Ben's Patellar ACI

[bsonday]

Casey, Dr. Cole didn't mention anything, but I didn't ask, either.  He did confirm, though, that it seems like the best way to get a good ACI result with "smooth" cartilage is to do things like the bike--lots of motion, low impact, and strengthening.  He also said that another scar removal procedure in the future (6 mos or so) is not out of the question.

[Room 101]

Do you do a lot of biking?  I am at 9 weeks post tomorrow and have only been able to do a full revolution for a week.  I seem to definitely have a limit of around 10-11 minutes right now, but I can do that a couple of times per day.  When did people start doing more?  I figure it's all individual by how you feel, but figured I'd see what others could tolerate at specific times.

Glad the scope helped you!

Take care,
Room 101

[bsonday]

Great question.  I am curious about everyone else's answer to your question as well.

I've been able to be on a bike comfortably ever since a month or two after the surgery, but I never really used my left knee (the ACI knee) to pedal because it hurt to use it.  Biking is how I get around.  I suppose I did use my butt muscle (gluteus maximus?) on the left side, but certainly never the quads.

Dr. Cole removed a ton of scar tissue from that leg about a month ago, and now I can bike relatively hard for 10 minutes, or bike gently probably forever.  During these 10 minute "drills", I try to not even use my good leg as anything other than weight to get the pedals back around, and I make the ACIed knee do most of the work.  I believe I am starting to have some ITB syndrome from all the biking, though.

Back at 9 weeks, I couldn't do anything but SLRs . 

[Room 101]

Hi, Ben.  Hope you're still doing well.  It's good to read your experience.   I do worry about scar tissue.  When i am on the bike, it's definitely right leg doing the work and left leg riding along, and i don't feel like that is getting a ton easier.  Walking sure has, but I still have this insane stiffness.  I still have to tilt my foot forward to get around, but not as much as I was a week ago. 

I am 10 weeks past now and just need to keep working on ROM.  I do feel stuck, and I hope it's just inflammation still.  I'll see what, if anything, has changed in PT tomorrow.

It's good to hear how quickly your motion resolved after the cleaning.

Take care,
Kim

[bsonday]

Update!

It's been almost 8 months now.  Wow that went quick!  Still seeing definite improvement every 6 weeks or so it seems--day to day, I see nothing, but every six weeks I look bag in my log and notice that I'm a bit ahead.  I still have a long way to go, though.

I can do the elliptical lightly for quite a while.  20 minutes at least.

I can also do the bike and go somewhat hard for 5 or 10 minutes, but then I start to feel it in under the kneecap and I back off.

I either bike or do the elliptical 3 times per week, and I'm usually slightly sore for about a day afterwards.  Based on that, am I working too hard?  Not sure, but I don't think so.

I've noticed that I get VERY sore, on the order of days, if I try to do wall sits.  Still not ready for these yet, I guess.

I'll be on the beach in Miami at this time next week, and I think I may try to run around a bit.  Not much, but maybe a 10 second jog here and there just to try out the ol' knee.

Slowly getting there...

-Ben

[jonhark]

Ben--

Your progress sounds very similar to what I experienced in my recovery from my first ACI.

Definite improvement from pre-op...able to bike and do elliptical with no pain...but maybe some slight irritation in the days afterwards...but no sharp pains. Swelling was never an issue for me. At 15 months, before I got my other knee ACI'ed, I was biking outdoors at a nice clip with no pain...which wouldn't have been too easy at 9 months.

The true benefit of this surgery is both the pain relief and the fact your defect is filled-in and not empty. My defects rapidly got worse over the last five years. If you read posts from those that are in the 40's and haven't done anything about their patella defects---it is most likely too late to treat with ACI or their defects are HUGE!!

J

[flash717]

Hi Ben,
Thanks for sharing. I may be a ACI patient in the future, but I am trying to hold off for as long as possible. So far, I have had great relief from my AMZ. My patellar deficit is on the medial facet and they were hesitant to address anything with it during the AMZ. They just re-did my lateral release.

karen

[bsonday]

Brief update:

I wanted to try running a few steps on the beach in Miami (I'm here for a math conference), but I didn't for two reasons:

1.  It's been really cold!  What the heck!
2.  I've been at least a tad sore underneath the kneecap for about a month now.  I still feel like I'm progressing VERY slowly, but as Dr. Cole said, I have some scar tissue under there which may be causing issues.  With a patellar ACI, it's important to minimize shear forces.  Scar tissue really interferes with this goal, and might explain why I'm a bit behind everyone else in terms of recovery...

I have an appointment with Dr. Cole in early April, so we'll figure out, or at least guess, what's going on then.

Until then, I'm going to try to ignore the tens of well-groomed municipal beach volleyball courts right in front of my hotel.

To fill everyone in, here's a list of things I can and can't do.  I would LOVE to see a list like this for whoever else would like to share, even though I know with an ACI, it's not good to compare yourself to others:

Things I can do pain-free:
1.  Walking miles and miles
2.  All range-of-motion type stretches and exercises

Things which cause a small amount of pain:
1.  Going up or down stairs
2.  Biking for 10 minutes with a little resistance
3.  Long arc quad (google it if you're not sure what it is)
4.  Elliptical machine for 5 or 10 minutes
5.  Some pool running (quick extensions of the leg in the pool against the resistance of the water, which you do when you run, are somewhat painful)
6.  I've tried some light running barefoot on grass for 10 or 20 steps, and it's not too bad.

Things I absolutely cannot do:
1.  Squats
2.  Biking with lots of resistance
3.  Running, jumping, etc
4.  Wall sits don't hurt much during, but I'm very sore for days afterward


-Ben

[SamB]

Hi Ben,
Looking over they things you can do, I don't think we're that much different, especially considering how close our surgeries were.  I can walk pretty much as much as I want, and ride with light resistance on a bike for about as long as I can (not being in very good shape anymore, you know).  I cranked up the resistance a couple nights ago, and I'm still feeling the effects of it - so I'm thinking that lots of resistance should maybe be put off for awhile, or at least started a bit more gradually.  I can also do some lunges, although I'm pretty cautious anytime I do something like that. I'm trying to schedule myself to pass an Army PT test at the start of July, the hard part being running 2 miles in under 17 minutes. I don't know if that's attainable or not, but I'm going to be pushing the rehab about as hard as I can (always putting the success of my surgery ahead of anything, of course), so I'll keep everybody posted on how the next few months go.

Sam

[bsonday]

Thanks for the update, Sam.  I wish you all the best in your goal of passing the Army PT test in early July!  Are they going to make you run on concrete, or can you do your test in the grass or on a track?  I have a feeling that you'll be able to do it on a soft surface at the very least.

-Ben

[David3]

Ben, 

I think you're doing well and are on course for a good outcome. Your summary of what you can do with no pain/ a little pain / can't do is pretty similar to where I was at 8 months (I had ACI on patella, trochlea, MFC, LFC as well as TTO - patella was my largest graft). It wasn't until about 12 months that I started feeling pretty comfortable with most things (except running, squats, jumping). I didn't try to push things too much until about 12 months, at which point I resumed hard cycling outdoors, golf, faster up and down stairs, stronger leg kick swimming, etc.

By 15 months I could go up and down stairs fast (and very comfortably). To help with strengthening, I started doing 2 stair steps at a time with my ACI leg pretty much any time I was on stairs (my other knee is not great, so I only do one step at a time with that one!). By 18 months I could jog for 10 mins or so, and started doing a few squats and strengthening exercises. I could also hike for quite a few hours in steep terrain. I've seen further improvement since then (I'm now just over 20 months) and jogging is improving more. I can't say I'm anywhere near running hard, but on the other hand I'm still being pretty conservative. I'm also convinced I could be seeing improvement for another year yet. I've also noticed that my knee has become smoother from 12 months to 20 months.

I'd still advise not pushing things too hard until 12 months. Just be patient. You've still got alot of improvement to look forward to. Incidentally, I had an MRI at 7 months due to scar tissue problems. It showed that my patella graft was still a fair bit under full thickness. However, my 12 month MRI showed full thickness, possibly slightly thicker than normal. You've probably got more thickening to go too, which will contribute to improvement.

David

[bsonday]

David, thanks for a very informative, very helpful post.  Glad to hear your recovery is going so well.

-Ben

[jenworth]

Ben (and others!),

thank you soooo much for sharing your experiences. I found this site after my ACI surgery, and it's so helpful to read these posts. It's hard not to compare different levels of progress, but it does help in reminding myself of being patient. As my OS said, I get one shot at this. 

I'm 10 weeks post-op on my patellar ACI (right knee, of course). Did you have a lot of stiffness at this point? My patellar tendon is what seems to be ridiculously tight, but the joint also gets a little tight--especially first thing in the morning. When did you start to experience less stiffness, tightness, and have your knee really look like a knee?

This past week, I finally feel like PT is starting to get challenging and interesting. I'm still in the locked brace (unlocked to 50 degrees) and down to one crutch...the weakness/atrophy of my quads is quite something. Have you found that that comes back easily on it's own, with work? I'm doing full weight bearing w/o crutch at home, and I notice the knee joint gets a bit sore/tired by the end of the day.

So many questions....but thanks again for sharing your experiences!

Jen

[bsonday]

Hey Jen,

I didn't have too much experience with stiffness, but the skin around the incision site is still stiffer and less mobile (when trying to push it side to side) than the other leg, and might be forever.  It also felt tight near my patellar tendon, but this turned out just to be the Fulkerson osteotomy.

Frankly, my quads are still slightly weaker in the left leg.  However, it doesn't matter too much until someday when I really try to up my activity level.  A few weeks after my ACI, though, my quads were puny!  My knee only began to look like a knee recently because I had so much scar tissue (which was zapped off surgically at 6 months) that was preventing pretty much any rehab.  Just jump on the stationary bike with NO RESISTANCE as soon as you are allowed (and your pain allows) and your stiffness will get "ground up" pretty quickly.

It's tough to get those quads back, but they'll be mostly back when you start doing day-to-day activities with the ACIed knee regularly like walking, etc.

My knee still gets sore ALL THE TIME!

You're doing fine!

Best,
Ben

[bsonday]

15th month update

Hello everyone.  I'm 15 months out from surgery, and frankly, not too much has changed from pre-op.  There isn't a "clunk clunk" when I bend down and squat or anything like that, and perhaps there is slightly less swelling in the knee, but my pain level has not changed and perhaps even slightly increased.  No big deal.  ACI doesn't do a lot for some people, and at the same time, if I hadn't had my ACI, perhaps my pre-op knee would've deteriorated significantly by now.  I'm still glad I took this chance.

Sigh.

At least most of the heartbreak of the original injury is over now.  2 1/2 years of not running around and playing sports has gone by quickly.  Besides, technology for this stuff is improving all the time.  I hope health care changes, if there are any, do nothing but contribute to research on how to cure the cartilage deterioration epidemic--baby boomers are getting old!

-Ben (24 years old)