KNEE ARTHRITIS - Autologous chondrocyte implantation (A.C.I.) :
Trochlear ACI / Fulkerson experience. - - Posted by collins8 (collins8), 11 December 2003
I would like to offer my past experiences to everyone.
I have had large trochlear defects on both knees. I have had two ACI surgeries on each knee (that is right four total) and I have had concurrent Fulkersons done on both Knees. This has been over a five year span. I have learned much over the years. If anyone has a specific question regarding an ACI of the Trochlear area or on the Fulkerson, I will be more than glad to answer it.
I also have some great pictures of my defects and also of my repair tissue at the one year point. I do not know how to post Pics.
Posted by hmaxwell (Heather M.), 12 December 2003
Did you also have cartilage lesions on the back of your kneecap? I have those, as well as damage to the corresponding areas of the trochlea and tibial plateau. I've been told repeatedly that I'm not a candidate for ACI because 1) my Q angle is huge, so I have severe mal-alignment; 2) patellar lesions don't respond well to ACI; 3) I have a severe problem with forming tons of scar tissue.
I'm so frustrated to hear these comments from doctors--to be told at 33 that I have to live with grade II osteoarthritis of the patella, and to hang out for 20 years before I can have a TKR.
So I was wondering if you had any comments on the patella aspect--if this was something you discussed with your doctor. If so, who was your doctor? US, UK, Can, AUS, where? I'm desperate.
Thanks in advance for any information you can provide.
Posted by collins8 (collins8), 12 December 2003
Yes, I also have lesions on the right patella and you are correct Kissing lessions do not respond very well. We just cleaned the patella up and went on. I also have problems with scar tissue and on my last two surgeries I had tons of it removed and a lateral release on both knees.
In my opinion if any one can help you it would be Dr. Tom Minas in Boston, MA or Dr. Scott Gillogly in Atlanta, GA. They are the best out there!! I am partial to Gillogly though.
Posted by dhalem (dhalem), 13 December 2003
I agree, Dr. Minas has got to be one of tops in the US if not the world for cartilage repair/complicated cases. I have had two procedures with Dr. Minas in the last 90 days, and I am very pleased with his care and follow up www.cartilagerepaircenter.org.
I am battling arthrofibrosis, and working to try to get rid of stiffness. I am keeping about 121 ROM, passive, but cannot kick stiff knee syndrome which inhibits my gait.
Dr. Minas performed Manipulation with scope and a second lateral release Oct. 27 following bone graft procedure to try and restore ROM. My defect of 1.5 cm is partial trochlear and seems to be healing well with graft taken from top of my tibia. Hopefully no ACI in my future.
Posted by pcfu (pcfu), 17 December 2003
Gday everyone. I have just had an ACI procedure for 2 lesions, a 3cm X 2cm defect on the trochlea and a 1cm X 1.5cm on the back of the patella. i know all about the unsuitability of kissing lessions, but apparently my defects are not directly above each other, so have been told this shouldn't be a problem.
My main question for Rob, is how much of the defect covered with cartilage. Also i am only 20 and (used to) play heaps of sport, so just wondering if you can run, or play sport now?
I have heaps of questions, i spose like everybody, mainly about rehab protocols since they seem to vary, and most are based on condyle lesions rather than the patello-femoral joint. Anyway, my rehab so far (i am only 2 weeks post implant), hopefully get rid of crutches at 3 weeks, and out of brace at 6, and then into physio. Just wondering in general what others rehabs have consisted of. I am in Australia, so have noticed a few differences from the mainly American stuff (such as i was only on CPM for 2 days in hosp.)
Posted by collins8 (collins8), 18 December 2003
My defect covered the whole trochlear groove. Not sure on sqcm, but it was a very large one.
As far as rehab. Ice is your friend and get used to using it for the many Months to come. Get your range of motion back as soon as you can. The longer you wait the harder it is to get it back.
On my last two surgeries I have used an Exogen ultrasound unit to help stimulate growth and I can tell it makes a Huge difference!!
As far as sports, all I can say is DO NOT push this graft for 18 months. It is very slow to mature into durable cartilage You do not want to damage it. It is a very slow process. If everything goes well you will fell great about the 9 to 12 month point and want to have some fun. At this point the cartilage can not take the abuse from hard cuts or sudden loading. Be very Patient!!
Another thing, get off pain Meds as soon as you can. The longest I ever went was one week on them and then I toughed it out. The last thing you want is to develope a drug habit, It can happen to the best of us!!
Everything I have told you is my Personal opinion based on my experience.
Posted by wilsonrob (wilsonrob), 22 December 2003
I have had a similar trochlea problem and surgery. At 4 weeks post op i put weight on knee with bent leg while climbing stairs on my crutches. I had acute pain but this was only for a brief second. my surgeon cannot comment. do you believe i could have done any damage? what is your activity level at this point?
Posted by pcfu (pcfu), 23 December 2003
Yeah i know all the shoulds and shouldnts, there's a heap of em. i was only on pain killers for a couple of days cause i dont really like the idea of them.
Don't worry i'm not going try running tommorow, but can you run or play sport now? Yours was 5 years ago right? This is why i had the operation so i could get back to sport, otherwise i could have put up with a bung knee day to day, but i couldnt play footy anymore.
Now that i think of it, 5 years ago it might be hard for you to remember everythin but thanks anyway. Also you mentioned that you had some pics of your graft 1 yr post op, i wouldnt mind seeing them if its possible.
Posted by collins8 (collins8), 23 December 2003
As far damage to the graft. It is very hard to say but the there is good news!! At such an early point it can heal it self allot!!! Chances are you did not hurt it and do not worry about it. The only way to know for sure is give it time and monitor pain and swelling. For your info I ripped one of mine out at the 15 week point and we waited 37 more weeks before we went in to fix it. When we got in there only 1/3 of the original graft had to be repaired and the other 2/3 looked great!!
I am presently 1 year post op on my right knee and 6 months on my lest knee. I had problems with the first 2 surgeries, so I can not comment on sports. Hopefully someone else that is at their 2 or 3 year points wil let both of us know!!
Posted by pcfu (pcfu), 6 January 2004
Gday all, hope everyone is well.
Just wondering how long it took for you guys to get full ROM back?? i am five weeks post op and am only at 90degrees. anyhow, just curious.
take it easy.
Posted by collins8 (collins8), 10 January 2004
After four surgeries.
I would say it took about 12 weeks on average.
It all depends on how much swelling you have.
Stay after it, it will come!!
Updated Thu Apr 29 2010