My most recent mentor visit was probably the most fun one I’ve had yet. Although I left with a decent amount of homework, I enjoyed what I researched and I had a lot of laughs and good experiences in the clinic.
The patient Rachel was working with this week during my mentor visit was a very nice woman by the name of Cathy. Cathy is a former athlete who was once a part of the greatest softball team in the United States of her time and she is now an avid tennis player - or at least she was, before the cartilage in her knee deteriorated. She had to have what is called the OATS Procedure, which is what I learned about the most while I was in the clinic. I talked to Cathy for the majority of the session with Rachel chiming in from time to time in order to learn more about this procedure. An OATS procedure is referring to an osteochondral autograft transfer system and is one of the two kinds of cartilage transfer procedures used to treat injuries like Cathy’s. A cartilage transfer in general basically consists of moving healthy cartilage from a non-weight bearing area of the knee to a damaged area of the cartilage in the knee. In the OATS procedure, plugs of cartilage and bone are taken from a healthy cartilage area and moved to replace the damaged cartilage of the knee. What sets the OATS procedure apart from its other cartilage transfer counterparts is the plugs used are much larger, meaning the surgeon only needs to utilize one or two plugs of healthy cartilage and bone to the damaged area of the knee. This procedure is typically used in patients under the age of 50 and with minimal cartilage damage, usually because of trauma, and available healthy cartilage for transfer. Like the ACL recovery protocol, an OATS physical therapy program is extensive and difficult, but Cathy was doing a wonderful job and seemed to be very motivated. We both bonded over having sub-par knee functions, but I am confident she will be back and in better shape than ever on the tennis court in a few month’s time.
That experience was in the clinic, but the bulk of the information I gathered was in the homework assignment I did. Rachel wanted me to research over the different kinds of surgical grafts used to repair an ACL tear to help me with some of my final product research. The graft types are patellar, hamstring, quadricep (autografts), and allografts. I already knew some about the patellar tendon graft, because this is the graft my surgeon used for me. It is the ‘gold standard’, the strongest, and the most widely accepted method of ACL grafts, but one major drawback that an unlucky few suffer from is developing tendonitis in the repaired knee. I haven’t experienced this (yet), but it is a pretty big con in the discussion of the best graft to use. The hamstring graft has a lower chance of donor site morbidity than the patellar (less chance of anterior knee pain) but it isn’t as strong and has a delayed initiation of hamstring strengthening, which is crucial to athletes. The quadricep is a newcomer in the game, the cross-sectional area of the quad tendon is two times stronger than that of the patellar and it has clinical outcomes very similar to that of the contralateral hamstring graft. These are all autografts, meaning they do not require sterilization prior to surgery because they come from the patient themselves. However, the last graft type is an allograft, which is tissue taken from a donor and has a very low donor site morbidity but does indeed require sterilization of the graft prior to surgery.
I feel as though this mentor visit really progressed me in my final product research. I expanded my knowledge of ACL grafts past my own experiences and even learned about another kind of sports-induced knee injury. I had a great experience, learned a lot, and am ecstatic to do it all again next week.