2 WEEKS OFF AFTER ACI SURGERY?

[Rennschnecke]

Hi Andrew

I know that you're planning on taking just 2 weeks to get back to work post-ACI as you're worried about time off.  However, it's probably unwise to bank on it.  Whilst some people managed to get back to work in that time, some have said it was a strain and it's better to give yourself recovery time.  What has the surgeon said about time off?

I know that early on I had lots of rehab to do.  Although I had only 4h on the CPM I had loads of other stuff which meant I was rehabbing all day.

It would probably be wise to let people at work know you're having this op.  It is, after all, a two stage procedure although the first stage is usually fairly straightforward.  Once you go back to work you may well need to get some adjustments made so that you can elevate your leg, keep it iced etc., maybe work on the ground floor if you're not already.  I know some people couldn't cope with more than half days as well.  Also check out how to get to work as you'll be non-weightbearing (but you said you were well practiced with that bit) and may well have a brace on.  You'll also have quite a few days taken with reviews etc.  Also consider whether you want to go back when you're not able to perform to your usual standards either through pain or meds or appointments etc.

If you're reluctant to take time off at the start of your new job have you considered whether you be able to delay the op for after the probationary period?  I think it would be near impossible to hide the fact you'll have had a major op on your knee if that's what you were hoping for.

Sorry if I sound really negative, but I've been struggling to get back for the past 9 months and may only just have worked something out with a special pain management package.  Clearly, this is unusual but how would things be if you had problems too?  (Sorry, I'm letting my risk-averse side come out.)

I hope that things will go smoothly for you, but you also need to have some back-up plan just in case ...

 

[cfranc]

Hey Andrew...

Just read R's post...and noted again that you were thinking of a July Op date.  Just a thought:  I had mine done in early Feb and would have ideally preferred late November.  The weather is now starting to get nice and I am still probably another 2 + months off from being able to comfortably take a stroll outdoors.

Seeing as how you were pretty active you might want to think about having it so that you are not laid up during the nicer weather/seasons....though if you are in the NW then I guess it doesn't matter     3 months up there and I only saw the sun once...

[AndrewH]

cfranc & Rennschnecke - thanks for the advice, much appreciated. 

Rennsschnecke - I am going to tell my new employers about the operation, its just that I don't want to take time off work sick in a brand new job.

With regards to not being 100% at work, I think (hope!) I'll be in a better frame of mind after having the op, regardless of pain, than I am just now. I think I should be able to cope with the pain if I know I've had the op done and I'm on the road to recovery.

After microfracture last year I had 2 weeks off work but in reality I didn't need it. I had the op done on a Friday and I could have gone back on the Monday.

I realise however that this op will be open knee surgery so am unsure as to how much this will increase pain levels? It could be that I ask for a 3 week holiday and that would give me the extra week.

I don't see crutching as a problem and can't see working on higher levels being an issue either as I can use the lift. When I was on crutches last summer I had to negotiate stairs to get to and from the car park and found it easy enough. I also managed to do quite a bit of walking on the crutches. I went to the dentist 4 days after surgery last summer and got a taxi there but on the way home I walked a mile to the train station on crutches and got the train back. It was okay.

The only problem I encountered was having to ask people to carry my notebook and files to meetings for me!!

I also managed to go on holiday to Portugal while NWB on crutches. The crutches came in handy because I managed to avoid all the queues at security and go through the disabled section. 


cfranc - I'm not sure what the temperatures are like where you live but over in Scotland we don't get big extremes. Our winters are relatively mild and summers are never very warm. I think I'd rather go through the NWB period in better weather however - and I'd like to get it over and done with be on the road to recovery as soon as possible.

[momhanaway]

My daughter was 19 when she had her ACI, just a few months out from playing collegiate volleyball, in great shape.  She bounced back faster than most on the board, but I will tell you that nothing prepared her for the pain and exhaustion she experienced afterward.  She almost moved back home because the 6 weeks on crutches about did her in around campus. 

[AndrewH]

My daughter was 19 when she had her ACI, just a few months out from playing collegiate volleyball, in great shape.  She bounced back faster than most on the board, but I will tell you that nothing prepared her for the pain and exhaustion she experienced afterward.  She almost moved back home because the 6 weeks on crutches about did her in around campus. 

Was it the pain from the surgery or the crutching experience that did her in?

I'm prepared for the crutches and I don't see that as a problem. I did it last summer and I spend a lot of time in gym doing upper body work, particularly dips in order that the crutching will be okay.

Its the actual pain from the surgery that I'm looking for some insight into. I didn't really experience any pain after the microfracture surgery last summer and didn't need to use any pain meds. It was only when I ditched the crutches that the pain from the injury returned.... and hasn't improved.

Going back to work after microfracture last summer after 2 weeks was no bother, I reckon I could have done it after a weekends rest. How much different is ACI? Does the fact that its open knee surgery make a huge difference???

Any insight is welcome. 

[cfranc]

Hey Andrew...

I think more than anything it will be the swelling that will challange you.  They will be poking around a lot and most likely filling it with quite an amount of liquid.  Again, for me pain was only an issue for the first week and 1/2.  Though I know my pain threshold is fairly high after 13 dislocations and 5 other surgeries. 

Crutches can be tiring but as you say...but you can still walk a fair amount if your'e determined...though don't think my OS would have been happy seeing me hike around Tucson AZ a few years back after another surgery  

They (OS) will tell you they are weary of you falling, which could potentially damage the implant...I've always thought these warnings were overkill...and then I read some of the posts on this site...there are quite a few people who have had some pretty good falls.  Not sure that I understand it...but I guess some people have issues.  I think when crutches have grown to become like another appendage for you...I think the warnings are overkill.

The only warning I would give here...is something that is now happening to me.  The more you are up crutching around, the more pressure and abuse you will be throwing at your other knee.  For so many of us, it has eventually led to damage in our so called 'good leg'.  Mine was definitely over a fair amount of time and abuse but it sounds like you are not the type to sit still either. 

I've been to Scotland more than 1/2 dozen times so I hear you on the weather.  There's the time it was so foggy and rainy, we walked around for a 1/2 hr trying to figure out if we had really hit the top of the hill.  My favorite though is getting drenched on the second day of the West Highland Way, blistering my feet pretty and crawling the rest of the grueling 60 miles to Nevis.  Haven't worn those boots since

Anyway, I think the morale of the story from all of us giving advice is to be prepared for the worst case scenario and then you can adjust as you figure out where you will fit in the curve.  Everyone of these surgeries is different with recovery varying by patient so you never know whether you will be the worst, best or average case scenario.  We hope for the best for you though

When you get closer we can give you a list of things to do/prep for that will make things easier.

 

[cfranc]

On another note, I had my scope this morning to take out scar tissue.  Apparently, there was quite a lot but my OS thinks I will now have a much easier time working my ROM now.

I am also happy to say that it appears the new swelling is not as much as I feared.  I start the cpm again tomorrow, ROM exercises and begin PT early next week.  So things are looking up again

Will keep you posted as I progress....oh yeah and no need for pain meds today even!

[Rennschnecke]

Christine, when you had the scar tissue taken out did they give you a pain block?  I had one and had absolutely no pain whatsoever – couldn't walk, but was aware I shouldn't anyway.

Andrew, I didn't have any problems with crutching post-MACI and after the biopsy I felt so good I got to wondering whether I really needed to follow through with the second stage.  The pain post-MACI wasn't good, but also wasn't horrendous until 8 weeks post when progress was blocked and then it began to decline at aeound 10 weeks post.  I was cheerfully mobile in my brace and FWB as it was a PFJ implantation not a femoral condyle.  However, I was full on with the rehab programme and this is essential for optimising your recovery.

I know that some of the guys here had 6 to 12 h of CPM to do.  I know some slept in their CPM – I'm not sure how they managed.  I couldn't (and didn't need to) at home and at hospital (following LOA/MUA) I was on a nerve block and fully drugged up.

Even if the pain isn't bad you need to check what demands your PT protocol will demand of you.  If you want a good bet for the amount of time out to ensure you can get back easily, 6 weeks is the optimum time.  Assuming no complications, most people have got back to work by then and managed to do full days.

As cfranc says, everyone will respond individually to this op.  Whilst 2 weeks is doable under duress, most people need a bit longer.  It will also help to minimise the risk of complications.

Like cfranc I had scar tissue which necessitated another op.  I think this was due to not icing enough and getting the swelling down early on.  I'm now battling AF and after a lot of research I think this is due to an overly aggressive rehab schedule which kept my knee swollen for too long.  I've now got to settle back and relax (slow down my OS has been saying) and tackle everything more gently.  Runs counter to my instincts, but I'm now 9 months post-op, in pain management and struggling to get back to work so I need to do something different.

I really would want things to be different for you, and would probably advise to plan for 6 weeks off and return earlier if you are ready.  You can always get your GP to sign a return to work certificate for you if you are ready to go back earlier.  It would get better brownie points to go back earlier than find you need to stay off longer ...

Sorry if this seems like a negative rant, but I guess I'm coming from the other end of the spectrum of successes.  With success rates of 75–80% the odds are against you following my steps, but stats don't matter much for each individual.

In the end you'll need to work out what's best for you and your work situation.  You may also like to check out the posts of some others on the board to see how they got on.  Erin is a physio who was very successful; JulianUK, djs60 (?) and some others.  I was following mainly PFJ patients so there is a bias.  You may find a different track record for other ops.

Happy hunting!

[momhanaway]

My daughter was 19 when she had her ACI, just a few months out from playing collegiate volleyball, in great shape.  She bounced back faster than most on the board, but I will tell you that nothing prepared her for the pain and exhaustion she experienced afterward.  She almost moved back home because the 6 weeks on crutches about did her in around campus. 

Was it the pain from the surgery or the crutching experience that did her in?

I'm prepared for the crutches and I don't see that as a problem. I did it last summer and I spend a lot of time in gym doing upper body work, particularly dips in order that the crutching will be okay.

Its the actual pain from the surgery that I'm looking for some insight into. I didn't really experience any pain after the microfracture surgery last summer and didn't need to use any pain meds. It was only when I ditched the crutches that the pain from the injury returned.... and hasn't improved.

Going back to work after microfracture last summer after 2 weeks was no bother, I reckon I could have done it after a weekends rest. How much different is ACI? Does the fact that its open knee surgery make a huge difference???

Any insight is welcome. 

My daughter's comment to the nurses right after surgery when asked what her pain level was between 1-10 was "it's about 50." She said it felt like someone shot her in the knee with a gun. The first 2 days she couldn't go to the bathroom without someone holding her leg up.  The leg hanging down while using the crutches shot pain through her knee.  The Game Ready ice machine saved her life.  I had to set an alarm to make sure there was ice still in the ice holding compartment.  She has a pretty high pain tolerance.  She had a difficult time with the crutches trying to get to classes, carry her books, eat in the lunch room etc.  Everything was a chore and exhausting.  Once she was back at school, the athletic trainers pushed her fairly fast and her knee was pretty angry.  I was concerned.  BUT I just posted that she is back on the vb court as of this past Tuesday with no knee pain. It's been a year since her surgery.  She had no other problems other than the femoral defect. The doctor told her than this was a salvage project and that there were no promises returning to collegiate sports.  I haven't been great at posting because she is at school and I don't see her everyday, but you can read about it on the board.

Hope this helps. I'm not trying to scare you at all.  I just want you to know that it's a big surgery.  My daughter went in for microfracture the December prior to her ACI surgery in March.  They were not able to do the microfracture due to the surrounding cartilage and they went ahead and harvested the cells at that time.  She was up and around the next day.  Not with the ACI...

[AndrewH]

I've been to Scotland more than 1/2 dozen times so I hear you on the weather.  There's the time it was so foggy and rainy, we walked around for a 1/2 hr trying to figure out if we had really hit the top of the hill.  My favorite though is getting drenched on the second day of the West Highland Way, blistering my feet pretty and crawling the rest of the grueling 60 miles to Nevis.  Haven't worn those boots since

 

Always laugh when I read stuff like this or people who aren't from Scotland tell me stuff like this.....  You've probably seen more of Scotland than me and I've lived here all my life (40 years)!

I once went up to the Isle of Skye via Oban with my wife for a weekend and it poured with rain and looked like the most miserable place in the world - so we've never explored Scotland again!! Sute the scenery looked good but once you've seen one hill you've seen them all as far as I can see! 

My travelling around Scotland has more or less been limited to following my football team and that's mainly been to the cities and main towns in Scotland. Been up to Inverness a few times and its nice up there but again, all I've really done is go to watch the football and then have a curry in our favourite Indian restaurant up there! 

People say Scotland is a beautiful place, but as I live in the biggest town, Paisley, which is right next to the biggest city, Glasgow and live in a conurbation where half Scotland's population lives. I just seems like any other big horrible city in the world!! I could run the 9 miles to work quicker than I could get there using any other form of transport due to the traffic congestion. For me, I've always considered that I live in the worst town, next to the worst city in the worst country in the whole world!! 

Thanks for the advice by the way. It seems from those who have replied that there are differing experiences. I suppose a lot depends on the size and location of the defect and a whole host of other factors.

I don't believe the crutching will be a problem for me, I've done it before and I've got a lot of upper body strength. I actually looked upon last summer's crutching experience as a great daily workout that mean I didn't need to go to the gym!!

Not so sure about the pain though but I reckon even if its bad I'll be able to tolerate it more knowing that I'm healing. I hate they was I am just now knowing that its not getting better.

[cfranc]

Hey All...

Good news!! I had my scope on Friday to take out the scar tissue.  My OS said there was a ton!  Anyway...didn't even bother taking any pain meds after the scope and haven't needed any yet.  But the best news...my ROM has increased significantly!!  I don't want to jinx myself by throwing out any #s until I restart PT tomorrow....but suffice it to say...I will most likely be using a stationary bike this week

Swelling is still a problem and I am still using a machine similar to a Game Ready to try to keep it down.  My only concern now is keeping it down as much as possible so I can avoid developing any addiitonal scar tissue in the future.

Will post again tomorrow after PT!

Andrew...It wouldn't be fair to say my only memories of Scotland include rain....I've been lucky to see some unbelievable warm sunny days...Of all the places I've been it seems I've found myself in Scotland more than any other...you only need one day of sun to want to buy a return ticket.  And yes, I've even been to Glasgow and a Celtic game!

Hope to post more good news tomorrow.

[LILS]

Christine,
   That's great to hear. Do you have to use crutches? My ROM has decreased and I'm worried I'm at my limit. At what point to they tell you your ROM needs fixing, i.e., another surgery? Just trying to keep up with your progress, since we had similiar surgeries.

[cfranc]

115....115...115!!!     That's what they measured for my ROM before I even started my PT session today.  I can now begin using a stationary bike 

I still have a ton of swelling but am now walking fully without crutches.  I have to work on loosening up my ankles and focusing on my steps ..but I am well on my way to burying those things!

LILS...as for knowing when I needed to have scar tissue out...I think it may depend on the OS.  Mine believed once it became obvious I could not gain any additional ROM without real force then it is time.  I have read on this site however, that other OS' have waited a few months before going in.  I was at 8 wks (although the decision was made at week 6). 

For me, I knew when after consistently gaining ROM each PT session it suddenly came to a halt and hadn't been able to make any gains for a full week and 1/2 (even losing slightly). 

I can't recall how far out you are....but if you are going to PT regulary (I went 3xs wk) and are not making ANY progress for 4/5 visits it's time to talk to your OS. 

My PT says its normal to gain and lose ROM as you are going thru early stages of rehab.  I was lucky enough to continue gaining and maintaining the ROM until I hit that wall at around week 5/6.  However, I was putting in 11 hr days of therapy....8 hrs cpm interspersed with other stretching exercises....heel slides down wall, leg daggling etc.  I would push to an uncomfortable but bearable level and hold these positions for 10 minutes at a time.

If your concerned though I would see if you can either get your OS on the phone or see if he will work with you via email.  I have been able to communicate progress/concerns with my OS via email which has been really helpful.

Good luck and don't get too distressed....this is definitely a game of patience.

[Rennschnecke]

Sounds like a great result.  I hope it continues.

You're right about keeping the swelling down.  The trick is ice and elevate for incredible periods of time – something I didn't realise until late!

[LILS]

Cfranc: Congrats on the 115! I'm only a little over 3 wks post op., so I'm not too, too concerned about my ROM status at this point. I was just a little worried after reading some people's posts about having to get more surgeries due to ROM issues. My leg was really swollen today, even while sitting most of the day. I have a PT appt, so I know that will suck. Hopefully my swelling will better tomorrow or there is no way they will be bending it to reach any ROM goals. My OS told me the other day, "Wow, you're a machine!", since I told him I weaned myself off narcotics right after my 1st post op week. He said most people can't do that even with just the ACI surgery, so that's encouraging. I didn't tell him I only got off them because they make me too nauseated. I just let him think I was special . If the narcs didn't make me feel so sick, I would still be on them. I definitely stay on the Extra Strength Tylenol though; that works well. I'd rather have Motrin though!