Surgical options for early arthritis in young persons and athletes: the role of meniscus transplants, microfracture, Osteoarticular Transplants (OATs), Autologous Chondrocyte Implantation (ACI) and osteotomy

Edited By: Christopher J. Wahl, M.D., Suzanne L. Slaney, PA-C, ATC, MMS
Last updated Friday, June 30, 2006

Preparing for surgery

What type of preparation needs to take place before microfracture, meniscal transplantation, osteoarticular allograft/autograft transplants (oats), autologous chondrocyte implantation (aci) and ostotomy for arthritis in the athlete. for arthritis, osteochondral defects (ocd lesions), meniscus transplantation and cartilage loss in the knee.?

Surgical cartilage restoration is considered for healthy and motivated individuals in whom pain and mechanical symptoms interfere with normal function and activity.

Successful surgery depends on a partnership between the patient and an experienced knee surgeon.  When possible, patients should optimize their health to prepare for surgery.  Smoking should be stopped prior to surgery and avoided altogether for at least three to six months following surgery.  Any heart, lung, kidney, bladder, tooth, or gum problems and concomitant injuries to the skin or extremity should be managed before the surgery.  Any active infections will delay elective surgery to optimize the benefit and reduce the risk of joint infection.  The surgeon should be made aware of any health issues, including allergies and non-prescription and prescription medications being taken.  Some medications will need to be held or stopped prior to surgery.  For instance, aspirin and anti-inflammatory medications (Advil®, Motrin®, Aleve®, and other NSAIDs) should be discontinued as they will affect intra-operative and postoperative bleeding. (Discuss this with the doctor who prescribed the medications.)

Before surgery, patients should consider the limitations, alternatives, and risks to surgery.  Patients must recognize that the procedure is a process and not an event:  the benefit of the surgery depends largely on the patient’s willingness to participate inrehabilitation after surgery.

Patients must plan on being less active and functional for 12 to 16 weeks after the surgery.  Driving, shopping, lifting, walking, jogging, and running will be difficult or impossible if the surgery involves the weight-bearing joints.  Plans for the necessary assistance need to be made before surgery.  For individuals who live alone or those without readily-available help, arrangements for home help should be made early.  If the surgery involves the knee or ankle, patients will be able to walk with support devices immediately after surgery, but they will be unable to bear weight on the operated leg for up to six weeks.  Jogging is generally discouraged and is rarely resumed before 24 weeks.  It takes 9 to 12 months for a full recovery.

How can the costs of microfracture, meniscal transplantation, osteoarticular allograft/autograft transplants (oats), autologous chondrocyte implantation (aci) and ostotomy for arthritis in the athlete. for arthritis, osteochondral defects (ocd lesions), meniscus transplantation and cartilage loss in the knee. be anticipated?

The surgeon’s office should provide a reasonable estimate of:

• the surgeon’s fee
• the hospital fee, and
• the degree to which these should be covered by the patient’s insurance (some procedures, like ACI are not covered by many insurance carriers)

Who should perform microfracture, meniscal transplantation, osteoarticular allograft/autograft transplants (oats), autologous chondrocyte implantation (aci) and ostotomy for arthritis in the athlete. for arthritis, osteochondral defects (ocd lesions), meniscus transplantation and cartilage loss in the knee. and where?

Cartilage restoration procedures (microfracture, OATs, ACI, meniscal transplantation, and osteotomies) are technically demanding procedures that must be performed by an experienced, specially trained orthopaedic surgeon and skilled surgical team in a medical center accustomed to performing complex knee, shoulder, elbow and ankle procedures on a weekly basis.

The surgical team of an orthopaedic surgeon and certified physician assistant (PA-C) can dramatically improve the quality of care received by the patient.  The interdependent physician-PA team ensures continuity of patient healthcare, commitment to personalized treatment, and makes certain patients will have greater access to care.  The goal of this team is to magnify the efficiency and safety in the operating room and clinic, and to make certain the patient in receiving superior and quality care.

Patients should ask about the specific training and experience the surgeon and surgical team has undergone to perform such procedures (i.e. a fellowship-trained, sports medicine specialist familiar with arthroscopic techniques and equipment).

How can surgeons experienced in microfracture, meniscal transplantation, osteoarticular allograft/autograft transplants (oats), autologous chondrocyte implantation (aci) and ostotomy for arthritis in the athlete. for arthritis, osteochondral defects (ocd lesions), meniscus transplantation and cartilage loss in the knee. be found?

In what type of facility is microfracture, meniscal transplantation, osteoarticular allograft/autograft transplants (oats), autologous chondrocyte implantation (aci) and ostotomy for arthritis in the athlete. for arthritis, osteochondral defects (ocd lesions), meniscus transplantation and cartilage loss in the knee. usually done?

Surgery for Arthritis, osteochondral defects (OCD lesions), meniscus transplantation and cartilage loss in the knee. at the University of Washington

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