Day One down the ACI Road

[bsonday]

Keep it up, Jon.  Always nice to hear your updates.

-Ben

[Room 101]

Thanks for the update, Jon!  Always good to hear how it's going.  This is definitely a very mentally challenging stage of rehab.  Much more than physical.

Take care,
Kim

[Hathor]

Hi

My OS has prescribed some NSAIDs for a mild form of bursitis in my knee and when asked he said it should have no effect on the cartilage growth of my MACI especially as I'm at 6months. Has anyone got any other views from their OS around use of anti inflams?

I vaguely remember reading a post at some stage saying their OS was against their use....?

Hathor

[jonhark]

I've heard differing opinions on this. My current doc--Farr is against it as he thinks it affects the matrix formulation and growth. Cells grow up to 12 months. After that, I think it is perfectly fine to take NSAID's.

[bsonday]

Dr. Cole says wait 9 months, but he let me take them for a few days around the 6 month mark when I hurt my shoulder.  Try sodium naproxen (Aleve) instead as it does not interfere hardly at all with cartilage sythesis, etc.

[Room 101]

Dr. Cole actually prescribed them to me post op.  Advil in between pain killers.  I was never told not to, and I didn't take them right after, but I have popped a few since then for some different pain/inflammation issues unrelated to my knee.

[jonhark]

Cole prescribed them after my surgery as well. I had read on Minas's site that he doesn't recommend them until 12 months post-op. I really haven't had pain that has been too unbearable so it hasn't been an issue. 6-12 months is the period of time when the cartilage goes from soft and immature and starts to resemble the real thing as it fills in. 12-24 it hardens....

[Hathor]

Thanks guys. As the swelling comes and goes only occasionally and ice generally helps, I will play it safe and stay off them until 12 months...who needs OS advice when you can get it all on this board !!

[shell1mark]

I noticed that you work in Medical Devices, I am a pharma speciality rep. I am still not back to work it has been 12 weeks. My knee aches and occasional sharp pain if I move the wrong way and I cannot stand for long periods of time at all. I am doing local driving and if I do too much I am exhaused in the afternoon. I had an ACI on my right knee in Feb. My doctor does not want me to go back to work till July.....I do about 3-4 hours of driving a day and in and out of the car all day. I call on hospitals, pharmacies and offices. Any advice?? I just want to do the right thing...I am so worried about breaking the patch.

[jonhark]

I do marketing and not sales. I'll be honest, driving daily and standing in the OR all day would be tough before 6-9 months (depending upon size and location of defect). I have mostly avoided long trips and too much OR time for the first five months. Being able to keep my leg propped at work if necessary has been a luxury.

That being said, I don't think you would do damage to the patch after five months by doing too much driving, etc. You'll just have to put up with the daily aching and sharp pains until the graft hardens.


Yeah, keeping a an active job is definitely not easy with this type of surgery. I've had three cartilage repairs in less than 3 years and somehow have managed to keep the same job....knock on wood.

[Hathor]

Hey guys

This board has been awfully quiet. I am at 6 months in a couple of days and happy to have made it this far with no major mishaps.

By way of update, I'm now out on the bike Saturdays and Sundays for a whole hour at a time and 1/2hr alternate days during the week. Still only spinning but moving further down the gears each week.
I've also started squats and lunges using a swiss ball up against the wall on alternate days and doing a bit of rowing and elliptical.

The knee still feels good overall, but have days where it is still a bit sore. I have noticed that in the last 2 weeks I am only iceing only occasionally to relieve the soreness whereas a few weeks back it was almost every day.

Hope everyone else is doing ok. Keep the updates coming.

Hathor

[jonhark]

Can't say I'm doing as much as you Hathor.

I'm mostly sticking to good quality glute, core, quad and hamstring strengthening. Too much biking does irritate my knee....so I've been sticking to mostly spinning.

Most days I'm completely pain-free on stairs and walking. Stairs are fine as long as I don't load the knee too much.

I am noticing improvement along the way. I'm not a big fan of being sore so I've been staying away from things that create soreness. I haven't iced my knee in months.

Do you ice for soft tissue or patella pain? I literally have no swelling whatsoever.

[Room 101]

Good to hear from you guys.  I don't have any swelling either, and I don't remember the last time I iced.  Physical therapy I guess.  But I don't remember the last time on my own.  I'm with Jon, and I don't like soreness in the knee... if I screw up and get really sore, I back off.  Stairs are good for me now, unless I am super tired or doing a ton of them at once.  I still find myself holding on though 

[Hathor]

Jon

The soreness is generally soft tissue. I have no pain from the patella at this stage and no swelling. The clicking I used to get has also gone so not sure what that was all about.

I recall last time round ACI, I fell goofing around on skis at 18months and tore a whole load of scar tissue and couldn't walk for a week due to internal bleeding and horrible swelling. That was the only time I had any post op swelling after the 2-3 month mark....lol

My current big goal (and maybe a little ambitious at this stage) is I've booked to go to Vail in December where I hope to get back on the snowboard. My OS told me skiing and boarding at 12 months will be fine if the quads are up to it.

H

[jonhark]

Well folks, it is time for an update...I'm closing in on 8 and 24 months for my two patella lesions.

The improvement from 18 to 24 months for my right knee has been phenomenal. It feels better now than it did ten years ago.

My most recent knee is coming around slowly as well. I think less about it daily and only get minor pains occasionally. Stairs are becoming more fluid as I'm able to load into the knee without much problem.

I personally feel pushing the rehab/biking in the first 12 months is kind of pointless. I do daily leg raises, glute exercises and ab work. I find this strengthens everything well enough without aggravating the knee.

For those still struggling with the patella ACI post-op, my suggestion is to be patient and accept that this is a 24 month process. If your cells haven't delaminated then you should continue to see improvement along the way. Your cells will harden and mature over the course of the second year. As they do, you'll be able to work your leg more, which in turn leads to more symptomatic improvement.

I'm still not better than post-op on my second knee. My defect wasn't grade 4 at the time of surgery. It was symptomatic with stairs and some activity. It was basically severe chondro. I'll re-evaluate in 6-9 months and make the judgement if this was a success at that point. All indications are that I'm moving in the right direction. At least I'm getting better and not worse as would have been the case if I left the defect alone.