New Member, I am having ACI in mid October, Help!

[cdubb]

Renn,
I can understand you being disproportionately concerned about adhesions and arthrofibrosis.  Since I had a nerve impingement develop after a shoulder surgery that ultimately required decompression (another big surgery), I am a bit overly alert to nerve type symptoms.  I most definitely can tolerate ice and it helps a lot once the burning begins in the foot/ankle begins.  If I slap the ice on it for 20 minutes when the burning begins, it gets me a good 2+ hours of relief.

As for work, I am no longer in a brace.  I was given the okay to ditch the brace at 6 weeks, which I did. I then began my crutch weaning off process and was pretty much done with crutches in 5 days.   I like the skateboard under the desk though idea. I think I'll need to try that.

Question that you more than likely know the answer to.  How much stationary biking is okay to do?  We just purchased a stationary bike and I know I need to have the seat up high and I know no resistance at this point, but I don't know if I should stick to 5-10 minutes sessions a few times per day or if I can do up to 30 minutes sessions?  I planned on e-mailed my docs PA tomorrow to find out, but you probably know with all you've been through.

[Rennschnecke]

Hi there,

I was thinking of the brace only in terms of giving your joint a bit of rest when seated.  You'll probably know that the best angle is around 10 degrees – not too straight, and a brace can help the muscles relax.  Best to be without brace and hence the point about it being a pig when needing to be up and about.

Re. bike – as you know everything is individualized.  The principles I work to conservatively is to cycle for a duration which is easily achieved and then increase the duration a minute at a time every three days or so (assuming you cycle every day) as long as you don't have a reaction.  As to when you reduce the number of sessions, that will normally be dictated by your own circumstances (e.g. return to work which prohibits a third session).  One option for cutting back is to reach a total duration for 3 sessions which does not lead to a big step up over two sessions (e.g. 2m x 3 = 3m x 2).  If you're at 5 – 10m already then you'll probably be looking to cut back on the sessions to begin with, accept a total reduction for the day and build up slowly.  I know it's awkward to stay with 2 sessions a day, but until 3 to 4 months I'd stick with it whenever you can as you keep the joint moving and this helps lubrication and nourishing and shaping of the graft.  If you do the skateboarding during the day you may be able to reduce to 1 session a day, but I'd probably still be conservative about increasing duration and aim for 2 sessions a day as often as possible.

Email your PA anyway.  Some guidelines indicate that you could increase duration at 10% every other time, but I was doing this when I was fitter and didn't have a cartilage defect.  I also discussed options of interval training at zero resistance v. increasing resistance, and I was told not to increase my rpm to more than about 60, but I am allowed to increase resistance (I think this is still restricted for you).  Hopefully armed with differing strategies you will be able to develop your cycling and adapt as you feel able in the light of how you respond to the cycling.

If you want any more info feel free to PM me.

All the best!

[cdubb]

Thanks Renn! You're always so helpful. Next time I have a question, I may PM you, so we're not hijacking a thread!

[Youthist]

Hey Renn,

I hired it from www.fithire.com

Cost 15 quid per week for 6 weeks (4 week minimum I think). Think it was around £40 delivery and pickup charge. Its an electro magnetic one, which is pretty tough going on the lowest setting when plugged in. Currently doing about 10k on it in around 35 mins. Tough on both the legs though!

[Youthist]

Hi All

Been a while since an update from me, so thought I would drop one in. I had my ACI last year in mid Oct 2010. Medial femoral condyle, 2cms by 2cms. Been having physio 3 times per week since then pretty much, and steady progress.

Been on a mountain bike now 2 or 3 times per week, 20/25k per session, since late Jan.

Today had a good physio session where we started running drills for the first time (kind of like a hop-scotch then jumping in and out in various different ways). Then a session on the trampoline, and then a session walking fast backwards on the treadmill at different inclines.

My physio then told me that we are "very close" to starting gentle / light running with him, he is planning on 20 mins gentle runs in the next couple of weeks.

It felt great hearing it!

Hope everyone, at whatever stage you are all at, is holding up well and keeping the faith.

PM  me if you want to discuss anything

cheers
tony

[Rennschnecke]

Congratulations!  You sound like you're rehabbing very well.  It's reassuring to hear that the schedule does work out for some. 

Good luck with the running!

[Melissa S]

Congrats, that is awesome news Tony.  I am about 3 weeks behind you but I am not close to running yet.  I had a patellar ACI though, so I think the recovery protocols are different.  Thanks for updating with successful results, they are always so encouraging to hear.

Melissa

[Youthist]

Hi All,

Thought I would drop a line on progress, last update was at the end of April - where is the time going!?

Everything slowed down markedly on my progress after my physio felt I was "close" to running at the time of my last post....it didn't happen!

I can jog on the spot ok, and I can run on my toes forward slowly for a few minutes, but I cannot really put impact thru the knee at the point of the graft, and I still struggle to put impact through the knee when it is not locked straight. I guess just more time is needed.

Upstairs is good now, i can take two stairs at a time, and can almost "skip" up them. Coming down is a lot better, but I still "drop" when right at the bottom of the bend before just as my other knee touches the next stair.

Overall the knee and leg strenght is about 70% of the strenght of the good leg IMO. Continue to work on the strength of it, as well as mobility and core excersises at physio. 

The graft site still bothers me from time to time, and there is some creaking and "noise" during open chain, but I do not think that will ever go and it has been there for many years before the problem surfaced.

Keep going everyone,  I hope you are progressing well and keep the faith!

[Melissa S]

Youth,
Was your graft site patellar or somewhere else?  I can't remember.  Mine was a patellar ACI in Nov and I still can't do stairs the normal way and I am nowhere close to running.  I am pretty much done with PT, my last appt was at the 6 month stage and they said I didn't need to return until the 9 month stage which is coming up.  I don't feel like I have made much progress in the last 3 months though.  I can't lift my leg off the ground and straighten it without pain and that crunching feeling.  I took about 3 weeks away from the gym because I was busy and went on vacation and I went back last night, needless to say my knee was quite sore last night, but is feeling better today.  I just don't know whethere this surgery worked or not??

[Youthist]

Hi All

So I am coming up to a year (mid October will be one year) since my ACI. I had a Medial femoral condyle, 2cms by 2cms, left knee. Been having physio 3 times per week since then pretty much, and steady progress, and the physio is still underway.  I can run for 15 mins but not very even, and I went 45 Miles on a bike a couple of weeks ago for a charity event, with no issues.

My main problem is still with the graft site itself - sometimes when I get up and start to walk, its like someone is pressing their finger on an "open sore" within the knee. Not extremely painful, but imagine someone pressing gently on freshly picked scab on your arm or whatever - this is the best way I can describe it.  Some days are worse than others for this, and I can go up and down stairs without feeling it. When I run I cannot really feel the graft site, just a lot of general knee weakness.

Dr Skinner said a month or two ago "lets see how it is at a year" but I do not feel that this  graft soreness issue is healing itself, and he thinks he might have to scope it to see whats going on (which might well set me back).  Could be an undergrown or overgrown edge, or something, maybe?

Does anyone feel its unusual for me to still feel the graft site in this way after 12 months?   Do you think I am just being impatient, and give it more time for the graft to harden further before worrying that it hasnt completelely covered the lesion properly?

cheers all
tony

[cdubb]

Hi Tony,
I'm patellar, so completely different forces being put on our grafts, but I absolutely still feel my graft.  My surgery date was 11/3/10, so just about a year post op.  I am so much improved from pre-op though, that even though I still can feel it loading and can't squat or anything, I'm not complaining.  I can walk and get through cardio workouts.  I was pretty impaired pre op.  I now conisder my left ACI/TT knee my "good" knee and my right is my "bad" knee.  Trying to move forward with my right knee, but oddly my insurance is creating some obstacles right now...that and my cells in storage are no longer viable (even though US Bio has only had them a year - there is something off about my cells I guess)....so either we do a different graft material or I need another biopsy.   Have to clear some insurance hurdles first though.

[elliottl73]

Hi Everyone,
Wow I am so happy I found you guys.  I have read through all your posts.  I am scheduled for ACI on 1 Nov.  I had a failed MFX in January So I have been pretty inactive for about a year now and am a little worried about how my recovery will go.
  Thanks for all the info and insight.  I am in the States and will be in the hospital for at least 2 nights.  I am thankful for this for pain control. I think it may also depend on insurance whether they keep you or not.
  I hope this works after already having one failed surgery am a little nervous about that . I want my life back And I am sure my family will enjoy having me back to normal too.  My husband will be home with me for 2 weeks or our daughter if he has an emergency at work she is 18 and is in college for nursing plus we have a nurse next door so I am good with help once I am home.  My mother will be flying in for the holidays as well.
  I feel like I have some idea what I am in for after hving had the MFX. Am I right in this assumption? I am sure I will have a CPM I did last time.
  We are going to ask the doctor to order a hopital bed for my use at home for the first month or so too. The thought is I will be more comfortable with that in the family room than being on the couch with the cpm for so many hours and I could use it at night without keeping my husband up all night. Plus we have 4 dogs and they like to jump on me on the furniture but won't get up on the bed.  Any other suggestions I should ask for or need to buy? I was sent home with a cryocuff last time so we have the ice covered. It was my best friend for a long time.


Thanks again for all the insight,
Laurie

[cdubb]

Hi Laurie,
I'm also in the States.  Has your Dr. indicated you would be in the hospital for 2 nights?  I was discharged a pretty quickly about an hour or so after waking up and I also had a tibial tuburcle osteotomy in addition to the ACI.  Docs here in the US seem to d/c much more quickly than those in the UK from reading these boards.   Seems most get d/c same day except those that are with Dr.'s  Minas/Gomoll out in Boston.  Their patients do report being kept overnight 2 nights.   I woke up at 5:30 pm, was out the door waiting for the valet at 6:30 pm and home on my couch by 7:30 pm after swinging by a friend's to pick up our son and a stop at Panera for soup!  I fared fine pain with between the Oxycontin and Norco, as well as the icing.  Some docs do femoral blocks, but I didn't have one and did okay. 

I had a Gameready ice machine which was awesome, as it provided compression in addition to icing and covered a huge area of my leg...highly recommend this! The wrap fit under my brace and the hose came out a hole on the brace.   I am lucky enough to have our guest bedroom on the main floor, so I didn't need to tackle stairs and I still had a bed to use vs. the couch.  So, if you don't have that, then the hospital bed may be a good idea.  I still did the CPM on the couch though during the day and never tried to sleep with it.  I had to do 6 hours per day. 

One thing that I found incredibly helpful post op was a leg lifter strap.  Sounds stupid, but you'll be surprised at how difficult it is to lift your leg post op...it's like the quad forgets what to do...  It's just a simple little device that has a loop at the end and you can hook it on your foot and lift your leg.  I also highly recommend a shower chair and I also used a raised toilet seat...I am 5'11" though, so it was a long way down to sit with the leg in a locked out brace and on restricted weight bearing. 

I'm actually now getting ready to do my right knee tibial tuburcle osteotomy with DeNovo NT (instead of ACI...my cells died at US Bio...weird...).  Scheduled for 12/13, so I won't be too far behind you.   

Good luck!  I did a post op diary for my left knee...but doubt I will for my right.  I may change my mind though.

[elliottl73]

cdubb,
Thanks for the info. I am in NC seeing Dr. Creighton at UNC.  I will find out at my pre op about the osteotomy.  Dr said they will do full leg and hip xrays at that time to check allignment. At this point I just want it fixed whatever that means.  All I can say is thank God for good insursance with three surrgeries for me this year and three for my family the year before.
  We have talked about a bathbench I have a stool my dad used before he passed but it wabbles a little. I am only 5'2" on a standard height toilet I can swing my feet if I don't point my toes down to touch the floor lol.
  My neighbor asked if I would have home healthcare have you heard of that for this op?

Thanks again for the info,
Laurie

[cdubb]

Laurie,
You won't need home healthcare.  I think you'll be surprised at how mobile you'll be.  Even with the osteotomy in addition to my ACI, I was able to get up and move about.  It's exhausting and you certainly don't want to be up and about a lot, but it's certainly manageable.  I actually also had my right knee scoped the same day as my left knee ACI/AMZ.   I showered 2 days post op, as well as having to crutch quite a bit in and out of urgent care for a post op complication (urinary retention...very embarassing).  Getting in and out of the shower is tricky with restricted weight bearing, but doable.  You just get a giant Tegederm patch and slap it over the incision, so you can shower normally (if sitting is normal). I just then propped my foot up on the side of the tub.  My surgery was a Wednesday, so my husband took the rest of the week off, but really...I totally would have been fine by myself.    Except needing the drive to urgent care of course..ha!  He returned to work the next week, so I had to fend for myself by day 5 from 8 am - 5:30 pm.  He was nice and set up my CPM on the couch for me, ensured my Gameready was stocked with ice, had my coffee made in in a travel mug on the table with a bowl of grapes and crackers.  So...he set me up before he left.  He of course had the kid pick up/drop off duty for awhile also.   If he was in the office, he would sometimes come home and bring me lunch, but if he was out on assignment he couldn't. 

At 5'2" you will likely not need the raised set, but keep a little stool there, as it helps to prop your heel on.

So, surgery is exhausting and certainly restricts mobility and makes things take more time, but home health not really indicated.  Although...keep in mind...I am a year out, so things may not be as fresh in my mind and I could be just trying to convince myself that this is easy breezy since I'm going through it again in 2 months from today!  Ha!

Feel free to contact me directly with any questions.  I'll send you a message with my e-mail.  Feel free to use it or not.