Bilateral patellar and trochlear ACI

[joew]

Hey Erin,

I came across this website that I thought was interesting.  Doug Kelsey is supposed to be a well known PT, although I had never heard of him - maybe you have.  The link will bring you to a page on supplements for joints and there are some interesting articles on knees and other categories on the left hand side. 

Joe

[kathat]

Hi Guys,

Am watching these posts with great interest as I have just found out the depth of my lesions (two are down to bone and one almost to bone) a couple of days ago. I was only first referred to my OS about 4 weeks ago due to pain and grating on stairs and gnawing pain when on my feet for too long, so it's been a steep learning curve for me. In the last 4 weeks I have learned I have OA, had surgery (chondroplasty and LR) on both knees at once, and then learned that I have worn my knees down to bone and am facing major surgery at some stage in the future. Whew! As I am not yet ready to face joint replacement (I'm 35) I have decided that ACI is looking like a good option. Like you, Erin, I'd have to go bilaterally. I'm a rehab nurse and would need to use all my sick leave, annual leave and long service leave to have the surgery and rehab properly regardless of whether I did one leg or two. I have to be well and truely back on my feet before I can return to work and I just don't have enough leave to do one leg and then the other, unless I only staggered the surgery by a few weeks so I could be PWB on one leg before having the other one done. I already have a great PT and OS but I think I need to wait till my kids are older and more self sufficient before I lump more surgery into their laps - and my poor hubby needs time to recover from my last surgery!

Anyway, hope all of you who have had their ACI surgery are going well. Keep up the updates! I await them with interest.

Cheers,

Kathy

[joew]

Erin,

I forgot to include the web link on my last post.  Here it is.

http://sportscenteraustin.blogs.com/the_view/2005/02/how_to_use_supp.html

Joe

[erinee]

Just over 6 mo out...
Things are going well.  I can function without much trouble, going down stairs is still a bit of a challenge although better.  I am increasing my exercising, which is where I feel frustrated.  Although I intellectually know that I am doing extremely well from a medical/rehab perspective, having a high level of fitness pre op is where I want to be-and I'm not there yet.  Patience is not my strong suit, not anymore.  I had prepared myself well for the first 3-4 mo post op, but I've been a bit impatient since.  I am adhering to everything I am supposed to, though-these suckers better work and last a while!
I am still icing after my workouts and in the evening, I think I will continue that for quite a while.  Last week I had some discomfort on the right knee-the fat pad has always been a bit more swollen on that side, and I think as I stepped up my workouts a bit it got a bit irritated.  Seems better now.  The clicking on the left has gotten a bit better as well, although it is still there not a big deal.  I am slowly getting my muscle back, of course too slowly for me!
I see my doc 11.13.07 for follow up.
Hope all is well!

Kathy-
Good luck!!

[David3]

Good to hear your progress Erin. Stay patient - slow and steady....

A quick question - maybe I can benefit from your personal post-op experience and your PT experience. You refer to the fat pad on your RK getting swollen and "a bit irritated". Is it possible for swollen soft tissue to give an irritated, stinging sensation? I am frequently getting an that on my lateral side, to the lateral side and lower side of the patella. I keep wondering if it is the LFC graft, but I'm not having any pain when walking or cycling (not really sure whether the LFC is truly WB in the same way as the MFC?). The lateral side is the only area where I'm experiencing swelling - any idea whether the discomfort I get could be irritated soft tissue, possibly from the lateral release area? My OS didn't seem overly concerned when I saw him 10 days ago, but as a patient I can't help wondering what's going on.

David

[djs60]

Erin,

Sounds like we remain on pretty similar trajectories.  I had dialed back my activity about 7 weeks ago when I got more swelling & stiffness in the context of doing more biking.  The swelling has resolved, but I think the knee is still stiffer than it was 7 weeks ago.  I'm going to see what my OS thinks about my again trying to increase activity when I see him tomorrow.

David,

I have swelling & slight pain lateral to and _above_ the patella, which I think is where the lateral release was done.  I think this is also where my MRI from a few weeks ago showed some scarring, but I hope to get some clarification on this when I see the OS for my 6 month f/u visit tomorrow.  My PT thought this scarring could be the reason for the stiffness I am complaining about.

djs60

[erinee]

Good to hear your progress Erin. Stay patient - slow and steady....

A quick question - maybe I can benefit from your personal post-op experience and your PT experience. You refer to the fat pad on your RK getting swollen and "a bit irritated". Is it possible for swollen soft tissue to give an irritated, stinging sensation? I am frequently getting an that on my lateral side, to the lateral side and lower side of the patella. I keep wondering if it is the LFC graft, but I'm not having any pain when walking or cycling (not really sure whether the LFC is truly WB in the same way as the MFC?). The lateral side is the only area where I'm experiencing swelling - any idea whether the discomfort I get could be irritated soft tissue, possibly from the lateral release area? My OS didn't seem overly concerned when I saw him 10 days ago, but as a patient I can't help wondering what's going on.

David

David-
Without trying to internet diagnose-you may also have a bit of fat pad impingement, mine is lateral and swollen as well, same area as yours.  I think it could certainly be irritated soft tissue.  Keep icing!  And thanks for the reminder-I'm not so good at slow and steady

[erinee]

Erin,

Sounds like we remain on pretty similar trajectories.  I had dialed back my activity about 7 weeks ago when I got more swelling & stiffness in the context of doing more biking.  The swelling has resolved, but I think the knee is still stiffer than it was 7 weeks ago.  I'm going to see what my OS thinks about my again trying to increase activity when I see him tomorrow.

David,

I have swelling & slight pain lateral to and _above_ the patella, which I think is where the lateral release was done.  I think this is also where my MRI from a few weeks ago showed some scarring, but I hope to get some clarification on this when I see the OS for my 6 month f/u visit tomorrow.  My PT thought this scarring could be the reason for the stiffness I am complaining about.

djs60

I think the scarring could definitely contribute to stiffness-I really only notice stiffness when I've been in one position for too long-ie:first thing in the morning, or if I sit at my desk with my knees bent (I still elevate my legs at work quite a bit).  Best wishes on your MD visit!

[erinee]

Let me blow the dust off this thing...
Happy post Thanksgiving to all as well 
7 mo post op!!
Saw the MD on 11/20/07, he approved the increases I'd made to my exercises at 6 mo post op, and we're going to do another MRI at the end of Jan, 9 mo post.  All things are going well, but since I'm really itching to get back to a very high level of athletics he wants to get a look at the grafts prior to clearing me for more.  The clicking is almost gone, I do get a "snapping" from time to time, but no big deal at all.  I still have crepitus at end range extension, but I don't care about that.  Going down stairs, although easier, I still a challenge.  Going up much better.  Did a lot of walking in chicago with no difficulties, just felt a little extra stiff in the morning due to the cold.  My body is happy to be back in FL!
A few things he still wants me to hold off on:
Squat with weight on my back.  I am allowed to hold a dumbbell in front of me, and also allowed to do lumberjack squats.
No lunges
No riding my bike outdoors until 1.5 years post op-only because of where I live, people get hit by cars all the time, and getting run off the road and crashing on my knees is a risk that's just not worth it.
No running, obviously.  He said at about 1.5-2 years post op I may begin to be able to run across the street
He did say I'm allowed to jump rope, which I haven't tried yet.  I do know my explosive power is crap.
He gave me the OK to try to train for another figure show next October, of course, that's all pending how my legs come back.  The muscle is coming back, albeit much too slowly for my taste!
So hopefully that will give some an idea of what 7 mo post op looks like.  Things are going well.  Some pain from time to time, a little w/ activity, but I try to avoid sharp pain and be smart.
Be well all!
Erin

[MT]

Wow Erin I am so happy to hear about your progress.  Awesome.  Figure show next Fall wow that is great.  Just don't risk anything.  There are always shows to do.  I promote a show here in MO throught the nanbf.  Wow, I am just pumped to hear about your progress.  I am still waiting for a donor.  I just don't know if I will be able to return to competition that quick.  My left quad is getting farther and farther behind.  Can you load the leg press with enough weight to stimulate hypertrophy?  Please keep up updated often.  Erin, I am so happy for you.  Awesome.  Michael

[erinee]

8 mo post op and belated happy holidays to all...
Thigs are going well.  I am slowly getting some muscle mass back.  Weights are going up on all exercises, cardio is good.  I am getting very anxious for the next MRI, which will be 1/12/08, exactly 9 mo post op.  I see my doc 2/5/08.  Very minimal clicking at this point, intermittent pain but sporadic.  Walking is pretty much unlimited, I can put the treadmill to 3.7 mph at 7% no problem, same w/ bike and elliptical.  I can even do the stairmaster and stepmill now, which I wasn't able to do preop.  I tried jump rope-definitely not ready for that yet!   I visited my Dad at Christmas (who I hadn't seen since he was here helping me at 4-6 weeks post op) and he was shocked when we went to the gym and saw what I could do!
Still shooting for a show in October, so that gives me until about June/July to build before I'll need to begin dieting down. 
Be well, all.  I'll update again after the next MRI.

[erinee]

Michael, as far as weights-I'm sticking relatively low weight and higher reps, except for conventional deads whch I'm keeping at 5x5.
Examples-this was yesterday's workout-

Conventional DL 5x5 (just made it back up to my preop PR, which was also limited by knee pain, so up from here!)
Leg press-single leg, 4x10 each, calf raises between sets
Step ups regular bench w/ 10# DB in each hand 3x10
Goblet squats 4x12
It's getting there, it's just SLOW!!

[MT]

erin that's absolutely fabulous.  I am very impressed with your progress.  I am still waiting on a donor.  driving me nuts.  check out my website and shoot me an email.  www.michaelthomasonline .com. 

[erinee]

9.5 mo post op and 9 month post MRI results
Saw my ortho today-whoo hoo!!!
MRI shows 100% fill in of the left knee, and about 95% of the right.  The new cartilage is thick and healthy-looks amazing.  It's really cool to see it on the films with the doc explaining!  So specifics...
the hypertrophic reparative response on the left has decreased, and there is absence of chondral defect.  YAY!!!  On the right, there is "filling in" of a previous delamination response, there are 2 2x2 mm spots which show continued delamination, but they aren't in an important spot.
I have full ROM, occasional clicking on the left, and still w/ crepitus.  Doc hopes the crepitus will eventually subside, and it is certainly not problematic to where I'd want a scope.  Pretty much painfree, occasional pain on the left which has always been my "worst" knee, which make sme wonder if there's a neurotransmitter chronic pain pathway at work.  Strength and muscle bulk coming back, but very slowly.  I've been cleared for full return to activity to tolerance, with the exception of outdoor biking and lunges.  YAY!!!  He had to do a bit of convincing me that it's really OK, that I essentially have new knees.
As some of you know my protocol was a bit more aggressive than some, and I've had phenomonal results.  Best wishes all!

[casey2291]

Wow, you got some great news!!!  I am so happy for you.  Thanks for posting all about your recovery.  It is very encouraging to me to know that one day I might be given the clearance to return to full activity because I have a "new knee".  Enjoy returning to all your activities!