunately Denovo is new to him, so he didn't have much comment on it.
But it looks like I'll be using the boot until March 26th.
Ferkel must have learned that in the last 15 years, because he didn't hesitate to microfracture me back in 2000 when I was an active 16 year old. Sure enough, I started feeling the pain about 10 years later. That makes me a little mad.
I say this with the best possible intentions - as casper1955 had said, in the year 2000 I don't think Denovo was even an option, and doctors used what they thought was the best procedure at the time. MF, according to my research, was more or less perfected during the mid-90's, so it would need several years of real data before they concluded that MF generally isn't a long term solution. I'm sorry you feel this way about what happened. I totally understand. You had 10 good years, I only had about 2. Dr. Ray Nickel in Ventura performed MF for me, and I think he did the best he could at the time. And besides, who knows...Denovo could end up failing in the long term. It hasn't been around long enough to draw any consistent conclusion. All I know right now is that it worked for me, and I will cherish each moment that it continues to work.
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I am so glad for your OCD site! I noticed for the first few weeks after I started walking I would get all sorts of pain in my foot--my therapist said it was from atrophied muscles in the foot, so we've been working on all sorts of balance and other foot strengthening exercises, and I'm pretty sure it's been helping. Perhaps that would help if you are not working with a therapist anymore?
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The custom orthotics are working. The pain isn't completely gone, but it's gone down A LOT. So for those of you with flat foot that are considering any kind of OCD surgery...custom orthotics is something to look into.
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The custom orthotics are working. The pain isn't completely gone, but it's gone down A LOT. So for those of you with flat foot that are considering any kind of OCD surgery...custom orthotics is something to look into.
Thanks for the advice, I'm going to ask about orthotics at my appointment in 2 weeks. For the past few months the pain in the tendons around my Achilles has been pretty significant, but has actually started to get way better (almost unnoticeable) in the past week - ever since I started doing balancing exercises on a blow-up stability cushion.
How much did the orthotics cost?
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The custom orthotics are working. The pain isn't completely gone, but it's gone down A LOT. So for those of you with flat foot that are considering any kind of OCD surgery...custom orthotics is something to look into.
Thanks for the advice, I'm going to ask about orthotics at my appointment in 2 weeks. For the past few months the pain in the tendons around my Achilles has been pretty significant, but has actually started to get way better (almost unnoticeable) in the past week - ever since I started doing balancing exercises on a blow-up stability cushion.
How much did the orthotics cost?
My orthotics costed me about $100 sometime back in 2008. However, I hear this price is not typical. Somehow my chiropractor knew how to get one made. At my most recent visit to the Orthopedic, I was quoted $450 >:(
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I can't believe it's been over 10 months since surgery. On October 19th I had a little scare after coming home from the gym. After doing my usual weight lifting routine, my left ankle was slightly hurting again. Of course I got scared, but I decided to give myself a rest so that I would be ready to travel in 5 days. My ankle did heal up and I was ready for international travel. I first flew to Bangkok for 10 days. I walked everywhere as if my ankle wasn't ever diagnosed with OCD. It felt great, while I was walking. When I got back to the hotel and rested my foot, the fatigue and pain around the ankle did set in. I expected this, so it wasn't necessarily a problem. Despite the pain and fatigue, if I got up and started walking again, it was fine. Meaning, the pain disappeared.
Obviously I'd prefer no pain at all, but this is so much better than before the surgery. Prior to surgery, the pain at the OCD site would prevent me from walking again after resting. In order to walk again, I'd have to tightly strap the ankle brace on and usually take a 50 mg pill of Indomethacin. The brace and medicine are no longer necessary. I still didn't push it too much. I made sure most of the time I wore a shoe with orthotics and not sandals unless it was at most two blocks of walking. It felt great walking amongst other civilians in public while not experiencing the pain that I once had to endure in silence.
My ankle isn't as flexible as it used to be and I feel I may have hit a plateau. I want to improve it, but I've already decided it's OK at the current state. I've also decided that if this is the best my ankle will be, it's also acceptable. The bottom line is, while my ankle isn't 100% back to normal, I have managed to get a good part of my life back: traveling the globe. Obviously I can't predict what will be the result 6 months or a year from now. I just know I'll be waiting at least another year before I consider doing any activity that requires me to "stomp" on my foot, like running or jogging. And this works for me because I'm not an avid runner.
For anyone else recovering from Denovo, I hope it's going smooth too. I know it hasn't been the case for everyone, and I really do hope a solution will be available as soon as possible for those not getting the results they want.
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That's awesome to hear you were able to walk around. I was worried before my Southeast Asia trip as well but I did 3 months walking around everywhere! I think the right footwear makes a huge difference.
Also I'd recommend just never, ever doing any kind of running, jogging, or jumping.
My microfracture has lasted 8 years now.
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Hey guys,
just trying to warn anybody reading this post about what can go wrong with this treatment and the need to take it really easy after the surgery. I know all the doctors say to go weight bearing after 8 weeks or so, but I really don't think it's long enough. My ankle felt great after 8 weeks, so I went right back to full activity right away. A year later, and I'm worse than where I started.
I think the main thing is to get MRI/ arthroscopic assessment to make sure the lesion is completely healed before you take a single step. My doctor didn't do wither of these things, and that's one of the reasons I have a new doctor now.
Just trying to warn you, because while you might feel ready after 8 weeks, being on crutches for 3 to 6 months, or even more, sure as hell beats not being able to walk for the rest of your life.
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Hey guys,
just trying to warn anybody reading this post about what can go wrong with this treatment and the need to take it really easy after the surgery. I know all the doctors say to go weight bearing after 8 weeks or so, but I really don't think it's long enough. My ankle felt great after 8 weeks, so I went right back to full activity right away. A year later, and I'm worse than where I started.
I think the main thing is to get MRI/ arthroscopic assessment to make sure the lesion is completely healed before you take a single step. My doctor didn't do wither of these things, and that's one of the reasons I have a new doctor now.
Just trying to warn you, because while you might feel ready after 8 weeks, being on crutches for 3 to 6 months, or even more, sure as hell beats not being able to walk for the rest of your life.
I mentioned this in your thread, but I would like to again discourage providing actual medical advice with regards to recovery. The orthopedists are experts in the field and have developed their own recovery plans based on clinical data and experience - to act against their will (by using crutches for longer than expected, etc.) might actually hurt your recovery. I was more conservative than I think I needed to be and now I am working through fixing tendinitis because my leg is still too weak, even after a year.
I agree with the idea of getting a post-op MRI - however I would think that most would agree 8 weeks is too early, as it is known that DeNovo takes much longer to grow and integrate with native cartilage. My doctor has every patient get one a year after surgery to see how things are coming along. Even though mine looks great, he warned me that the new cartilage is not fully integrated into my own until 2+ years, so no running/jumping/pounding until then.
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I would have to concur with Namelike on rehabilitation. My Dr. told me to start gradual weight bearing with the goal to be out of the boot and off the crutches within 2 months. He said listen to your body. I pushed hard and was off crutches and out of the boot in 2 weeks and felt like I was making great progress. Then the ankle swelled up. I sent the OS an email and he had me come in and said back in the boot and on the crutches. Luckily I did not do any damage. I am now 8 months post op and feeling pretty good. There are times when it hurts or feels like someone stuck something in the ankle, and probably about once a week on average I get a shooting pain like I got hit with a hammer. I am walking about 3 miles a day.
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My Dr also told me to get out of boot gradually. He said don't over do it. He also suggested to get an MRI at the 6 month or 1 year mark to see how it's progressing.
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Hey guys,
just trying to warn anybody reading this post about what can go wrong with this treatment and the need to take it really easy after the surgery. I know all the doctors say to go weight bearing after 8 weeks or so, but I really don't think it's long enough. My ankle felt great after 8 weeks, so I went right back to full activity right away. A year later, and I'm worse than where I started.
I think the main thing is to get MRI/ arthroscopic assessment to make sure the lesion is completely healed before you take a single step. My doctor didn't do wither of these things, and that's one of the reasons I have a new doctor now.
Just trying to warn you, because while you might feel ready after 8 weeks, being on crutches for 3 to 6 months, or even more, sure as hell beats not being able to walk for the rest of your life.
I want to be clear that I didn't go full activity after 8 weeks; so please anyone that is reading this thread do not interpret it as such. I was simply just about off crutches at about 8 to 10 weeks post-op, and then carried it around in case I needed it. It's completely a gradual process. Going full activity after 8 weeks is not practical at all, and is VERY dangerous. On the flip side, continuing with crutches after 3 months post-op COULD BE a very bad idea. I echo Namelike's comments: Find a good doctor and consult with him/her for full medical advice. I am more than happy to share my recovery story, but don't take it as the definite solution.
And just in case anyone wants the short answer about full activity: I didn't even attempt it until at least 9 months post-op.
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Hello
what is Denovo Surgery? could you explain is this I am researching my surgery and have not seen it before. You had the microfracture surgery first and you recovered and needed this surgery after? was this considered normal after your microfracture surgery or unsual? I was recommended to have microfracture surgery and am nervous/researching the recovery process.
Thank you for your time
-K
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Hello
what is Denovo Surgery? could you explain is this I am researching my surgery and have not seen it before. You had the microfracture surgery first and you recovered and needed this surgery after? was this considered normal after your microfracture surgery or unsual? I was recommended to have microfracture surgery and am nervous/researching the recovery process.
Thank you for your time
-K
Kea82 - by no means am I trying to dodge your question, but Alan does a good job explaining it.
For microfracture: http://osteochondraldefect.net/the-ocd-book/treatment-options-conservative-and-microfracture/
For Denovo: http://osteochondraldefect.net/the-ocd-book/surgery-oats-aci-and-denovo/
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13 months post op. Time does fly. That nagging residual pain I mentioned several times in past posts is now GONE. My guess is that it was a scar tissue that the PT wasn't able to break up during the PT sessions. But while I was at the gym in December, it suddenly went away. I think I might have broken the scar tissue while I was performing a squat. Whatever it is, I'm glad it's gone. I can wear shoes without orthotics now; previously I had to wear it to bring down the residual pain. I'm feeling good, REALLY good.
An MRI was performed on my ankle on Dec 31, 2015. I'll let you all know what the results are when I see Dr. Ferkel again in March.
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Congratulations Good Luck
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13 months post op. Time does fly. That nagging residual pain I mentioned several times in past posts is now GONE. My guess is that it was a scar tissue that the PT wasn't able to break up during the PT sessions. But while I was at the gym in December, it suddenly went away. I think I might have broken the scar tissue while I was performing a squat. Whatever it is, I'm glad it's gone. I can wear shoes without orthotics now; previously I had to wear it to bring down the residual pain. I'm feeling good, REALLY good.
An MRI was performed on my ankle on Dec 31, 2015. I'll let you all know what the results are when I see Dr. Ferkel again in March.
That's great news BLT, congrats. Out of curiosity what kind of treatment/exercises did the PT use to break up that scar tissue / eliminate the residual pain? I'm also at 13 months and just did 3 months of PT, and the (what I think is) tendinitis in my peroneal tendon feels kind of worse. When I'm up and standing for a while it feels great but if I drive for a bit and get out of the car it's really really stiff/painful/irritated. I'm considerably stronger from PT but the pain has not subsided.
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13 months post op. Time does fly. That nagging residual pain I mentioned several times in past posts is now GONE. My guess is that it was a scar tissue that the PT wasn't able to break up during the PT sessions. But while I was at the gym in December, it suddenly went away. I think I might have broken the scar tissue while I was performing a squat. Whatever it is, I'm glad it's gone. I can wear shoes without orthotics now; previously I had to wear it to bring down the residual pain. I'm feeling good, REALLY good.
An MRI was performed on my ankle on Dec 31, 2015. I'll let you all know what the results are when I see Dr. Ferkel again in March.
That's great news BLT, congrats. Out of curiosity what kind of treatment/exercises did the PT use to break up that scar tissue / eliminate the residual pain? I'm also at 13 months and just did 3 months of PT, and the (what I think is) tendinitis in my peroneal tendon feels kind of worse. When I'm up and standing for a while it feels great but if I drive for a bit and get out of the car it's really really stiff/painful/irritated. I'm considerably stronger from PT but the pain has not subsided.
The scar tissue breakup mostly happened with their hands, post PT exercises. They used their hands to figure where to put pressure on my ankle as they flexed it in whatever way they could. If I knew more about PT I could better explain. I don't think they did anything that was particularly special. I was squatting about 160 lbs when I finally felt the scar tissue "disappear."
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So happy to read how great you're doing!
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Hi guys -
I have had an OCD lesion on the left side diagnosed since 2011. I'm at the point of looking to surgery, since nothing else has helped.
What have people heard or experienced about denovo vs biocartilege? Any doctor recommendations in NYC?
Thanks!
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Hi guys,
Any thoughts about denovo vs biocartiledge from the effectiveness standpoint (I know one is much more expensive but am more concerned right now about effectiveness and longevity).
Also, any OS recommendations in Manhattan?
Thanks!
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Hi Kerri - unfortunately I can only comment on own experience. Microfracture didn't work. Denovo so far has been great for me.
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Thanks!
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I just returned from my 14 month post op follow up. I think at this point the appointments are mostly to make sure nothing out of the ordinary has happened. Dr. Ferkel and I went over the MRI taken from Dec 31st, and all in all the lesion is covered well. But there's no surefire way to know the exact details just from an MRI, which is understandable. There is still some swelling in the bone, but he said it's expected and will simply take time to heal, but couldn't say how long it would take. This might explain the minor dull pain that I feel from time to time, but it's mostly unnoticeable in my day to day activities. In the summary, there is one line that says "an improvement in comparison to the prior study." For now, I'll take that.
I did ask him about running a 5k. His response: "I don't recommend it." He gave me a very conservative response, and I can understand why. It's most likely because there isn't enough data yet to support what Denovo can or cannot withstand in the long run. This is sort of a moot point for me because I don't use running or jogging as a regular form of exercise. I only asked because at times I do run 5k's as a social event with friends. I don't want this response to discourage any avid runners from pursuing Denovo as a potential treatment option, but at the same time I want to "keep it real" with my experiences from this.
Overall, my ankle is doing great and each day I'm glad my mind is no longer occupied by the random acute pain.
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It's been almost a week since I saw Dr. Ferkel, and now my ankle is starting to feel some minor inflammation. I guess things were going too well for the time being, but I'm not terribly alarmed. This is likely the swelling that he mentioned that was found in the MRI. I still don't have the catching pain that had prior to surgery. When I am sitting I can feel my left ankle is slightly warmer than the right ankle. After hearing about another forum member's over growth of the denovo, I can't rule out any complications that might occur even though I've been having awesome results relatively speaking.
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Hi BLT & All - I am actually on a plane right now from NYC to LAX, and have an appointment this afternoon with Dr. Ferkel. You know that phrase "lawyer up"? Well, I decided to "doctor up"!
Seriously, I got two completely conflicting opinions (about what to do with my lesion - not about the fact I have bilateral OCD) at HSS in NYC from Drakos and Kennedy (and neither of those opinions match what my original doctor recommended). So, since I'm lucky enough to be able to afford it and have the time, I decided to get an opinion from Dr. Ferkel.
So far here's what I have.
1. Drakos - clean out the divot, put in a small piece of bone from my hip (I have a deep OCD), do NOT micro fracture, fill in the divot with a mix of BMAC and bio cartilage. The theory is to grow hyline cartilage instead of fibro cartilage. When I asked what he would do if he got in and discovered the lesion was bigger than it appeared on the MRI, or more on the shoulder (uncontained), he said he'd still repair it this way.
He does this because he says MF has an 85-90% success rate in the first 1-2 years, but then it drops to 50% at 5 years. He defines success as people who think they are better than before the surgery. However, he was talking about me getting back to running (which I can actually live without, but if in theory I could run, then it seems to me the other activities I want to do would not be nearly as taxing).
2. Kennedy - He believes I need to go straight to OATS (the allograft kind) because of the size/placement of my lesion. He cited same statistics as Drakos re MF, but didnt offer me the option of bio cartilage + BMAC without MF. (I'm seeing him again next week and plan to ask.) He defines success as me running again and thinks this has a 90% chance of success. Every other doctor I've seen seems to cringe at the thought of me going straight to OATS and I've been encouraged not to underestimate the potential complications of doing the more invasive procedure.
3. My original Lennox Hill doctor would do transitional MF + bio cartilage but would mix the bio cartilage with PRP instead of BMAC. He said that was the FDA approved method of using bio cartilage and he didn't want to chance growing things other than intended (or more than intended) with stem cells. I've already decided that as much as I love that doctor, I need someone that does this very regularly. So right now HSS doctors are my plan.
I am really hoping that Ferkel can shed light on the difference of opinions.
Have a nice day!
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Wow to your credit, you are really doing your research--please keep us posted!
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Well, so far two things have become clear:
1. Except for one doctor, there is a strong consensus that OATS is overkill for my lesion today. I have been advised by everyone else not to underestimate the potential complications and significant additional recovery needs -- and that those added risks outweigh the benefits in my particular case. So a "repair" procedure it is.
2. There are a ton of variations on repair procedures, and each doctor has his/her favorite because its either been the most successful for them or its part of the research they are doing. So now wading through the variations to make a decision will still take some work!
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Kerri - when do you have your consultation with Dr. Ferkel?
Just a quick update on the inflammation I complained about not too long ago. It seems to have went away. Thank goodness!
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Hi BLT - glad to hear that!
I saw Dr. Ferkel last Thursday. The big take-away for me from that (as well as from seeing an HSS doctor earlier last week) was that I shouldn't start with OATS. A couple of people have told me now (and this makes sense) that each doctor tends to recommend the thing they happen to do the most, and feel successful with. However, in my case the consensus view is that OATS would be too aggressive as a place to start.
Unfortunately by the time I actually saw Dr. Ferkel (it was 4:15 from a 2:15 appointment time), I was really tired (I had left NYC at 4am that same day), and so I didn't do a great job of digging into questions about the actual repair procedure he wanted to do with me. I basically understand it was some form of MF/lighter drilling, with the possibility of juvenile cartilage (interestingly he never called it de novo, and further research has told me the general term seems to be PJCAT for particulated juvenile cartilage...something transfer). He did invite me to ask follow up questions after the appointment, so I have sent some by email and hope to hear back from him or his Fellow (Dr. Ni, who I also really liked) shortly.
Where this puts me: I'm now just trying to figure out which repair procedure and by whom. So far the HSS docs all use bio cartilage and say they have stopped using the de novo stuff. I am told its because its harder to work with (as well as more expensive). Ferkel couldn't comment on the difference because he said he had never used bio cartilage.
I am now on my way to Baltimore for an appointment today with Dr. Schon. At that point, plus the follow up questions with Ferkel, I think I'll have all the info I am going to reasonably get / need to try to make a decision.
After my appointment with Dr. Ferkel I spent the weekend with my Dad in Palm Springs. And, of course, since part of my brain still asks whether I can't just live with this instead of having surgery, I went for 3 hikes of approx 2 hours each over 3 days. I was able to do them, but not at my normal level of confidence and comfort (these are hikes I've been on before), and when I got back to NYC on Monday I was in a ton of pain. For me, the pain is often a day after the activity - not during the activity. So as frightened as I am by surgery, I think its time.
How are you doing?
Kerri
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So far so good. I went to the gym yesterday to do my usual weight routine and I felt great today! Again, I'm not doing anything crazy like running miles on a treadmill. I wish I could comment on hiking, but it's not really a favorite activity of mine :-)
I can understand your situation about pain the day after an activity. That's exactly the same problem I had. I remember once I ran in the morning, and then that same night I took a red eye flight into Philly. I was in constant pain throughout my time in Philly!!! A few months before my surgery I started taking indomethacin every other day to keep the pain in check. I just couldn't live like that anymore.
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I just realized it's been a while since I've posted in my own created thread. The last few months have more or less been kind of the same. Two days ago I had some unexpected pain in the Achilles area, but it's gone today. My OS always keeps saying discomfort will randomly come and go. Things sometimes won't be linear, but for the most part it will be.
But to focus on the big picture, it's been a blessing. Except for the rare off days like described above, I go to the gym when I feel like. I wake up the next morning with no pain. I'm feeling stronger and more confident about the ankle. I can still feel the minor swelling from what my OS saw on the MRI, but it doesn't interfere with me day to day. When I'm sitting down at a desk working, I can feel the swelling, but still not noticeable when I'm focused. It's also not noticeable when I'm walking.
At this point, not sure what to say...it has been more or less the same and much better than pre-surgery. I encourage anyone to contact me if there is any question or concerns you have with surgery. I can explain the experience from a patient's point of view, so that you can make the most informed decision possible.
I am very thankful for this forum. The stories I've read encouraged me to fight through this.
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Hey B - so glad to hear things are generally continuing in such a positive direction! That's great. I'm now just over 2 weeks post op. Out of the mummy cast and into a boot, with another 4 weeks of total NWB. I was amazed when they took the mummy cast off how good my ankle looked. Sure there were two holes and it was black and blue, but overall really not bad at all. I'm starting PT tomorrow for ROM, and still keeping it elevated as much as possible since I'm getting swelling and throbbing if I get too excited about having a knee walker. Kerri
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I just finished up an appointment with Dr. Ferkel. This will probably be my very last one, and will return only as needed. He'll continue take MRIs of my ankle to show evidence of the efficacy of Denovo procedure.
My ankle is more or less the same as when I last saw him in March. Denovo has, up to today, worked well for me. It's given me back the lifestyle that naturally suits me. I walk about each day, 95% of the time, never even thinking about my ankle. I'm at a loss for words now...but I'll keep checking up regularly on this forum to let you all know how I am years beyond the surgery.
As always feel free to send me a message!
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Brian - that is awesome to hear!!! Mazel Tov!
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Goddamn I am envious (and proud and happy) for you BLT. I have been busy and haven't read these forums, but you guys are doing some amazing research. Thank you for sharing this with us. especially you Kerri. You have got me thinking again about doing another surgery.
Please keep us posted. Kerri, how is your recovery going?
BLT, are you able to jump or run? congrats on your walking without thinking again.
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I don't jump or run. Dr. Ferkel doesn't recommend it, but I think he's telling me to proceed cautiously. I will occasionally run if I am in a hurry, or jump when needed, but I rarely do both. My lifestyle simply doesn't need to do these things often, so it really doesn't bother me.
I couldn't say for sure if I could or could not for the long term, but I definitely feel like I can.
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It's been a while, so I wanted to stop by again before the year end.
Things have more or less been the same. So that's good news.
Swelling occasionally happens on days where I walk longer than usual.
If I change shoes, the transition of wearing orthotics on those new shoes take some time to adjust, which in turn causes more swelling to my foot at night and early mornings. It does cause me to limp, but after walking for less than a minute the pain subsides. This is most likely due to my flat foot problem. So if you have surgery but also have flat feet, then expect this to happen. The best way to avoid this is to stick to the same brand and model of shoes.
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Glad to hear you are doing so well BLT
It has been awhile since I last posted. A quick update
it is 22 months since surgery. I was pretty much pain free up until about two months ago. The pain I did have before that was usually at night. I sleep on my stomach. I found if I let my feet hang over the end of the bed there is not as much pressure on the ankle and therefore less pain. For the last couple of months I have been having some intense periods of pain in the ankle and top of the foot. I am not sure but it might be related to the cold weather. It also hurts going down stairs so I walk sideways down the stair keeping the right leg constantly straight. It was right ankle that was repaired.
I have not run or jumped in over two years. I do walk about three miles a day in the warm weather and in the cold weather about 40 minutes three days a week on the treadmill, stair stepper swim and bike. I alternate so as to use different muscles and do not constantly put strain on the same joints.
I feel pretty fortunate that I have done so well and wish you all good luck with this injury. Hopefully if I ever need surgery again they will have discovered a fix that lasts
I have no plans on going back to see the surgeon unless I get to the point were I am limping all the time.
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Hey Brian,
Glad to hear you are doing so well!
I'm also being introduced to the world of orthotics. Flat feet and a propensity to load the outside of my foot too much / not put enough weight on the big toe.
Do you find they are generally helping? I'm having trouble adjusting - I want to blame them for other aches and pains up and down my back and hip and knee -- but am trying!
Kerri
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Yes, the orthotics are doing wonders for me. Initially I had been using a pair of old ones made way back, like almost 10 years ago. I recently had new ones made and after breaking those in, it's helped a lot. In particular it helps with my back.
But keep in mind it takes time to get used to orthotics. If you've never used it before, it'll take your body some time to get used to it.
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