Ben's Patellar ACI

[bsonday]

Thanks for all of the reassurance, everyone.  The graft site is still hurting quite a bit, but I've sort of stopped worrying about it.

Physical therapy is going pretty well, but even simple things like isometric quad sets are irritating my patella ever so slightly so I've had to back off and watch my quad muscle get smaller and smaller.  It's a long haul and so I'm not too concerned about where my quads are a whole year before I can even begin to start playing around on my knee again.  Things like straight leg raises (SLRs) would still hurt too much, mostly due to the Fulkerson I think.

On a good note, my scar has healed up very nicely and swelling is down overall.  It appears that I will have a scar but that it will look more like a scratch on the leg than an incision site.  My range of motion is also good.  I'm 3 weeks, 1 day out of surgery and although the knee starts to tighten up at about 45 degrees, I can go to about 100.

Best,
Ben

[jonhark]

I met with Dr. Cole this week. I was very impressed with him and you should have no worries about the level of care you received. He commented it takes a minimum of 12-18 months before his patients start to feel a ton better.

My thoughts (and Ill defer to others as well) are you shouldn't be doing anything that causes you a great deal of discomfort at this stage.  My advice from my OS at the time was only do the CPM through a ROM that wasn't painful. If I remember correctly, I stayed around 40-60 degrees for the first six weeks. Dr. Minas (the pioneer of ACI in the US) only recommends 45 degrees for the first six weeks.

If you are pushing the CPM too far and too long that could be causing your discomfort in the patella. Work with a therapist to allow you to gain your passive motion.

Your quad will be puny in six weeks. There is no way around it. An electostimulation device might be worth trying for isometric exercises.
SLR's aren't a good idea until six weeks to allow your bone to heal properly.

Your big priority should be to protect your graft and slowly regain ROM and strength.

The first 3-4 months are kind of miserable to be honest. Once you hit six months you'll start to notice an improvement but it won't be until around 12 months youll really feel a huge difference and then improvement at 18 and 24 and 36 months onward.

Results differ based upon prior surgeries, size of defect and overall leg strength. You have a lot going for you due to your young age and relatively small defect.

[bsonday]

Time for the weekly update...

I think my overall patellar discomfort has gone down a lot.  I notice that the more horizontal I try to be, the better the leg feels.  I just have a few things to say:

1.  It seems like everyone who posts on this site ends up doing pretty well in the end.  Statistically, I know that ACI fails all the time, but I've had trouble finding posts of people with failed ACI's on this site.  Perhaps the collective wisdom of this group is making us heal better .

2.  My other, good knee is starting to hurt and make strange popping/creaking noises.  Has anyone else experienced this?  I was worried about it at first, but I'm pretty sure the reason is that even the good leg atrophied while I was curled up on the couch for those two weeks, and now I'm feeling the effects.

3.  I had a bit of a scare a few days ago.  I was sitting in a chair and I bent my leg and heard kind of a squishy popping noise (no pain).  I bent my leg back and forth gently and heard it a couple of more times.  My patella seemed perhaps slightly more sore for the rest of the day.  Dr. Cole's PAs assured me, however, that strange noises are normal and nothing to be worried about, but it scared the crap out of me!

4.  It seems like most of you all are good about keeping your brace on for most of the day.  I'm supposed to keep it on pretty much all the time up through week 6, but I've been bad, and I really only wear it when I'm up walking around, in a car, etc.--basically, when I'm changing location.  Does anyone think this is a big deal?

5.  Finally, has anyone heard anything about the success of Fulkersons in preventing future dislocations/subluxations?  In the absolute worst case scenario that my patellar ACI doesn't work out, I can still run around on sand fairly painlessly and play sand volleyball, but sand volleyball is how I dislocated initially.  Now that I have a Fulkerson, though, things are supposed to be safer, but who knows...

Thanks for the support.

Best,
Ben

[SamB]

Hi Ben,
I've noticed some soreness in my good knee too.  When I first injured my knee, I brought this up to the doc.  He said that just the fact that it's basically doing double the work is going to make it more sore than usual. I didn't keep my brace on all the time.  Pretty much anytime I was out of the immediate area of the CPM machine I had it on, but I would always take it off for that.  For getting up and crutching to the bathroom, or something like that, it generally didn't seem worth it to put it on.  Granted, I was pretty careful with the bad leg, and the potential for disaster was there, but I made it.

Keep your head up...once you're off crutches, it's like a whole new world!

Sam

[dileigh]

I'm with Sam, I got to where I kept it off if I was sitting around.  I also didn't use it for going to the bathroom as it's only about 5 crutch steps from the couch.  Other than that it was on.  I got a different brace after a couple of weeks, that would allow for some flex.

The crunching and other noises will go away once you get back to using both knees.  I still have a little bit of crunching if I've been on the steps alot, but that's it.  The popping noise could be some scar tissue breaking up.  I wouldn't worry about it much.

[Room 101]

Hi, Ben.  I'm a patient of Dr. Cole also.  6 months post AMZ/lateral release.  I am do for ACI this Fall.  I have noticed fabulous mechanical changes with the AMZ.  I don't dislocate anymore, and my overall balance is amazingly different... so much better.  I knew it immediately when I started walking.   I just still get major catching, swelling and pain when bending due to the cartilage tear.  Dr. Cole hoped the AMZ would take the pressure off, but it didn't.  At least I go into ACI knowing my tracking is excellent and the AMZ a rousing success.

It sounds like everything is going great, so keep it up!

Room 101

[bsonday]

Hey everyone,

Thanks again for the comments.  It's great about everyone's experiences, and I enjoy hearing that other people like Dr. Cole as well.  I'm posting to let you know that I can now do a pain-free straight leg raise (even though my rehab doesn't call for them for another week, at the 6 week mark), so that's something!  Other than that, I just have a concern:

When I'm on my back and doing heel slides, I often feel a catching sensation as I move my heel away from my body.  Is this "catching" feeling normal with the knee/graft after ACI or something to be concerned about?  I guess I may have read about a few people having this "catching" sensation from scar tissue, in which case I'd like to hear how you knew it was scar tissue.

Feeling terribly paranoid as usual,
Ben

[dileigh]

Catching some seems to be normal and not much to worry about. We all know it's scar tissue because that's what our collective OS's have said, including mine.       Mine still does it from time to time, but not as much as it used to.


Diana

[bsonday]

Hey everyone,

My non-ACI leg has really been bothering me lately even though I am (basically) fully weight-bearing.  I figured this would go away with time, but it didn't.  So I went to the doctor here (not Dr. Cole in Chicago), and since all health care is free for me until Sept. 1st (I maxed my out-of-pocket for this school year with the ACI), I got an MRI done of the right leg.  Sure enough, there is a meniscus tear in the right leg.  Chances are that's it's been there all along, and that I aggravated it while hobbling around on one foot only for those weeks.  So for now, we're not going to do anything...

So some bad news, I guess, but not really that bad.  Menisci are (usually) a fricking piece of cake compared to ACI stuff.

The only thing concerning me is that I am still getting a "catching" feeling in the ACI leg which really feels a lot more like there is a big hole in my kneecap than some scar tissue, but as I've been told, it's really not something to worry about...

Swelling, however, has dropped a lot.  I've noticed that staying hydrated makes it feel better, and pretty much the worst thing for it is being out at a bar, standing up, and dehydrating myself with a few drinks.  But hey, it's my birthday in a few days, so I guess I'll just have to enjoy myself ...

[Fisher201]

Hey everyone,

Thanks again for the comments.  It's great about everyone's experiences, and I enjoy hearing that other people like Dr. Cole as well.  I'm posting to let you know that I can now do a pain-free straight leg raise (even though my rehab doesn't call for them for another week, at the 6 week mark), so that's something!  Other than that, I just have a concern:

When I'm on my back and doing heel slides, I often feel a catching sensation as I move my heel away from my body.  Is this "catching" feeling normal with the knee/graft after ACI or something to be concerned about?  I guess I may have read about a few people having this "catching" sensation from scar tissue, in which case I'd like to hear how you knew it was scar tissue.

Feeling terribly paranoid as usual,
Ben

Getting a sharp catching pain when sliding my heel away from my body is still my biggest concern, and I'm almost 10 weeks out from my trochlea ACI.  I wish it would go away!  I think the pain is from the graft site, not the scar, so perhaps mine is different from other peoples'. 

Seeing the OS next week so hopefully he'll be able to give me some guidance as to when I can expect the pain to fade.

[dileigh]

Hope you had a good birthday 


Diana

[bsonday]

Haha thanks.  I did have a great birthday.  My girlfriend got me some great, meaningful stuff, but unfortunately, she leaves for China for a year in three days .

On a positive note, I have my first post-surgery appointment with Dr. Cole in Chicago on Monday, so I'm pretty excited to have some professional inspect me and all of the little noises my knee is making .  I will post an update afterwards.

Best,
Ben

[bsonday]

Hey everyone,

I saw Dr. Cole on Monday.  I asked him about the catching I feel when I am lying on my back and extending my leg with little quad effort, and he said that it is completely normal and not to worry, and the phenomenon is even present in perfectly healthy knees.  I guess he's right--my other knee does it a little bit too.  He then told me that I'm healing just fine, and encouraged me to push it a little in rehab.  I've been doing only things that are absolutely pain free, but he told me the rule is to avoid sharp pains and push ever so slightly through the dull pains.

He said that we'll see each other again in 3-4 months and likely get a ~6 months MRI checkup then.  I forgot to ask him for pictures, unfortunately, but I bet they are fun and gruesome like the rest of yours.  Before the end of the appointment, I complimented him on his suturing since I have virtually no scar, and he responded with something like, "Well, based on your amount of swelling, quad strength, etc., perhaps it's just that you are a good healer."  I responded with, "Well, I guess we'll just call it a team effort then" and then we fist bumped.  It was pretty cool.  As he left the room, I heard him say to his assistant or whatever, "That was Ben.  His ACI is looking really good, and I think he's going to be one of our all-stars."  I'm not getting too optimistic since nobody knows anything at 2 months, but it was great to hear him say that.

That's all for now!

Best,
Ben

[dileigh]

Always good to hear from the doctor that everythings OK. 

At least he didn't tell you to cut back from the PT,  I always want to do more than I'm really capable of.   Just impatient I guess.  My PTs keep telling me that swelling should be a guide as well.  If it swells too much, then cut back.

Keep up the good work!

Diana

[Fisher201]

Glad to hear the appointment went well.  It always feels good to know that progress is being made and all the effort will be worth it one day. 

I just had a positive visit to the surgeon too (am now 11 weeks out).  No fist-bumping though, will have to try and get that going when I go back in 3 months

JF