Hi Puyao,
I did get back to what would be considered normal flexion at about 143ish....it was a few degrees off from my other knee, but nothing that really I even would ever notice unless I specifically compared the two.  I probably achieved that about 10-12 weeks post op?? Hard to remember now, but I'm sure it is buried somewhere in my post op diary.   I actually didn't struggle too much at all to get my ROM back.  I do remember that I was really worried about it because I read a lot on these boards about how focused everyone was on ROM, but I wasn't even allowed to do much for ROM for 6 weeks having a patellar defect and the CPM and brace having such restrictions for ROM.  As I just started to move about, pedal back and forth on the stationary bike and then one day I could make a full revolution and slowly it came back.  My PT never had to crank on my knee at all to get it back.  It just came back on it's own as swelling went down and I just worked it in PT.

At 8-9 months post op, I see no issues with you being on your feet a lot.  Your defects were condyle and tibial plateau vs. my patellar, so probably not good to draw a direct comparison, but at that point out, I wouldn't think you would be fine walking and being on your feet.  I actually had to do a trip for work when I was 10 weeks post op that involved a flight, trekking through airports, walking through downtown Houston from hotel to restaurants, etc. and I did fine at 10 weeks post op.  My travel partner forgot I had surgery even.  I was a bit sore getting home that Friday and made sure to ice, etc and may have even popped a left over pain med I had, but overall, it was fine.  By 5 months post op, I was able to take my son to the zoo and walk for 3-4 hours no issues...at least with the ACI/TT leg!  The right knee is a different story...at least all approvals are in place from insurance and I'll be having a patella DeNovo NT with the TT in December...so I'll be going through it all again in less than 2 months.

Good luck to you!  Feel free to send me a message with any questions or just ask here.  Now that I'm heading into my next surgery soon,  I've been popping in more frequently.  Hadn't been on in months until recently.

Good to know about the Benedryl!  Thanks! Not random/creepy at all....I posted it on the boards, so all is fair game to comment on!   I get totally itchy from narcotics...not with actual hives or anything like any actual allergy, but just kind of an overall itchy feeling, which I'm told isn't uncommon.  I also get more of a "high" that makes me a bit more agitated and keeps me awake vs. just getting sleepy like a lot of people, so Benedryl served 2 fold in combating the itching, as well as helping me sleep while taking narcotics. 

The whole urinary retention thing was weird anyway....I had a spinal when I had my biopsy scope and ended up with a spinal headache requiring a blood patch and then I have general for the ACI/AMZ and get urinary retention.  Not sure which is the lessser of the two evils....having another needle be jabbed into my spine 2 days post op to inject blood to create a clot or some random nurse at urgent care poking around "down there" trying to get a catheter in my urethra 2 days post while wide awake and then having to leave with a bag strapped to my leg.  Neither is very pleasant... Fingers crossed no anesthesia complications (or otherwise) with right knee. 

Good luck in your continued recovery. 

Hey Ricketycricket,
Good luck with your upcoming surgery.  I am quite certain it was me that Natalie was referencing.  I'm 2 weeks out today from my surgery and doing pretty well.  I go back on Thursday for my first post op.  I think it was delayed a bit due to the holiday.  I'll send you a PM with my e-mail address if you're interested in e-mailing directly.  I haven't been on the boards too much lately.  It was an excellent resource and really helped me a lot through my first surgery, but I just don't feel as compelled to be on as much after this one.  Probably having been through it once already. 

You're comment about people assuming the ACL is so funny.  I totally know what you mean.  I was just out today dropping with my husband dropping our 5 year old off at a basketball camp and a couple people looked at me and said, "ACL?"  There is no "quick" explanation to this procedure....

I go to an ATI for PT.  It works...I was spoiled with a really awesome PT in college who rehabbed my shoulder and it was almost all 1 on 1 for an hour, so getting used to a chain place like ATI or an Athletico is different.  I'm am pretty knowledgeable and can work independantly with minimal direction, so it works for me.  I think if you don't have those traits, it would be difficult.  You were an athlete though, so you'd probably be fine. 

The AMZ isn't fun, but it's not the worst thing ever.  You'll definitely need the pain meds and with your prior history, the pain pump will probably be a blessing.  I didn't have anything like that going on. The worst part of my first rehab was this nerve pain I developed in my ankle about 10 days post op that was determined to be periosteitis from blood tracking down the lining of my bone. It was pretty awful for awhile.  Dr. Cole opted to put in a drain to track blood out of the leg this time and in the first 18 hours, it tracked a pint of blood off.  I iced like crazy, elevated like crazy (even had a purple  bruise under my butt cheek as evidence). I wore TED hose starting at a week because swelling was pretty ridiculous and the ankle was starting to hurt.   Even so, by 10 days, I had a  burning ankle again...so despite the efforts....it still happened.  It's worse at night.  I spend the night swapping out ice packs on my ankle.  Even though it happened to me twice, it apparently is not common, so I wouldn't stress about that.  Should have started the TED hose immediately. That may have helped.  Now at 2 weeks out, I have very minimal swelling due to the TED hose. I think they'll be pretty impressed when I'm there on Thursday for my lack of swelling.

Anyway...I'll send you a PM with my e-mail if you'd be interested in e-mailing direct vs. on the board.  I don't log in here very often anymore.

Hi Jamey1215,
I am in the US. Chicago area.  The AMZ is an anteromedialization, but in my case, it really was more just anteriorizing than medializing. With the slope of the osteotomy cut, there is some medialization. I did not disclocate or sublux, but just track laterally (with a positive "J" sign).  The goal of the osteotomy was more to just change the forces throughout the knee and unload and protect the cartilage graft.  Both knees central grade 4.  Left knee 20 mm x 20 mm with a large osteophyte and right knee 18 mm x 15 mm. 

As for insurance approval, my left knee was approved in under 2 weeks on the first request.   Strangely, when my right knee request for the ACI, my insurance denied it. They also denied the appeal.  Very strange because they approved it the prior year and I had a decent outcome.  Anyway, the ACI request kind of ended up being a moot point because the cells in storage weren't good anymore, so a new request went out under allograft coding for the DeNovo NT procedure and it was approved as quickly as my left knee ACI was.  I had my right knee done with DeNovo NT with the AMZ on Dec. 13th.  Clearly no regrets since I did it again!  Good luck with your insurance approval...I'm only 32 now, so there aren't many other options other than this!  I hope it goes as smoothly as my left knee ACI request and my right knee DeNovo NT request!  Insurance definitely doesn't like patella grafts, but if your doctor does a lot of these, then his admin staff knows how they need to submit the requests to get approved. 

Currently, I am doing okay, but sincen I'm only 5 weeks, 5 days out of my right kneen DeNovo NT/AMZ, activity levels are obviously restricted since I'm on crutches still.   My left knee is not pain free by any stretch and I still have PF issues with it, but much improved from pre-op.  Pre-op, I could be walking on flat ground and get the sharp kneecap pain that stops you in your tracks...add in stairs or ramps...forget about it....  Clearly, my ACI/AMZ knee was doing well enough where I felt confident moving forward with my right knee.  The left ACI knee is a little irritated from the extra work it has to do now, but I'm hoping it calms down as I'm further along with my right knee surgery.   I still have a lot of atrophy in my left knee because my right was beginning to limit me decently, so as I can do more and start hitting the gym outside of just formal PT, I expect both knees to really start turning around.  Prior to my right knee surgery on Dec. 13th, from late April/early May when I finished formal PT, I was trying to get to the gym at least 3 x's per week (some weeks only twice, but others 4x's).  There I would do 20-30 cardio mins and I found that elliptical was easier on my right knee than stationary bike was.  I think the ACI knee was handling biking okay, but the right just couldn't.  I was focusing a lot on my core with planks, crunches, twists and also doing closed chain activity like standing on upside Bosu balls.  I also could do the upright leg press with low weight and I would just try and do high reps until my quad was shaking. I would try and focus on the left and just do touchdown for balance with my right (the right wasn't tolerating much here either).  So, I was indepenent with workouts for 6 months or so prior to having my other surgery. 

While I was under anesthesia anyway, I had them remove the screws from my left knee when my right knee was done.  Verdict still out if it actually did anything to resolve the issues I thought were hardware related.  I think the issues that I thought may have been hardware related are more related to the very pronounced tuburcle that I have now.  It sticks out pretty far....  I suppose it's early though and it may take time for the bone to fill in where the screws occupied, so I could still get improvement.

Interesting you had the Fulkerson at age 21.  After my chondroplasties and LR's in my early 20's, it was briefly mentioned as an option (I was already grade 4 at that time in spots), but I was functional enough and I was done competing, so I shut the conversation down...I do wonder now if I had explored it more then if I would have preserved some articular surface...who knows. At least I was so bad going into the initial left knee surgery that I had no doubts or second guesses at all. Plus being so bad really sets the bar low for surgical success! Ha!!

You're lucky your doc allowed full weight bearing for the osteotomy. Mine doesn't...I asked because I've seen people on here be permitted FWB post TT. He said it's risky and can lead to tibial fractures. The osteotomy is the only reason the restrict WB post a PF graft. You have to follow the protocol given by your surgeon though. Will yours for this procedure?

My insurance is BCBS Federal Employee Plan. The requests go through the local affiliates though, so BCBS Illinois did my review for the procedures codes and BCBS Texas for US Bioservices because that is where the Carticel people bill out of. I hope it all works out with minimal stress...it was just so weird my left knee ACI was approved and them not the right?? Again...moot point with the cell problems, but stressful nevertheless...

I am finishing up my FINAL 10 CPM minutes now!! Will be so glad to not be attached to this machine 6 hours a day!

The realignment code shouldn't change anything.  In fact it just supports the patella defect coding if you read the literature about how the success rates of patella implants went up drastically after they began doing them consistently with the realignment procedure.  I'm sure it will all be fine. 

Definitely too soon to tell if I'll get the same results, but I'm really hoping for better.  My left going into surgery was worse than my right in terms of pain, functionality, actual defect size and that I had an osteophyte formation already (not known until the actual ACI procedure), so with the knee not being quite as bad (although still quite limitiing and prior to the left knee tanking - the historically worse knee), I'm hoping that it will get better results.  Although, then the question would be if I get better results is it due to the above factors or the cartilage graft material??  Probably questions no one can answer... The left knee is a far stretch from what most people would be satisfied with, but it's much better than pre-op...and that's really all you can ask for with these sorts of procedures.  Improved pain, functionality endurance and hopefully significant time bought before something even more drastic like replacing knee parts needs to be done!!