Skifanatics ACI Surgery - Nov 8 2010

[cdubb]

Kids will definitely keep you on your feet and active!! 

My osteotomy was a tibial tuburcle osteotomy to realign and unload my kneecap. So, different than yours, but I'm not sure by how much.  My tibial tuburcle was cut and then moved medially and anteriorly.  I have a huge bump on my knee now that kind of looks like an Osgood Schlatter's bump. 

I can also go up stairs if I have 2 rails to unload the weight, but out and about with wider staircases where only one rail is accessible, I mostly still one step it....same with down.  In our house, I can do up and down unloading weight.  I have 2 bad knees, so it really makes stairs difficult...I figure I'll get the other knee done about a year or so out.  Need to have more confidencen in my left still.

[skifanatic]

I am now 5 months post ACI & HTO surgery for a huge FMC defect.  Spring begins to settle in to the northeast and my recovery timing is coinciding quite well. 

My normal day-to-day routine is no longer heavily impacted by restrictions due to my knee.  I can walk up and down reasonably small flights of stairs with one foot in front of the other with the assistance of a railing.  My gait appears to now be normal with a very slight limp at times.  Pain is only present when I overdo it and typically lasts a day or two.  There are still small, occasional, painless snaps in my knee that arrive with certain positioning under 100% load.  I have been advised by many that this is quite expected.  I visit the surgeon for my 6 month follow-up in a month.  I've only needed to see the surgeon 4 times since my surgery.  From all my research, I'd consider my recovery at this point to be classified as "normal".

Some of my fitness routine has shifted a bit to address a slight snapping that has developed in my hip.  This is probably a result of muscle weakness and it's currently more annoying than my knee.  In addition to coutless stretching and routine muscle building activities, I perform the following noteworthy items:

- 30 minutes (10 miles) on spinning bike, 5 times per week with moderate-heavy resistance.
- 10-20 minutes on eliptical machine with very, very little resistance, 1-2 times per week.
- No more than 1 mile on treadmill with no incline, 2 times per week (3.4 MPH).
- No more than 1 mile of outdoor walking, 2 times per week (moderate pace)

Over the next four weeks I will begin outdoor cycling on a flat, paved bike trail and slowly ease up my distance capability.  In addition, I'll slowly bump up the treadmill walking to 2 miles as time progresses.

One important observation I've made recently is that I can cycle like crazy with solid resistance without negative repercussions (knee pain).  I DO notice that when I make significant, positive, adjustments to walking/eliptical duration and speed, I sometimes experience negative reprecussions.  I am making very certain to slowly EASE forward in these areas and continue to focus on cycling as the leading factor of my recovery.

[Melissa S]

Sounds like you are doing great with your recovery!  Wow, I can sure tell that our defects were in different spots with different protocols.  I am not allowed to have any resistance with cycling and haven't been cleared yet to do the eliptical.  The treadmill causes my knee to flair up as well.  Basically the only thing I do is muscle strengthening with some cycling.
It is getting a little frustrating to be feeling pretty good and still be so limited in activity.  With summer coming I am hoping I will be able to swim since we have a pool in the backyard.

Take care and keep up the good work!
Melissa

[skifanatic]

I am now 6 months and 2 weeks post ACI.  Overall, I believe things are going quite well.  My 6 month follow-up with Dr Gomoll was uneventful and I won't be seeing him again until my 1 year.  I've been cleared for low impact activities.  Going both up and down stairs without assistance is quite reasonable.  I do not limp any more.  Pain is minimal.  Being jammed in the economy section of a 747 for 9 hours is tolerable.  Like many others in here, my knee does snap, crackle and pop.  If I noodle around wiith full extension on full weight, sometimes I can experience a subsequent lock.  I have lerned not to provoke these things. Walking on moderate terrain, light construction, lifting heavy items, lawn mowing, shoveling, etc, seem to be okay as long as I take it easy.

I continue to perform a daily regimen of lunges, leg/band work, leg raises, stretches, core, eliptical, treadmill, anywhere from 20-40 minutes a day.  In addition I've resumed biking with 2-3 rides per week averaging no more than a humble 10 miles per ride.  Hills aren't much of a problem.  Currently using my mountain bike on the street due to its versatility, stability and safety.  I do plan to get back on the racing bike when I feel more comfortable with the notion of being clipped in. 

I continue to wear my unloader brace for about 75% of the time and absolutely love it.  The brace provides the reasurance I need when active.

Looking forward to trying out some swimming things summer although not sure if kicking is considered high impact or not.  I suspect it is.

[Dennis BadKnee]

Hi skifantic,

After you wrote to me around November (on my posts), I wondered how you were doing. As usual, I was looking on the wrong board for info on your surgery, failing to realize that there is a post op diaries board (until this moment).  I should have posted my post op here instead.  This is the story of my life - always on the wrong board.

You seem to be doing well.  Even though I am cautious as to the absolute force put into my knee, I am aggressive on the duration aspect, if this makes sense.  I hiked 22 mountain miles in the past three days (some with a light pack) and am now mountain biking (in mountains) 20 mile loops several times a week.  For some reason I felt too vulnerable to begin outdoor biking sooner (began around 18 months post op).  You had asked me about biking last year, but I keep holding off.  Immediately I was able to ride without problems.  Although the rate of improvement is slow, improvement continues at the same rate as 6 months ago (giving me great expectations).  Every month I realize is better than the month previous.

You mention swimming.  Dr. Minas insisted he wanted me to flutter kick.  So I swim laps one hour per session, 3 times a week.  I keep my leg mostly straight (which is natural).  Initially I felt slight apprehension/pain, but that quickly gave way to an increased healing affect.  I also retro walk (backwards) at maximum slope on the treadmill, 2.1mph, one hour, three times a week (after my swim - this gives slight aerobic affect while strengthening my quad) – a slight extrapolation from Dr. Minas wanting me to simply rehab retro-walk initially, I just made it longer and harder.

What I am trying to say is that I expect you to have similar great results after I read what you are doing now already. 

Keep up the good work. 
Dennis

[skifanatic]

Hey Dennis,

It is great to hear from you.  It goes without saying that your progress seems very good considering the gnarly job you had on your knee. 

When hiking, how is your knee on the descent?  Are you using poles?  Do you mitigate the large down-steps?  I did hit a local "hill" the other day with a 400' ascent/descent.  That was enough for now.  Later in the summer I'll try some 1000+ footers. 

Yesterday I pulled out my racing bike and took it for yummy 20-mile loop with some very large hills.  It was pure bliss.  I wore my unloader brace and I think it really provides a great sense of security when biking.

Wow.  One hour of swimming, three times a week is an extraordinary workout!!!  I was in Florida last week on vacation and spent a good deal of time swimming in the water.  Overall, no major issues but I am not a super swimmer...I just like snorkeling, treading water, etc.

Keep me posted.  I do anticipate you'll be knocking off a 14K'er in no time!

-Deane

[Dennis BadKnee]

Hi Deane,
You are making remarkable progress at your post-op timeframe.  I suppose I could have biked sooner, but I feared either uncontrollably high forces or perhaps a fall.   I think it is good to teach the knee (ACI-wise) what we intend for it, but not so much as to cause failure – the distinction is like walking a tightrope. 

Ok, hiking, great question about decent.   Until very recently, I did not feel great on descent (or down stairs), but could move out aerobically fast on the ascent.  Just in the past month I am feeling pretty good on descents as well, but not as good as ascent – but it is improving all the time.  I live in mountains, so I get to walk and bike hills all the time.  And no, I do not use poles.  I have a set, but never learned to like them.

I have a new unloader brace, but Dr. Minas told me not to use it, so I don’t.  I always felt any brace provided a false sense of security – but that is not to say that this would go for you, we are all different.

Don’t be too impressed with my slug like swimming performance.  I may swim the 3 hours/week, but at my snail’s pace (still a feat for me) I only cover 1.25 miles in an hour.  But at least it is continuous.  Besides, drowning (which approximates my swimming) is a highly aerobic exercise.  Treading water would not be good for me with the sideways motion of the leg.

How is your sensation (pain), heat or swelling?  I still ice very regularly, but otherwise do well and feel strong.  Perhaps I may be having a rebound effect from all the icing.  I do not do as well when I attempt to stop.  Do you ice?  How do you feel your improvement is progressing?  I suspect we will see improvements for up to 3 years.

Keep providing updates.  It is encouraging to see progress.

…Dennis

[skifanatic]

Checking in today at approximately 9 months post ACI.

Although far from perfect, I'm very pleased with my current progress.  I'm still not experiencing any pain worth mention.  Sometimes I have a slight limp, but it usually resolves.  There's no more locking or catching, only an occasional light snaps.  My leg is strong and my muscle tone is getting much, much better.  For the past several weeks I've cut back pm the mundane, routine, indoor PT regimen in favor of enjoyable outdoor activities.  I'm up to 100 miles per week of cycling on variable terrain.  I also swim regularly and perform basic strengthening activity in the pool.  Last week I enjoyed my first reasonably sized hike on Mt Wachusett in Princeton MA.  The hike involved about a 1000' ascent and I wore my unloader brace for the whole hike.  I took it easy on the descent and took advantage of a mountain fire road.  It was pure bliss to be back out on the trail again.  Most importantly, I'm enjoying some serious quality time with my family.  I can keep up with the kids now and I can't ask for much more than that.

As Fall approaches, I do plan to return to a more structures indoor routine, but right now I'm having too much fun.

Hope every is coming along well and enjoying their summer!