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Author Topic: DeNovo Recovery  (Read 16889 times)

Offline bferguson

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DeNovo Recovery
« on: September 16, 2010, 07:23:39 PM »
Hello everybody!

Since there wasn't a ton of info about DeNovo on here when I was looking, I thought I'd post info about my rehab and recovery and maybe it will help someone.

Here is my history: I experienced pain and clicking in my knee at the end of a soccer game in the summer of 2009. I went to the orthopedic and was diagnosed with cartilage defects. The plan was to take pieces of cartilage from rarely used places and plug the holes. When the doctor did went in, the defects were too large and performed microfracture. The recovery was fairly easy except for being non-weight bearing for 4 weeks which was a real pain. Range of motion returned and most of the pain went away within the first couple months. Over time, I didn't experience any pain with normal walking except when going up and down hills or stairs. However, any activity more than walking was uncomfortable and the movement was not natural. I dealt with it for a year thinking that it just took time. After a year with plateauing, I decided to go back to the doctor, hoping to someday return to active sports. He recommended the DeNovo Procedure to hopefully fix things

I had the surgery on Sept. 8th, 2010 and am 1 week post op. I am non-weight bearing for 4-6 weeks and have PT 3 times a week. Surgery required an overnight stay which was both miserable and helpful at the same time but, in the end, I am grateful for. No major pain now, just some general dull throbbing and some pain when doing flat leg lifts. My range of motion is better than it was after 3 weeks post-microfracture. I can bend well over 90 degrees and lay my leg down virtually flat. Only pain seems to be from the stretching at the incision site when bending or from swelling. Driving and back to work living normal life with the exception of the crutches. I will update in one week for progress.


« Last Edit: September 21, 2010, 09:15:49 PM by bferguson »

Offline fire535

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Re: DeNovo Recovery
« Reply #1 on: September 16, 2010, 08:42:15 PM »
Look forward to hearing about your recovery.

Offline Melissa S

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Re: DeNovo Recovery
« Reply #2 on: September 17, 2010, 09:27:02 PM »
Where was your defect?  Did your doc talk about ACI at all?  Just wondering what indicates using Denovo vs. ACI.

Melissa
Injury with knee hitting concrete 7/07, partially torn ACL, and cartilage damage
Scope and debridement 2/08
2nd scope 1/10 with carticel biopsy
Carticel implant surgery on 11/8/10

Offline bferguson

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Re: DeNovo Recovery
« Reply #3 on: September 21, 2010, 08:59:21 PM »
I went to my Orthopedic yesterday for my first post-op check up.  He said that things look good so far.  I got to see the pictures from the surgery and it was pretty eye opening.  You could tell what the Microfracture surgery had produced in the main defect and it was not solid at all.  He said that the "cartilage" just fell away when he started probing around it.  He showed another picture of the defect cleaned up and it was about the size of quarter.  Then he showed the defect filled in with the juvenile cartilage cubes. 

From my last PT visit, I can bend well over 90 degrees, probably more like 150 degrees, and I can lay my leg down virtually flat.  So, I'm ahead of schedule there.  All exercises cause very little discomfort except for trying to raise my leg up from a flat position.  This causes quite a bit of pain.  Enough pain where I can only do one or two.  The dr. said this is normal and will get better with time. 

The only bad news I got was that he was adamant about 4 more weeks of crutches.  He wants to be very sure that he's giving the implant enough time to hold and start to grow before I start to walk.  This is more of a nuisance than anything.  PT is 3 times a week for the next 4 weeks and then another follow up with the doctor. 

My doctor did mention ACI when I first had the microfracture and said that he did not have much luck with it.  He did not mention it at all for this surgery and said he is seeing very good results from DeNovo.  It seems the differentiator between the two is your dr's comfort level.   I don't remember the name of the location of the defect, but it is to the right of my knee cap, looking down on my right knee.  He also cleaned up some arthritis under my knee cap. 

Overall, I feel better at this point with the DeVovo than I did with the Microfracture.  My range of motion and strength are better even with the open incision versus the arthroscopic openings.  So, so far, I would recommend, but it's very early. 

Offline bferguson

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Re: DeNovo Recovery
« Reply #4 on: September 21, 2010, 09:03:12 PM »
Anybody have any ideas for some sort of cardio or exercise with being no weight-bearing?  Would like to continue to do something while letting the knee recover.

Offline hwa

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Re: DeNovo Recovery
« Reply #5 on: September 22, 2010, 12:47:11 PM »
I had the Denovo juvenile cartilage transplant with TTO 8/6/10.  My flexion is only 90 degrees.  They have me doing a lot of stretching to get past 90 degrees.  My defect was below the kneecap in the patella femoral area and larger than a quarter.  My surgeon mixed the minced cartilage in a substance and then glued it in.  due to the size of the area (he thought it would be smaller) he stitched an artificial ACI patch over it.  I spent one night in the hospital and only needed pain killers for 4-5 days. I have in week 7 and discouraged with the range of motion.  However the doc says it will come and I am in the ACI rehab guidelines which say 90 degrees by week 6 and 120 deg by week 8.  Not sure I will there.  When was your surgery, did you have the TTO, how did he implant the donar cartilage, how many degrees were you at week 7 and where was your defect?  I was off crutches at 5 weeks, but limping, stronger now, but due to limited range of motion I walk funny.  Do not see many Denovo people on this site.

Offline bferguson

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Re: DeNovo Recovery
« Reply #6 on: September 22, 2010, 03:47:24 PM »
Hey hwa,

My surgery was on 9/8/10, so I am officially 2 weeks post-op now.  I'm not sure what TTO is so I don't think I had that done.  It seems that our initial recovery is similar.  I stayed overnight and was my last pain pill was last Friday, so that was 9 days.  It seems by the reaction of the doctor and the PT people, my range of motion is not typical.  For some reason, I was able to bend without any problem.  I did push the bending very shortly after surgery, knowing that it was going to be a focus, but I just didn't have any issues.  I wouldn't be too concerned, because people heal at different rates.  My defect was (looking down at my knee) on the right side of my knee cap.  He glued the donor cartilage in and I'm not sure about the ACI net.  My biggest issue now is working on straight leg lifts because they are very difficult and painful.  Had PT this morning and that has improved a great deal since Monday.  The lesson I learned from last year's surgery is keep positive, keep up with the PT and exercises and be patient.  I'll find out a more exact place of the defect and post. 

Offline Lottiefox

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Re: DeNovo Recovery
« Reply #7 on: September 22, 2010, 10:30:18 PM »
Hi there

There is a KG member who also has a blog on his De Novo recovery - he is a triathlete:

http://www.10-hours.com/about-marc_rubin_blog.php

The blog is good reading and very positive.

For cardio without weight bearing....can you access an arm bike? Those funny things you sit at and pedal with your arms - they can really get the heart rate up and help cardio fitness. There is also the possibility of punching - if you can sit stably and punch upwards onto pads with a partner holding them, or out to the front. Or even get some weights and punch up, out, to the side, endless variations enough to make your heart rate go up and some sweat occur. Work HARD for 20 seconds, rest for 10 - repeat x 8. Rest for 30 seconds and repeat the 8......with a different type of punch. Even just standard resistance exercises done seated can help - lateral raises, front raises, shoulder press etc.

Good luck for the continued recovery.

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline markld

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Re: DeNovo Recovery
« Reply #8 on: September 23, 2010, 05:07:10 PM »
Who is your surgeon?
April 2008 microfracture left knee trochlea
Jan 2009 ACI harvest from right knee
Mar 2009 ACI right knee trochlea
July 2009 Aci left knee
Nov 2009 left knee scope to check graft

Offline bferguson

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Re: DeNovo Recovery
« Reply #9 on: September 24, 2010, 08:18:12 PM »
My surgeon is Dr. Cantrell from TOC Madison in Madison, AL.  He is excellent and I very highly recommend him.

Offline Rennschnecke

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Re: DeNovo Recovery
« Reply #10 on: September 27, 2010, 08:00:19 PM »
bferguson, it sounds like you have full ROM lucky you!  As I understand it you're one of the people who simply have no problems with adhesion formation.

If you have full ROM are you allowed to get on a bike?  If so, I guess you could also use that at 0 resistance, but go conservatively for duration and speed.  The guidance I was given was increase one parameter only every other session.  If you have any reaction, e.g. increase in pain, heat or swelling, cut back so that you work only within the range that is comfortable for your knee.

Lottie's idea of an arm bike may feel more satisfying though as you can really hammer it without any possibility of compromising your op.  Power work using free weights for upper body work outs is also good, but the CV effects accumulate differently.

Look forward to hearing about your recovery!
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

Offline ajschnelk

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Re: DeNovo Recovery
« Reply #11 on: September 27, 2010, 08:06:14 PM »
I had the Denovo juvenile cartilage transplant with TTO 8/6/10. My flexion is only 90 degrees. They have me doing a lot of stretching to get past 90 degrees. My defect was below the kneecap in the patella femoral area and larger than a quarter. My surgeon mixed the minced cartilage in a substance and then glued it in. due to the size of the area (he thought it would be smaller) he stitched an artificial ACI patch over it. I spent one night in the hospital and only needed pain killers for 4-5 days. I have in week 7 and discouraged with the range of motion. However the doc says it will come and I am in the ACI rehab guidelines which say 90 degrees by week 6 and 120 deg by week 8. Not sure I will there. When was your surgery, did you have the TTO, how did he implant the donar cartilage, how many degrees were you at week 7 and where was your defect? I was off crutches at 5 weeks, but limping, stronger now, but due to limited range of motion I walk funny. Do not see many Denovo people on this site.


HWA, if you don't mind me asking, who is your Doc?  It wouldn't be Dr. Cole by chance, would it? 


Offline bferguson

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Re: DeNovo Recovery
« Reply #12 on: September 30, 2010, 02:30:24 PM »
Hello everyone,

Well, I'm three weeks post-op and I'm kind of in a holding pattern as far as progress goes.  Because I've been blessed with a good range of motion, my PT has cut me back to 1 session a week until I'm off of crutches.  I have a follow up appt. on Oct. 18th. with my OS and hopefully he'll cut me loose. 

As far as PT, things have gotten much better with the flat leg lifts.  A week ago I couldn't do 2 without pain, now I can do 20 without much pain at all.  I'm to the point now where I experience no pain unless I happen to twist.  The crutches and the inconvenience they cause is by far the worst part of this and I'm very much looking forward to the 18th!

I'm going to try the arm bike this week as I have not been given clearance for a bike yet.  That's all for now!

Offline ajschnelk

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Re: DeNovo Recovery
« Reply #13 on: September 30, 2010, 09:19:37 PM »
Thank you for the update...it sounds like you're doing very well considering it's only been a few weeks.  You mentioned that your defect is under the patella...is it in the trochlear groove or the backside of the patella?

Offline Rennschnecke

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Re: DeNovo Recovery
« Reply #14 on: October 01, 2010, 01:01:03 AM »
As far as I am aware turning over the bike is dependent on the ROM you have.  It shouldn't damage any graft as long as you set the bike to zero resistance and don't try to work out fast from the outset.  The forces from the bike help to 'shape' and nourish the cartilage cells.

However, you should consult your key contact for this (whether it is your OS or physio) to ensure they are happy for you to do this.  I know that my OS was keen for me to get on the bike as soon as possible but I didn't have the ROM to turn the peddles round.  In the end I had to just swivel the pedals from one direction to the other for whatever benefit I could get.

NB Bike should be at Zero resistance and turned over at slow pace initially and any reaction monitored.  On the conservative side I'd say leave it for a week to ensure you don't have any delayed reaction to the stimulus, even with your healthcarer's blessings.
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

 















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