Skifanatics ACI Surgery - Nov 8 2010

[skifanatic]

WEEK 6
Today I'm five weeks post surgery and still generally feeling well.  I continue to be persistent about remaining non-weight bearing and have not slipped up at all.  Swelling is minimal yet my right knee does not appear anything like my left.  My leg is obviously extremely weak and there's a lot of rebuilding ahead.  The pain is still minimal though every now and then I get a quick shooting pain that lasts a couple seconds...typically after being in the brace.  Repositiioning and leg movement gets rid of the pain.  The past couple of nights I've slept straight through the night without the brace, on my side, without any pain or stiffness.  Icing is down to 3-4 times per day (as needed).

The big item on my mind is a follow-up appointment with the surgeon next tuesday.  I suspect I'll be given permission to drive!!! In addition I'll probably begin outpatient physical therapy and will receive some guidance for increasing load on my right leg.  To say I am excited is an understatement.  I've departed the house three times now in six weeks, and while I do thoroughly enjoy being isolated from the hassles of society, I'd like to get the hell out of here.

Same rehabilitation protocol as described previously with a couple minor exceptions -

• Leg raises - now up to 20-25 per workout
• Recumbent Bike - now up to 30 Minutes per day, all at once.  Use dumbells while biking to strengthen my upper body
• Quad sets - now up to 15 per workout and holding for 10-20 seconds each time

[Melissa S]

Hey Ski,
Yes we are officially 5 weeks post op!  I can't believe you haven't seen your OS yet or been to outpatient PT yet.  I didn't realize that.  Did they just instruct you on exercises to do at home all this time?  I have been going to PT since the day after my surgery.  Although sometimes I wonder if I could go less because they really haven't added much to my at home routine.  Now that I am on the ERME machine at PT that is really helping with my ROM though.  I can only go so far bending over my bed even with my ACE bandage under my leg so the ERME machine really helps me push the bending farther.  Other than that I basically do the same exercises at home that I do at PT. 
I also spoke to my therapist about the possibility of driving now that my brace is unlocked.  I haven't tried it yet because we have been having such bad weather.  I would really like to take the burden of transporting me everywhere off my husband.  They told me to try a short trip to see how I felt.  The problem is my PT is about 50 minute trip so that isn't exactly short.  I don't know how well I would do with my leg bent for that long so I am hesitant to attempt that.  I really miss driving though!!

[skifanatic]

Hi Melissa,

I had some inpatient PT for about three weeks.  I've had almost full ROM since week 4 so there was nothing else for her to do.  She bailed and left me with a list of daily exercises.  The main objective of this phase for me is protecting the ACI and letting the osteotomy heal so I can't do much.  I would LOVE to start putting some weight on this leg, but rules are rules.  Soon I hope!

I'm not familiar with an ERME machine.  What is it?

-Ski

[Melissa S]

Oh, I see.  You are lucky with the full ROM thing.  I guess since your graft wasn't under the knee that was easier for you.  Is the NWB due to the bone?
The ERME machine is something to help with ROM.  You sit in a chair with your foot in front of you on a platform.  You crank the machine and it slowly brings your foot towards you causing your knee to bend to your chest as far as you can go.  You do this until you can't bend any farther and then hold that stretch for about 30 seconds.  They have me do this about 10 times and then measure my ROM.  It seems to help me get the most ROM I can.  Except for yesterday I could only get to 98 and I had gotten to 102 the last pt session.  So the head PT guy got a hold of my knee and worked on me until he got 105, but I was ready to cry at 105 it was very painful.

[skifanatic]

That ERME machine sounds quite effective.  Take it slow.  I'm really quite susprised you didn't get a CPM Melissa.  Especially over the past couple weeks.  Maybe they aren't effective for patella???

The NWB is for both the ACI and Osteotomy.  My defect is huge and it's right smack dab on the medial femoral condyle.  A high impact spot, particularly for men who require realignment like myself.  Not sure what that is.

[cdubb]

Ski,
I had a CPM for my patella ACI, so it's just different protocols.  My range really isn't much different than Melissa's though.  Patella ACI is very typical to be stiff post operatively.  I was told that the CPM wasn't really about range, but more for motion for a patella ACI.  I actually just got rid of mine today, as well as I just got to full WB today (6 weeks post op).  My docs procol permits FWB for a patella ACI, but restricts it when the tibial tuburcle osteotomy is performed (which I had).  Melissa was restricted though with her WB.  Different docs...different rules...

[Melissa S]

I know it is wierd how different docs use different machines.  Everyone that does PT with me calls the ERME the torture machine, but it really does help me with ROM because I just have a hard time relaxing and letting my knee bend when someone else is doing it for me.  With that, I get to where I don't think I can go anymore but I am able to push it just a little farther if I wait 10 seconds or so.
I am hoping they will set me up with one at home, but who knows if insurance will pay for that.

[Overdidit]

Hi!  Thanks for posting on here it helps ease my mind . . .going in for ACI and High tibial osteotomy with Dr. Gomoll.  I have three large defects - two on my femur bone, one under my knee cap.  Did you have any problems with Dr. Gomoll's scheduler?  My surgery has been approved for a week and I can't get his scheduler to respond to me or insurance with a date!  Any tips you could pass along about recovery would be GREAT!

[skifanatic]

Hey OverDidIt,

It can take a little while.  As I recall, once Dr Gomoll's office received my insurance approval in writing, they called me to schedule the surgery.  The holidays may slow things down some.  Try calling there around 11:00AM.  If you get the VM, follow the instructions EXACTLY when you leave a message.  Sometimes it would take a while to hear back (couple of days), but they never blew me off completely.  I'll be over there tomorrow for my 6 week follow up.

There are a couple things I have learned that I can pass on to you...

• Have a support network in place.  It would have been very very difficult for me to do this alone.  My wife has been instrumental in my recovery.
• Be sure to understand your personal recovery protocol from Dr Gomoll very well.  Follow the instructions without exception or deviation.
• Rent or purchase a high end ice machine.  Freeze ice blocks (2" x 4") in plastic containers.  They last almost a whole day.
• If you can work from home I recommend it.  I managed to keep myself very busy by working remotely.
• Early on, verify your PT activity with someone at Dr Gomolls office to make sure you're not overdoing anything.

-Ski

[skifanatic]

WEEK 7
I visited with the surgeon for my 6 week follow up today and had another round of x-rays.  I won't know anything from the x-ray results until tomorrow.  There's a lot to report, so I'll try to summarize.

- Driving is now permitted (Woooo-freaking-hooooo!!!!!!!)
- No more CPM (this is quite nice, but I will actually miss the CPM)
- Received prescription for outpatient P.T. and have my initial PT eval tomorrow morning.
- Received prescription for a new, custom, CTI medial unloader brace which I will use for many months ahead.
- Will continue using bledsoe brace until new one is ready.  I can now unlock the brace when I need to.
- In addition to my the PT routine, I will continue with the recumbent biking and very slowly progress resistance.
- Massage general area to help loosen skin
- Plan to reduce and eventually eliminate crutch usage over the next four weeks

Overall, I feel like the whole deal has changed from a conservative recovery approach to a more progressive recovery approach.  The timing was good.  I expect the next six weeks will not be easy, but I like the idea of making some faster progress.

[cdubb]

Sounds like a good report Ski!  Good luck over the next 4 weeks in ditching the crutches.  I'm trying to rush mine a bit and still walk with a marked limp, but since I can limp no crutches, I tend to do that for short trips than one crutch.  I just lost my CPM last Wednesday (my 6 week mark) and it was nice to not have that burden of having 6 hours to get in! I was lucky in that I could ditch my brace at 6 weeks...but I'm a patella defect, so an unloader brace would do nothing for me.

[skifanatic]

Hey cdubb.  Happy 7 weeks to you!  Do you miss the CPM at all?  I swear, I'm already having CPM withdrawals.  It is a VERY bizzare feeling to NOT be in it.

[Melissa S]

Hey ski,
Know what you mean about making faster progress.  Seems like just in the past few days the knee is starting to feel more normal and things are just kind of happening.  Like I was able to get to 110 deg yesterday on my own and the knee just seems to be loosening up and healing, if you know what I mean.  It is a good feeling to kind of see some light at the end of this long tunnel.
Good luck on your new therapy.  I am still going two times a week and I am hoping to start introducing some new exercises soon with some strengthening.

Melissa

[cdubb]

Hey Ski!
I actually do not miss the CPM at all. The last 2 days I had it, I was also working full days out of the house and physically in the office, so I was leaving home at 7 am and getting home at 7  pm (due to PT after work), so I was only able to get 4 hours in anyway the last 2 days.  I did like the motion it provided when I was early on though. 

[skifanatic]

Looks like everyone is coming along nicely and I'm wishing a pain-free holiday to all.

Had my first PT appt yesterday and have plenty of homework until the first pool session next week.  Looking forward to that!

CPM is going to be shipped home next Monday so I'm not using it anymore.  Spending much more time up and about.  The swelling has increased with my activity level.  I am doing a little 30% weight bearing with the crutches and that is seriously painful.  I really want to be able to be FWB in four-five weeks so I'll just have to suck it up.  Holding off on increasing the recumbent bike resistence for a couple weeks yet.  Still riding about 40 minutes.