Bilateral patellar and trochlear ACI

[Thabo]

Very glad to hear about your good results up untill now. I am watchibg closely as I have bilateral grade 3/4 chondo patellae and feel I dont have many options. Amazing to hear that you are even getting back to activities where you can actually sweat!! For the past 2 yrs I can only walk 1000 steps a day and climb stairs very slowly and reluctantly. Best of luck.

[erinee]

11 months post op 

All is well.  I'm very slowly regaining strength and muscle mass.  No lunges, but everything else.  Stairmaster, treadmill, bike, leg press, deadlifts, single leg work, even front squats!!  No pain whatsoever with stairs, I go up and down the 4 flights at my office every hour now.  Really, no pain at all.  I still have some crepitus, but who cares!

I has been a long, challenging road, but it's amazing that I can do what I'm doing WITHOUT PAIN!  I know many people are facing a lot of challenges with the patellar deficits, but this does and can work.  Grade 4 global patellar deficits 1 year ago.

Next goal is to get back in a figure show-I know my legs will still be lagging, but I need to prove to myself I can do it, then can continue to improve from there.  October 4th and 11th!

Best wishes to all-
Erin

[erinee]

20 months post op.....
All is well.  I'm truly amazed.  Our local Fox channel will be doing a story on ACI and have interviewed myself and my OS, Dr. Martin Roche here in Fort Lauderdale.  They will be coming to take some footage of me at the gym after the holidays.
I am doing great in the gym, breaking personal records with strength as now I am not limited by pain.  I competed in 2 figure shows and placed 2nd and 3rd in the Masters division.  I still have work to do with bringing back the muscularity in my legs, but they're getting there!
The only thing I'm still not doing is lunges, and that's fine with me.  There's plenty of other god exercises.  I will be having a follow up MRI in April at the 2 year mark to check in.  I do have some clicking and popping from time to time, most likely from some overgrowth, but its not painful.  Doc says it's up to me to tell him if I want it scoped-no thanks!
So keep trucking, keep rehabbing and work really hard-I truly think my outcomes have been so successful not just thru the skills of a good surgeon, but because I was DILIGENT about doing everything possible to maximize my results-from the CPM 6-8 hrs/day, to the NMES to the quads, endless SLR's and quad sets, Polar care out the wazoo, and maximizing nutrition.  There is hope for the patellar lesions.

[Room 101]

Congratulations!  Such a great success story (I read it start to finish today, haha) is what I needed.  I am 5 weeks 2 days post, so just getting started.  I hope you find continued improvement!

Take care,
Room 101

[MT]

Erinee, This is fabulous.  Long time no chat.  I am about 10 months out of my allograft on the trochlea.  Things are going very well.  I have quite a bit of crepitus and I still can't perform squats very good.  But I can leg press.  I may make my return to the pro stage this fall.  My doc may go in with a scope this spring and clean out some debris.  You look great keep working smart.  Michael

[ghost]

Sorry to jump in on this thread, but I could use some direction myself.  I'm 8  weeks post microfracture for a grade 4 lesion in the trochlear groove of my left knee.  Post surgery the lesion covers most of the trochlear groove because what was left of the cartilage wasn't stable so he had to remove most of it to get to a stable rim.  In some ways I feel like I'm doing OK, but the reality is that I've really just made it back to the point I was at pre-surgery.  I still can't push off with that leg or go down stairs ( though I can go up and could pre-surgery) and if I stomp my foot or even put it down with a bit too much force it earns me a trip to another planet.  One of my big concerns is that the knee is locking up in a big way in full extension or when I straighten it from a 90+ degree bend.  I've got the rom within 20 degrees of the good leg, but there is a definite end feel there so I doubt that I will get much more out of if.  I can't decide if the locking is a result of the cartilage regenerating and over filling the space or because it didn't regenerate and it's catching on the rim.  Also, the back of the knee near the top of the tibia is pretty sore.

At any rate, I'm a probable candidate for an ACI and my OS, Dr. Gill, has told me to start looking into the ACI and reading up on Dr. Minas.  I live about an hour from Boston and Dr. Minas' Carticel Center.  Maybe this will work, but my first and to date only post op visit, was started with, "you know this surgery doesn't always work." Followed by the suggestion that I research Dr. Minas and the ACI proceedure.  Somehow that just doesn't seem like a good sign.

Any thoughts or advise would be appreciated.  How do you know if the MfX failed etc.?

Thanks,

Sue
aka Ghost

[jonhark]

Sue--

I had mfx on patella by Dr. Minas (relatively small defect). I knew it failed within the first three months as I was in as much pain as pre-surgery. I waited six months and got the ACI surgery done (it became a more medium size defect in that time). Mine was on the patella.

I'd seriously doubt any intra-articular catching at eight weeks is due to overgrowth of fibrocartilage. Most times catching sensations are caused by rim of defect.

Most of the time these cartilage repair surgeries take a long time to work. Regardless, most OS's want to wait 12 months before attempting another one. Sounds like your defect is pretty large. That makes mfx a questionable surgery and ACI better-suited.

I would set something up with Minas. He is the best in the US for ACI.

[ghost]

Thanks for the scoop,  I emailed his office this am and they want to see me at the six month mark, early June and am working on setting up that now.  I kind of had the feeling that the catching was a rim issue rather than an overgrowth issue.  Combining that with the bone on bone end feel in flex and I kinda knew I was in trouble.

Sue

[erinee]

Hello there!
Time for a quick update...
4 years post op. Time flies.
Overall, I have been doing extremely well.  I have been able to do pretty much anything I want with the exception of high impact activity like running, and to be quite honest I haven't run in 20 years anyway, so no big thing.
In March I began having sharp pain and a significant amount of swelling in my right knee.  I've known for quite some time that I had some overgrowth from the ACI  and some loose bodies, but was putting off a scope until I erally needed it.  Well, the time had come.
I had both knees scoped, the overgrowth cleaned up, and loose bodies removed.  The good news is that the ACI looks perfect bilaterally, and the osteotomies are totally fine.  The bad news is that I have a new area of damage on the medial femoral condyle on the right knee.  It is a non weight bearing area, and is not a mechanical problem.  I had no trauma. My OS does not feel that it was caused by the loose body.  So we are back again to not knowing why my cartilage is shearing off for no apparent reason.
This time we are going with the DeNovo NT, which I am excited about.  The recovery looks to be SO much quicker and easier (and only one knee this time, natch!) and the results look so promising.  Surgery will be July 8th.
The frustrating thing to me is because we do not know why the cartilage is shearing off, there is no way to prevent it from recurring that I know of.  Very frustrating.  I do have celiac disease (autoimmune) but no other joints are affected to indicate an autoimmune disorder like RA.  So I'm stumped, my docs are stumped so far, and Google has been no help.

I'll be back to update you after the procedure and compare ACI vs. DeNovo NT.  Everyone be well and keep on trucking!

[erinee]

3 days post op DeNovo NT to the right medial femoral condyle...
Wow.  So much easier this time it's crazy.
I've had very well controlled pain.  The night of surgery and day after I did take Vicodin, but yesterday started with only Tylenol ES.  Ths surgery only required a mini arthrotomy, so my doc used my old scar and saved me getting another one.
Overall, of course this is only one knee, but the low amount of pain is amazing.  Also, quad control is coming back very quickly.  I can do quad sets with no problem and can do 10 SLR's out of the brace starting last night.  I am up to 50 degrees on the CPM, and could easily do more if the protocol allowed.  The hardest thing for me is going to be staying patient and following the protocol to the letter to protect the graft.  So far, WAY easier than Carticel.

[erinee]

Post op Day 16

All in all, physically doing very well.  I saw my doc for my post op visit on Wednesday.  He removed my stitches and was very pleased with how my knee looked/behaved.  The swelling is less than he expected and my ROM and quad control were more than he expected.  I was able to progress quite quickly with the CPM, and am up to maxing it out at 125.  I am still continuing it for 5-8 hours a day until 4 weeks post op.

I have seen the protocols for this procedure are a bit all over the map, so we are playing the conservative edge and basing it essentially on the ACI trochlear protocol.

He allowed me to open the brace (makes sitting MUCH easier!) but I am to remain non weight bearing until 4 weeks post op, so no driving either since this is my right knee.  I began using the stationary bike for ROM yesterday and it went very well. 
I am doing all my strengthening exercises: estim to the quads for at least 20-30 minutes daily, quad sets, glute sets, I am now allowed active range of motion for heel slides, short arc quads from 30-just lacking full extension to protect the graft, hip abduction and adduction, hip extension, bridging, and prone hamstring curls.  All without weight with exception of the hip exercises.  I am still icing at least 2x/day.

Mentally, I am really ready to progress and have to rein myself in.  The lack of pain/swelling after this procedure makes it a bit harder to "play by the rules" as you feel as if you can do considerably more than you actually can.  I think that is crucial to remember, that these grafts are quite fragile and we need to respect that.  I am getting a bit cabin feverish. 

At 4 weeks post op I can progress to partial weight bearing of about 30#, where I will stay until 6 weeks post op.  At 6 weeks post op I will progress to WBAT and drop to one crutch as able.  I see my doc again at 8 weeks post op, by which time I expect to be on one crutch or without. 

As my weight bearing status increases I will be able to increase and change the exercises as well.

[erinee]

Post op week 5 from DeNovo NT to the right femoral condyle:

-I am now partial weight bearing (50%) and feel great.  Very little to no discomfort.  Some minimal "popping", but no associated pain and no different than popping I have had as long as I can remember.
-CPM is gone!!  Yesterday was my last day.  I have had it maxed to 125 deg of flexion for several weeks now anyway, just was using it to keep that synovial fluid moving and nutrition to the cartilage.
-I am riding my bike on the trainer for about an hour several times per week, and have returned to the gym for upper body/core and some limited leg exercise (rehab, essentially.) 
-I definitely feel as if I can do more than I am "allowed."  It's only fear of disrupting the graft that is keeping me in check. 
-Swelling is minimal, still icing 2x/day
-Using NMES/estim once a day, about 30 m to the quads and have that puppy cranked! Quad control and "tone" is coming back. 
-Stability in the knee has not been a problem at all once I started weight bearing.  I wore the brace for a day or so when I forst started weight bearing just to be safe, but have felt totally stable without it and finally tossed it in the garbage today. 

Next week I can advance to WBAT.  I am sure I will be on one crutch and then likely no crutches by the time of my follow up appointment on the 31st.  Things are trucking along!  I have set a goal for myself to ride a 31 mile charity event on 10/2 and then to compete in figure again in spring 2012.  I thrive with goals, that's just my personality.

Til next time!

[erinee]

Post op 8.5 weeks
Saw my OS last week, at 7.5 weeks post op and forgot to update!

He is very pleased with my return of strength and ROM so far, and as I have had no signs of graft delamination we are feeling confident that the graft is healing and remodeling as it should be.  I have to continue to be cautious especially for the next 4 weeks, but I have been cleared for full return to activity to tolerance.  I am to allow feedback from the graft site (if I feel discomfort) to limit me.  The really awesome news-I am cleared to begin a return to real road cycling, which I’ve not been able to do for the past 4 years.  I am a huge fan of Zimmer’s DeNovo NT right about now
 
I have been out on the road bike 4 times now, and feel really good.  Not breaking any speed records, but I did do 25 miles on Sunday.  Feeling good in the gym, spending 3 days a week lifting weights and really just paying very close attention to how I feel.  That is the part that I have to be very careful with, as I have had knee pain for most of my life and tend to ignore it if I'm not careful.  I've also done the elliptical without problems.  I do ice when I get home from doing any activity and again every evening. 

I do not go back to see my OS for 3 months, and we are thinking to likely do a MRI at 6 months post op to take a look at the graft.  All in all, very pleased.

[erinee]

12 weeks post op DeNovo NT to the right femoral condyle, 4.5 years post op bilateral patella ACI with osteotomies...

Doing very, very well.  Minimal to no strength lag on the right side now.  Muscle bulk back to meet the left (although up until this point my left was always my "bad" leg and lagged a bit anyway.)  Still icing at least once daily, but more prophylactically than anything else.  No real swelling or heat to speak of.

Road riding without problems, a little achy over bridges and with wind.  I rode 56 miles this past Saturday and my low back cramped up but my knees felt good!

This will likely be my last update until I have an MRI. 

Keep on working hard, everyone. Listen to your docs, therapists, and do the work.   

[Thabo]

Good tohear that Erinee! Please keep updating.