On September 16, 2016, I had knee surgery to reconstruct my joint after an injury that left me with damaged cartilage on the joint surfaces of both my tibia (leg bone) and femur (thigh bone). 5 months prior, I was jumping side to side over my partner during a warmup. As I pushed off to jump towards my right, my knee gave out and seemed to dislocate inward. I immediately fell to the ground, writhing in pain. I had previous anterior cruciate ligament (ACL) reconstruction in 2005 using a cadaver ligament, which, according to my surgeon, my body rejected as a foreign tissue. I lacked the stability in my knee without this ligament to resist the inward movement of my knee, and injury resulted. My MRI did show a missing ACL and extensive damages to cartilage on both joint surfaces. They also found a bone cyst in my tibia which had formed where the cadaver ACL was attached in my previous knee surgery in 2005.
The surgical procedure included an Osteoarticular Transfer System (OATS), microfracturing, and another ACL reconstruction using an “autograft,” part of my own hamstring tendon. The surgeon also removed the tibial bone cyst and fill with calcium phosphate. An OATS is procedure in which the surgeon removes part of the joint surface of a bone with attached healthy cartilage and uses it as a graft to replace an area of unhealthy cartilage. The surgeon explained it as “robbing Tom to pay back Harry.” In comparison, microfracturing is similar to an OATs in that it also replaces damaged cartilage. However, in this case, the surgeon drills holes on the joint surfaces of the bone. This allows blood to come up and form a layer of scar tissue on the joint surface that would act as “new cartilage”.
I am now 9 weeks post-op and recovering well. The doctor had me non-weightbearing for the first 5 weeks after surgery to allow the joint to properly heal. Not been able to stand or walk for that period of time resulted in severe muscle atrophy or muscle shrinking and joint capsule tightness. The knee joint capsule consists of fibrous connective tissue that encloses the joint, and when stiff, can limit movement and range of motion in that joint. In my case, it severely limited extension, and until this day, I still have trouble fully straightening my knee. To address this, I am currently going to physical therapy 2-3x/week. My therapist performs mobilizations to stretch the capsule and loosen up the joint. We have also been focusing on strengthening my shrunken muscles as my mobility improves. The pain continues to decrease as time allows my knee to heal and I am now able to perform lunge and squat holds to work towards my goal of being able to perform functional movements such as walking and sitting-to-standing.
As a physical therapist myself, I can appreciate and fully understand the importance of physical therapy after an injury and/or surgery. Consequently, I go to every appointment, I diligently perform my exercises 1-2x/day on my own at home, and ice 2-3x/day as recommended by my therapist. I work hard to contribute in my own treatment, avoiding activities that will harm my knee and try not to “over-do” things. As an avid crossfitter and weight-lifter, my surgeon acknowledges my eagerness to return to working out regularly. He has advised to avoid high impact activities such as running or jumping to preserve my newly reconstructed knee joint, but reassures that I can return to heavy squatting and lifting when my knee fully heals in months to come. With proper compliance to my physical therapy, I am sure to reach this goal in a timely manner.
Here at Oahu Spine & Rehab in Kailua, we see patients daily that are post-surgery. Our physical therapists specialize in pre and post surgery treatment plans that assure that our patients will get back to full strength. As an integrated health center, we will make your recovery as smooth as possible. To schedule an appointment, contact us here or call 488-5555!
Franzino, F.J. (2016) What is Osteoarticular Transfer System (OATS) Surgery? http://www.sportsmedicineofnapavalley.com/uncategorized/what-is-osteoarticular-transfer-system-oats-surgery/
Neumann, D. A. (2010) Kinesiology of the Musculoskeletal System. St. Louis, Missouri. Mosby, Inc.