KNEE ARTHRITIS - Autologous chondrocyte implantation (A.C.I.) :
Autologous Chondrocyte Implantation - - Posted by DaveinSC (DaveinSC), 7 June 2003
Help...I'm approx. ten days away from my ACI. While the 1st procedure was OK, I'd really like to hear from anyone who has already undergone the second part. I'm prepared physically with condition, but would really like an insiders view on what to look forward to...except the discomfort (pain).
Posted by Iona_-Uk (Iona), 7 June 2003
Hi Dave & welcome
I've not been through your sugery so I can't give you the insiders view, I would like to wish you well and hope you have a good reovery in due course.
Posted by DaveinSC (DaveinSC), 7 June 2003
Thanks for the wishes. It's rather funny though, that when I asked my OS whether I'd be running any more marathons, competing in any more triathalons, or doing any more tap dancing, he said "I don't see why not." While I've never tap danced in my life, I though this was encouraging...although with a potential rehab of 12-18 months, I'm still apprehensive. Anyway, thank you for the wishes...
Posted by ergomaniac (ergomaniac), 7 June 2003
Take a look on the arthritis strand as there are a few threads on ACI there but PLEASE bear in mind that a lot of people who have had successful ACI's don't need the support of the forum and leave kneegeeks so sometimes the threads may seem a bit too focused on the negatives.
I'm having my harvest in a week and a halfs time and then the implantation mid July in the UK. I undertook 4 months of research into the technique, outcomes etc and 'hand-picked' my OS even though that means travelling 800 mile roundtrip each time I see him. The outcomes for ACI are extremely good as long as a. your OS is really stringent on the selection criteria for offering ACI in the first place and b. the adherence to the rehab program. So from what I've gleaned once you're on board for the ACI the best way you can help your outcome is to dedicate yourself to the rehab and go exactly by the book.
Hope it all goes well for you Dave. Let us know how you get on.
Posted by cat (cat), 7 June 2003
Just curious, what are the selection criteria for ACI?
Good luck to you Dave and Ergo!
Posted by DaveinSC (DaveinSC), 7 June 2003
Hmmmm, Selection Criteria ? Well, first and foremost my OS querried about my insurance...just kidding. Actually you need to be between 25-50 y/o, within the appropriate height/weight parameters, demonstrate the ability to become dedicated to a rigid PT program, have cartiledge which can be harvested, not have any age-related degenerative processes/ immune deficiencies, and not be a candidate for a TRK/PKR due to being too young. These plus good insurance are probably key factors. There really isn't a wealth of info available, but I thought this would be a good place to seek those lil' ideas which can make my life post-op more bearable.
Posted by Allan (Allan), 12 June 2003
Due to go in for my ACT operation at the end of June and so far I've found quite a few sites on it but all american heres the main one I found http://users.erols.com/equinox/aci_patient.html
Has loads of good links but again it is solely about the american treatment system.
If anyone knows of anyone who has had the treatment in the UK would love to hear from them about how they coped afterwards
Posted by rlister (rlister), 12 June 2003
I had an ACI in November 2001 at Thorbury, Sheffield under D.Bickerstaff.
The first 4 - 6 weeks post op are the most important and it is best to keep activity to an absolute minimum. Pain was sharp, but bearable with the drugs (voltorol and paracetemol/codeine). Signed off work for initially 4 weeks and I think it was 6 before I actually started again. You must bear in mind that for the first few weeks, the implant is the consistency of very thin hair gel.
After that, I figure it depends on the site and the size of the implant as to how quick you can recover. I've had numerous knee ops, both arthroscopic and the old open/explore/remove/scrape/close. It's obviously more invasive than arthroscopic so don't expect to be walking within an hour. I could bend my knee pretty much after 6 weeks, but it was probably another month before I could fully straighten it. About 3 months to walking without a visible limp.
Don't rush things!!
Unfortunately I can't give too much encouragement as either my meniscus packed in (feels like it) or the ACI didn't work (doubt it) as about 6 months after the op, I started walking like Mike Ditka (old American Football player/coach) and still am. My insurance stopped paying for privatre treatment and, needless to say, I'm still waiting for an NHS appointment.
Posted by Allan (Allan), 13 June 2003
Thanks for the insight Rob, how long did they keep u in plaster, and what was the therapy like?
Now its getting near I'm trying to sort everything for when i come out but unfortunately i'll be back at work pretty much straight away sat at desk only though so shouldn't be so bad, disadvantage of own company.
Hope you get yours sorted out properly.
Posted by DaveinSC (DaveinSC), 15 June 2003
Well, I'm now down to 1 day and counting. I'm scheduled for the ACI tomorrow and feel ready...I hope. I had the CPM brought in last friday and start out at 0-30 degrees from day 1 through 14. I'm only planning on taking two weeks off work as my OS said I could ambulate with crutches by that date...and as my occupation is very sedentary (sitting at a desk making diagnosis by records with no patient contact) I can afford, I think, to at least perform minimally without too much impairment. At least I say that now...I may be thinking somewhat different in the next 24 hr though. I'll try to stay posted with my laptop and keep all abreast on the day-to-day situation. I just need to abide by what all have said and remember to "take it easy and not rush things!"
Posted by DaveinSC (DaveinSC), 20 June 2003
Wow...I'm now 4 days postop, quite medicated, but all in all, fairly well satisfied. The first 3 days post-op were non-existant as I was so medicated, I can't recall them. The pain was pretty intense, however I'm ambulating today with crutches and a strict NWB status- right leg. I'm going to abide by all my OS rules and take it very slow and easy.
Posted by Allan (Allan), 3 July 2003
Now 6 Days post op feeling gr8
Like you didnt notice the first two days in hospital as i had an epidural and didnt even know i had a leg
Was sent home 2 days after op and was able to move around on crutches with little pain, due to have backslab and bandaging removed on monday finally see my knee again
How are you holding up? Started physio yet?
I had my op done at New Hall Hospital in Salisbury under Mr Shergill highly recommend him to anyone but it is only private.
Hope all is going well
Posted by ergomaniac (ergomaniac), 3 July 2003
It would be good to move this strand onto the ACI thread under the common pathway now that there is a dedicated section for ACI.
Does anyone know how to go about that or does the Kneeguru have to do it?
Posted by DaveinSC (DaveinSC), 4 July 2003
When I had my staples removed Monday, I expected my OS to OK the starting of PT. However while he was really pleased with how the knee looked, he wants to wait three more weeks before any PT. He at least unlocked the brace and is increasing the ROM on my CPM to 0-50 degrees. Disappointed ? Yeah, but I have to just remember this is a long rehab process, but the end result is far better than a TKR or a PKR.
Posted by Allan (Allan), 8 July 2003
Finally have a visible knee.
Now on crutches for 6 weeks and physio twice weekly,
no strapping or support just crutches so its interesting to see how each hospital is using a different procedure during trials to find out best method.
Glad yours is going well Dave
No strength as yet but trying hard to build it back up
Nice scar though
Posted by rlister (rlister), 8 July 2003
Glad to see you're both doing well.
DaveinSC, when you state 0 - 50 degree ROM is that 0 as in straight leg?
Makes me wonder whether staples work better than stitches. It appeared (to me) that it was the scar tissue that was causing most of my straightening problems as it was pushing on the kneecap.
Now I think about it, the straightening wasn't too bad if NWB. It was only styraightening with all my weight that took months (and a very high pain threshold).
I saw my NHS consultant last week and have an op date of end of Sept. for someone to go in and take a look. They think it could be a flap that has opened on the implant site. Hope not, but need to get this sorted once and for all as my left quads have totally dissappeared.
My first couple of days weren't too bad, but then again, I didn't move out of my recliner for most of the 48 hours ( I was turfed out of hospital 18 hours postop).
Good luck guys.
You will be able to walk/run/train again soon as long as you don't rush things. Make sure your physios do something about the scar tissue if you want your knees to look like knees and not extensions of your upper thighs (or that could just be 'cos of the number of ops I've had).
Posted by DaveinSC (DaveinSC), 8 July 2003
The 0-50 degrees was indeed 0 degrees at straight leg. I've had several good arguments with other people in my field concerning ROMS with some arguing full extension should be at 140 and not at 0. Either way, the CPM setting is at 0-50 degrees with 0 degrees being straight.
And I do agree my knee/thigh area has no definition as of yet. Still with the atrophy setting in, and no PT yet, my leg as a whole more closely resembles a breadstick (with some regrown hair).
Updated Thu Apr 29 2010