KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: bioprof on September 17, 2006, 06:02:18 PM

Title: 4 weeks down the long ACI road
Post by: bioprof on September 17, 2006, 06:02:18 PM
I'm so glad to have found this forum.   I'm 44 yrs, married with 2 young kids.  I'm 4 weeks ACI post-op.  I had a trochear and a MF condyle lesion repaired.   As you may have guessed from my username, I am a biology professor, so the biology of ACI is intriuging, but from a patient's perspective it's scarey as hell.   It really has been helpful and encouraging to read about other experiences with ACI.

The nightly pain has finally subsided.  What a relief it is to be done with the 2 am Vicodin!  One my biggest frustrations and concerns is trying follow my surgeon's rehab protocol, which differs from the standard Carticel protocols, in some cases signficantly.  For example, I was only on the CPM for 2 weeks, at which point we had it dialed up to 0o extension and 120o flexion.  No brace at all.   My surgeon is very bright and personable, but is somewhat challenged in the communications area.

One question I have is how everyone chose a PT?  The one I'm working with (just started last week) seems very competent, but has no ACI experience.  Should I seek one that does?

Thanks.




Title: Re: 4 weeks down the long ACI road
Post by: DJF on September 19, 2006, 02:26:45 AM
Wow, Bioprof.  I don't know how I missed this post.

How is it going?

With my first surgery (Lateral Release) I had SEVERE pain in themiddle of the night.  I would have to bend my leg which hurt REAL bad for before the pain would subside.

Is that the type of pain you had at night?

Did you ever get an immobilizer?  PT?

I have told my surgeon I want the recovery to go slow and careful.  He is not beig on rehab either.  My intention is to MAKE hime follow the Carticel recovery protocal from the webiste.

Don
Title: Re: 4 weeks down the long ACI road
Post by: DJF on September 19, 2006, 02:33:08 AM
Bioprof,

Didn't you get a Carticel Rep?  ou might give them a call.  They are very interested in your recovery as the reputation of the company is a stake.

Don

I am lucky enough to have a PT who has helped several Carticel patients.

Are you on crutches?  Partial weight bearing?

Fill me in
Don

My Implant date is Oct 17th.
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on September 19, 2006, 02:31:45 PM
Hi Don.  I've really benefitted from your posts throughout this forum.  Thanks.

I wish you the best of luck and a speedy (relatively speaking, of course) recovery.

The best way to describe the pain the first 2 weeks post up was a prolonged category 5-7 toothache, i.e. throbbing pain.  Vicodin (7.5 mg) knocked it down to a 2-3.

The brace/immobilizer experience was a fiasco from the beginning.  My OS prior to surgery said I would be in it 24/7 for at least 4 weeks.  As I was being discharged, I asked about the brace which was sitting on a shelf.  The nurses looked at each other and finally admitted that none of them new how to attach it.  Two PTs were called in, but after about 10 min and a helluva lot of pain, it was clear they didn't have a clue either.  I demanded that they call my OS.  I didn't hear from him until that afternnoon, at which point he told me he decided not to use the brace!  He apologized for the confusion.

I'm NWB w/crutches.  I see my OS in 3 days, at which time he may order PWB.  I have a hunch that he his varying rehab protocols on his ACI patients to evaluate which works best.  Who knows????

My OS's coordinator gave me a list of PT's in my area, but provided no information about who may be best for my ACI rehab.  I have a PT who is young and very personable, but has no experience with ACI patients.  That, combined with my OS's inconsistent communication, concerns me.  I think it'd time to use your assertive tactics on my OS.  The problem is that his office blockades patient calls directly to him, routing all calls through his coordinator.  I'll give my Carticel rep a call.  Thanks for the suggestions.

With all that said, my knee is feeling much better.  I just hope all those little chondrocytes are happy and do their thing!

Title: Re: 4 weeks down the long ACI road
Post by: DJF on September 19, 2006, 03:56:13 PM
First off, I'm glad your getting better.

Your OS's protocal is VERY different and a little scarey.  SO, I assume you jest try and keep the leg straight? 

For my Lateral Release, my OS did not prescribe any rehab.  And he ownes the rehab center!!!!  I finally went to another OS for a second opinion on the Carticel.  He agreed that Carticel my be a good alternative for me, but said he would not operate on me with the muscle tone I had in  my quads.  He thought I was too weak and with another surgery it would be VERY VERY difficult to come back.

I too that information to my current OS who then prescribed rehab.  I have been doing the rehab exercises sincce March and have noticable improvement in my leg.

This time, I have the protocals with me every time I go see the OS and we WILL follow them with only minor variations.

Rant off.
Don
Title: Re: 4 weeks down the long ACI road
Post by: Nick_Knack on September 19, 2006, 10:30:06 PM
1) There are few PT's who have considerable experience w/ ACI alone as this is not that mainstream of a surgery.  So, my experience, was just concentrate on finding a PT who generally has a lot of experience w/ knees and works at a high volume place.

2) Carticel will give you- via your surgeon- a pretty detailed rehab protocol.  So, just be knowledgeable as to what is prescribed and question anything that seems odd or against the protocol.  PT's should have tons of experience w/ ACL's and Total Knee Replacements and be tempted to apply what they know there for ACI.  But in ACI, you want to protect the knee through certain Ranges of Motion (for trochlea) and open vs. closed chain excercises in the early stages.  I don't believe these restrictions exist in ACL's or TKR's where the point is to get the swelling down and the knee moving as quickly as possible.

3) I like PT's that do manual work.  That is: efflurage/ petrosage or lymph drainage techniques (i.e. where they manualy work and "massage" the lymph or swelling down from your knee into your draining lymph nodes of your groin.  I made sure that the PT worked w/ her hands and didn't just watch me doing a bunch of exercises.  The manual work really helps reduce swelling and restore range of motion quicker. 

4) after the first 3-4 weeks, you will be much more independent and able to do majority of rehab on your own, w/ the PT's guidance.  I stopped going to rehab now and just do it at gym where I can combine it w/ a cardio workout  (i.e. stairmaster, elliptical and leg weights on my own)>


Best of Luck,

Nick

Title: Re: 4 weeks down the long ACI road
Post by: bioprof on September 20, 2006, 12:41:13 AM
Thanks Nick.  You mentioned that it is advisable to "protect the knee through certain ranges of motion" with trochear lesion repairs.  Are you referring to limiting flexion?  I read the reab guidelines for trochear ACI and it does seem that the schedule is more conservative.  I don't have a clue why my OS hasn't adhered to this.  I will be sure to ask that question and others when I see him in 3 days.  If this forum does anything, it empowers patients through knowledge.
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on September 22, 2006, 04:38:32 PM
I know many veterans of this forum are aware of the Carticel Rehab Guidelines on their website, but for those nubies like me, here is the address for the guidelines document(note:  It's a pdf document):  http://www.carticel.com/pdfs/carticel_rehabilitation_guide.pdf

It's a very informative document that I believe all current and perspective ACI patients should have in-hand when they meet with their OS and PT.
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on September 23, 2006, 01:16:56 PM
I had my 1-month post op visit with my OS yesterday.  He was generally pleased with the progress so far.  I'm about 0 extension/105 flexion.  I still have general aching pain at night, and pain with full extension and leg lifts.  My OS finally fitted me with a brace and directed 25% WB, with a two week goal of being full WB.  And that's where things got interesting.

After the examine,  I let him know that I was not satisfied with the level of communication between his staff and me, including their failure to provide names of PT's with ACI experience.  I told him that even though I was working with a very pleasant and competent PT, I was concerned about her lack of experience with ACI.  It turns out my concerns were well founded.  My OS apologized, and referred me to a PT with ACI experience.  I called the new PT immediately and met with him that day.  Bottom line, the new PT concluded that the activities and protocols set by my first PT could have jeopordized my ACI recovery.  They were simply too aggressive for the trochear and MFC lesions I'm recovering from.  I was both relieved and angry.   It is frustrating to consider that the huge commitment and scrafice I and my family have made could have been wiped out by this lack of communication.

As I told my OS, I learned from a previous surgery on my R. shoulder several years ago.  I failed to ask questions about my rehab and ended up with a frozen shoulder that required very painful rehabe to fix.  I will not make the same mistake twice.  Ask questions folks!  And if you're not satisfied with the answer, ask again until you are!  Do not feel that you're going to insult you physician.  They're trained to answer tough questions. 
Title: Re: 4 weeks down the long ACI road
Post by: Nick_Knack on September 25, 2006, 12:29:43 AM
Thanks Nick.  You mentioned that it is advisable to "protect the knee through certain ranges of motion" with trochear lesion repairs.  Are you referring to limiting flexion?  I read the reab guidelines for trochear ACI and it does seem that the schedule is more conservative.  I don't have a clue why my OS hasn't adhered to this.  I will be sure to ask that question and others when I see him in 3 days.  If this forum does anything, it empowers patients through knowledge.


yeah,

for trochlear/ patellar lesions, you want to limit the open chain quad exercises to 0-40 degrees, I believe, in beginning.  Also, not to "snap" or fully extend on close chain quad strengthening.  Also, limit bicycle resistance in beginning of rehab.  Also, listen to your knee.  If you over do it at gym/rehab, it'll feel sore.  The stair master i have found is excellent.  a) You get cardio b) it isolates each leg so can't compensate c) limit range of motion so don't over do it.


Best of luck.
Title: Re: 4 weeks down the long ACI road
Post by: DJF on September 27, 2006, 12:53:26 AM
Glad you got the rehab straightened out.  I was very nervous for you when you described what you were doing.  Now, you can get back on track.  It is a little scarey that all the pain and commitment could have been wasted.

Congrats
Don
Title: Re: 4 weeks down the long ACI road
Post by: dillon24 on September 29, 2006, 05:20:05 AM
You guys have me a little nervous.  I'm in the process of trying to find a PT with ACI experience, but my OS's office hasn't let me know who in my area has that kind of experience.  My other problem is finding a place that accepts my insurance. You would think Cigna would be covered almost everywhere.

Anyway, the place I went for my chondroplasty, the PT's had never even heard of ACI much less treated someone with it.  I'm a little "gun-shy" to go there for PT, but I don't want to have to pay out of network charges ($40 -$60 per visit) each time I go. That could get rather expensive.

Dave
Title: Re: 4 weeks down the long ACI road
Post by: DJF on September 29, 2006, 01:05:16 PM
Dave,

I think worst case, I would take the Carticel rehab protocals with me to the PT and make sure they follow it.  THey may even call your Carticel rep. for assistance.

The more I read, the more lucky I feel that my OS practice also owns the PT practice and they hav elots of ACI experience.

Good luck
Don
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on September 30, 2006, 07:22:42 PM
Dave,

I think your experience so far and mine with trying to find a PT experience in ACI rehab underscores a weak point in the Carticel process.  Through their printed material and website, Carticel does a good job of educating patients about the procedure and the stages of recovery.  They fall short, however, in providing information about where ACI-trained PT can be found.  I'm guessing that they haven't invested any resources in a PT training program for ACI.  Ironic, given the critical importance of PT rehab to the entire procedure's success.

If they agree with this assessment, I would encourage other members of this forum to contact Carticel and express their concern. 

Mike
Title: Re: 4 weeks down the long ACI road
Post by: Nick_Knack on October 03, 2006, 03:52:11 PM
You guys have me a little nervous.  I'm in the process of trying to find a PT with ACI experience, but my OS's office hasn't let me know who in my area has that kind of experience.  My other problem is finding a place that accepts my insurance. You would think Cigna would be covered almost everywhere.

Anyway, the place I went for my chondroplasty, the PT's had never even heard of ACI much less treated someone with it.  I'm a little "gun-shy" to go there for PT, but I don't want to have to pay out of network charges ($40 -$60 per visit) each time I go. That could get rather expensive.

Dave

i don't know about CIgna, but w/ the bastards at Oxford I have had to fight for everything from CPM post op, to rehab, to even getting ACI approved in the first place.  I won all three external appeals and the bastards had to pay each time.  Am I bitter?  Only slightly..... but the point is that you have to fight for everything w/ money-hungry insurance companies and you should and you will often win the external appeal (i.e. via the state's insurance reviewer).

I am not necessarily a big proponent of rehab.  Having had so many surgeries, I know what to do myself.  However, ACI is a bit different and you may need guidance and motivation.  My rehab person didn't have any ACI experience, but was a great therapist and followed Carticel's detailed protocol to the letter. 

YOu don't need to go to someone specializing in ACI rehab.  Just find a good therapist who does a lot of knees and seems open minded and not set in their ways.


Best of Luck,

Nick

Title: Re: 4 weeks down the long ACI road
Post by: bioprof on October 06, 2006, 01:13:35 AM
Post-op week 6, but it feels like week 96!  The goal is 50% weight-bearing by the end of next week.  Looking forward to it, except for one thing.  I'm having a lot of pain over the condyle repair area, especially on the day following PT.  I'm convinced that most of this pain stems from a procedure done in PT - weighted leg extension (lying on stomach with leg hangin over table end).   This is very painful - primarily because the proximal end of the tibia compresses against the condyle repair.  I'm convinced that this aggravates the area, leading to pain and inflammation.

 My PT and OS tell me the condyle pain is normal.  But I'm not convinced.  Not this much.  Given 2 days rest,  the pain almost subsides.  I'm going to address this with my PT, and firmly suggest that we drop this from the routine.

Has anyone else who's had ACI for condyle lesions experienced this?   To what degree have you experienced pain 4-6 weeks out?

Thanks,

Mike
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on October 08, 2006, 12:45:00 PM
Just a quick update.... I discussed the pain issue with my PT and explained why I thought we should stop doing the prone leg extensions as described in my pevious post.  He was completely in agreement and used an alternative procedure which was much less painful.  I must admit that I was a bit anxious about bringing this up with him, but I've learned that we are own best (and perhaps only) advocates when it comes to decisions about surgery and rehab.

My PT also sent me home with an OrthoDx unit which provides high volt stimulation to improve circulation around the knee and also muscular stim to jump start my VMO (vastus medialis oblique), which at present looks and feels like a week rubber band.  Anyone else using this?

Mike
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on October 21, 2006, 02:55:07 PM
I haven't posted here for a while, so I wanted to give a quick update.  My PT is pleased with my progress.  We're working toward 75% WB by the end of next week and maybe 100% by 2 weeks  with 1 crutch.   I still have some mild pain at night, especially after PT or doing alot of "walking."  My quads (or what's left of 'em) are reawakening, albeit slowly.  I welcome the muscle soreness.  It's a reminder that the knee is getting stronger.  It's nice to be able to do a few more things at PT.  As the only ACI patient there, I feel like I'm on training wheels, while most others are speeding through reahab.  Probably more to do with my perception than reality though.

I see my OS in December for a 2 month follow up.  The overgrowth issue has me a bit concerned, though I haven't experience any signs of it yet.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: victoria628 on October 27, 2006, 02:37:22 PM
Glad to hear you are doing well!
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on October 27, 2006, 02:45:58 PM
Thanks Victoria!  How's your rehab going?  My PT wants me to use one crutch as of today.  He told me that if sees me coming in with two crutches, that he'll kick one out from under me ;D  He was kidding of course, I think!

Mike
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on November 02, 2006, 01:11:56 AM
Make that 9 weeks.  I must admit that I'm a bit jealous of the folks who have access to the MACI procedure.  I know that there are several reasons why it takes our medical establishment here in the US so long to get up to speed on new technologies, but it is frustrating to know that there are potentially better procedures out there for which we do not yet have access. >:(  OK, end of rant. 

My rehab's going well, but there's definitely an ebb and flow pace.  I have great optimism when I reach a milepost, such as one crutch and 75% WB.  But there's also impatience and frustration when my knee aches and stiffens following PT or other activities.   I'm hoping for less of this 2 or 3 mon down the road.  Not much in the way of useful information in this post - more reflection I guess.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on November 19, 2006, 02:22:19 PM
Just a quick update:  Week 13 post implant and I've finally tossed my 2nd crutch aside to go full WB...with my PT's blessing.   I wouldn't describe my walking gate as smooth, but it's a start...baby steps!  There was somewhat of a threshold breakthrough for me when it came to regaining strength in my atrophied quads and vastus medialis (the muscle directly medial to the knee joint).  Through week 10 post op, I experienced very little change in muscle size and strength.   Between weeks 11-12, the muscle ridges began to "rise from the ruins", and I could place much more weight on the leg without it feeling like it was going to collapse.  This progress of course was due in large part to my PT who's very much in tune with my rehab regime.  I've said it before, but having confidence in my PT (even more than my OS) is the most important factor in my recovery.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: victoria628 on November 19, 2006, 02:35:43 PM
Hi Mike!
     I am doing OK, thanks for asking.  I am on week 3 and I am only at about 68 deg.  My doctor had me limit the CPM machine to 40 degrees b/c I also had my ACL reconstructed during the surgery and he thought that too much of the CPM would damage it.  Do you know about what your range of motion was at 3/4 weeks?
     I am kind of frustrated with the progress but I am very impatient and usually very active and social.  I read the protocol for PT on the Carticel website and it is pretty different than the PT description the doctor sent me home with!  My PT is OK, but not too familiar with the ACI, but we have been following the doctor's PT description so hopefully it will be OK.
     I hate my crutches and I can't believe it has been only 3 weeks.  I am still no weight bearing and I get the pain you are describing - in the defect area.

Glad to hear you have tossed the crutches!  I can't freaking wait!!

Vicki
Title: Re: For a good PT, ask your surgeon
Post by: Chondrosoldier on December 01, 2006, 09:33:33 PM
Thats the biggest no-brainer on this board.  The surgeon relies on a PTs for a successful outcome like his/her left hand.  Call their nurse and ask who they recommend as it is guaranteed it will be somebody with extensive ACI experience.  PLUS, that PT will most likely be in-network.

Good Luck. I'm 6 weeks post-op and have nothing but OUTSTANDING things to say about the ACI experience.  Brant
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on December 02, 2006, 04:17:01 PM
Glad to hear your ACI is going well Chondrosoldier (great name!).  If you scan some of the previous post of this thread and others, I think you'll find that the OS - PT relationship is not always as you described, or it isn't always made clear to the patient by the office staff.  After my first post -op exam, I did exactly as you said.  I asked the PA and nurse for recommendations on a PT.  They gave me a list sorted by location.  When I asked them about which one they would recommend who had the most ACI experience, I got that vague look and a shrug of the shoulders - I dunno.  The OS happened to be out that day, so I left without getting an answer.  I then cold-called a few PT's in my area, finally settling on a nice, but ACI-inexperienced one.   That lasted two weeks ( a critical 2 weeks!) until I demaned to speak with my OS (very personable, but nearly impossible to catch for a quick question).  Only then did I get the name of a ACI-experienced PT near me.  The rest is history - so far so good.

Mike
Title: Pain, stiffness at 3.5 mons
Post by: bioprof on December 10, 2006, 08:08:46 PM
I'd like to hear from others about their level of pain and stiffness at about 3-4 mons post op.  I've been FWB for about 3 weeks, but since then I've had fairly consistent, albeit not excrutiating, pain at the iimplant site (medial. fem. condyle).  I saw my OS last week.  He said he's not concerned "yet", suggesting that he would expect the pain to subside in about 2 mons.  If not...Well, I can't even go there.

I've been in PT for about 3 mons (3 days/wk).  The routine has been stepped up within the last week including some step exercises and Total Gym workouts (sort of a leg press using the body weight).  Anyway,  I'm anxious to hear from those that have been through this stage.

Thanks,

Mike
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on January 20, 2007, 02:44:27 PM
It's been a while between updates (last Dec '06), but I feel compelled to keep at it because I drew so much information and inspiration from the brave folks on this forum prior to my surgery.  I'm now about 5 months post-ACI (Carticel).  There is no easy or quick way to describe progress on a small scale.  As anyone who has gone through this knows, day-to-day recovery is a physical and emotional rollercoaster.  Overall though, I'm making good progress.  I'm walking mostly without any noticeable limp.  Stairs are still a challenge, especially descending.  I'm at 0 degree extension and about 145 flexion.  Ironically, my PT wants to see my flexion decrease a bit. He explained that my loss of muscle mass in my hamstrings has allowed greater than normal flexion.

Most days are relatively pain free.  I have soreness (not pain) mostly at the end of the day (particlularly a PT day) when muscles, tendons, etc have had enough.  PT has been ramped up to wake up my "comatose" quads.  Lots of bike, squats, "monster walks", etc.  Stairs are still a challenge, particularly on the descent.  My quads are still too weak to support my weight, so I end up coming down with a thud on my good knee - which has taken much abuse but has held up so far during this ordeal.

I had to have a face-to-face recently with my PT.  The facility has undergone an expansion, adding more patients and staff.  At one point, I saw 3 different PT's in one week.  There was a clear breakdown in communication, with each PT not aware what the other one was doing.  I was constantly being asked, "How much weight were you doing?"; How long were you going for?", etc.  Each was also adding new activities to the point that my visits were over 2.5 hours long.  I finally spoke up and described my concerns.  The supervising PT was very understanding, and promised to address my concerns.  He noted that I wasn't the only one complaining about service.  Things have gotten much better after the meeting.  The lesson here is that if you are concerned or dissatisfied with your rehab, then your need to speak up.  There is already enough inherent uncertainty and stress associated with this type of rehab.  The last thing we need is to worry about whether our OS or PT is doing their job properly.

Wishing all here a new year filled with speedy recovery!

Mike
Title: Re: 4 weeks down the long ACI road
Post by: BarryB on January 22, 2007, 09:00:21 AM
Hi Mike,

I've just jumped on this site for the first time in a while (i am 2 years post MFC implant and 3 years post patella and trochlea implants).

Just wanted to wish you luck with your recovery and hope you don't stress about any pain etc too much! If i was to give anyone who was having this surgery any advice it would be not to rush things and not to judge your recovery on a month to month basis let alone week to week. You really need to look at how things have gone every six months and then when you look back you will be able to see that yes in fact the knee has improved. the first 6 months are a bastard, but at 12 months you'll be a lot better than at 6 months, and at 2 years you'll still be way better than what you were at 12 months!

Good luck!

Baz
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on January 26, 2007, 11:38:32 AM
Wow!  Thanks Baz.  Your comments are greatly appreciated, if not a bit sobering.  The literature on ACI doesn't exactly match your account, and I suspect each individual heals at a different pace, but I believe your experience is more realistic and closer to the "norm."

Mike
Title: Re: 4 weeks down the long ACI road
Post by: DJF on January 26, 2007, 10:01:38 PM
Hi Mike,

Sounds like you are doing very well.  I am at 4 months ACI(carticel) and TTT.  I had a setback in December when I got stuck at 70 degrees of flex.  I have surgery to cut adhesions away and I am now at 130 degrees.  My walking is a problem as I have about 4 degrees of positeve flex.  I am working on that with an extentionator.

Like you said, it is hard to measure progress at this point.  There is no giant leap each week, but it does get better.

My pt can last anywhere from a hour to 2 .5 hours.  We generall do some palattes, ride a stationary bike (I do about 3 miles on low resistance), leg lifts, balancing, NMES while standing in different positions.

The leg lifts are giving me trouble and I want to talk with the OS about it.  If I start at a 45 degree angle, I get a lot of pain.  I think that is putting a lot of preasure on my Carticel patch.  This makes me a bit nervous.

Thats about it for now.

Don
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on January 27, 2007, 02:06:43 AM
Hey Don.  It's good to know that your rehab is going reasonably well.   Sorry to hear that you had to have another surgery, but it sounds like it was well worth it.

I do get some pain, and an occasional pop in the area of my condyle repair.  My PT and I seem to think (and are hoping!) it's either an inflammed tendon, ligament or some scar tissue causing the problem.  Not sure what "positive flex" is????.   I'm thinking leg extensions when you refer to "leg lifts."  Is this right?  Are you doing weighted extensions?  I'm doing extension with 4 lbs mostly pain free. For what it's worth here's my basic PT regime:

- stationary bike (12 min, low resistance)
- step ups (forward, lateral, and diagonal; 2 sets, 30 reps )
- step downs (1 set, 20 reps)
- lunges (forward, lateral; 2 sets, 15 reps)
- leg press (30 lbs, 2 sets, 15 reps)
- wall squats (2 sets, 20 reps)
- 1-leg ply ball throw (2 sets, 20 reps)
- weighted walks (forward/backward, lateral; 4 reps each)
- 1-leg balance on disk (10 reps)
- theraband lateral "monster walks" (2)
- weighted leg extensions (4 lbs, 2 sets, 30 reps)
- weighted standing hamstring curls (4 lbs 2 sets, 30 reps)
-  ice (well deserved, 10 mins)

I was prescribed a portable muscle stim unit (Ortho DX) that I use once/day at home.  It gives simultaneous electrical current through the repair area and neuromuscular stimulation to my quads.  This is a very cool device that really makes a difference.  Immediately after a treatment, my knee just feels better, and it really does seem to awaken my much atrophied quads.

Take care.  Mike
Title: Re: 4 weeks down the long ACI road
Post by: DJF on January 29, 2007, 02:48:16 PM
Hi Mike,

Looks like you are about 6 weeks ahead of me. 

Positive flex?  What I mean is that I cannot extend my leg.  My extention is at +4 degrees or so.  This is causing me to limp more than I should.

You are doing a lot more exercises than I am.  I cannot do squats yet at all.

I did bend to 135 degrees of flex on Friday.  It hurt the area around my TTT and I have been having a lot of shin pain. around the screws.  I am also having buring pain around the screws.  The PT says its just nerve damage and will go away.

Don
Title: Re: 4 weeks down the long ACI road
Post by: LadeeStingray on January 29, 2007, 06:16:07 PM
Hi all

Wish i would have found this site back when i had my OATs procedure would have answered alot of my questions.   So now here i sit waiting for my ACI surgery (never got to return to work after my OATs 06/06)  I thought the first 24 hours after my OATs was terrible ... i can only imagine what this one is gonna feel like.  They are planning on doing three different areas  MFC, trochlea, and patella.    Of course my OATS went great .... its the area around those plugs thats gone now.  Of course with me its never a simple fix.   So please ... keep the posts coming ... this is helping my anxiety about this surgery. 
Title: Re: 4 weeks down the long ACI road
Post by: ivischwartz on February 25, 2007, 01:45:53 AM
Bio-P:

Would you tell me a little more about the stages of progress you went through. Of particular interest is the history of your gait as well as the continued pain you have in your implant area. These are the two things that worry me the most at this point, so any comparisons are helpful.
Title: Re: 4 weeks down the long ACI road
Post by: Rod G on February 25, 2007, 02:08:31 PM
Hi,

I just wanted to reinforce BarryB's post and confirm that the recovery from a maci/aci operation is a lot longer than what the literature states from carticel.  I couldn't imagine doing sport at 12 months post op.  I'm currently 14 months and it has certainly been a challenge.  My OS has confirmed that 75-80% of the graft has taken and i now only have a 2cm2 hole in my cartilage as oposed to 9cm2.

How does my knee feel?  It feels a lot stronger but it is very deceptive as i think the cartilage isn't mature enough to handle that much exercise.  I can gently kick whilst i am swimming and that's about it at this stage.  I'm hoping to get further improvement in the next six to eight months.

Oh btw don't worry about the pain it is fairly normal and there were many times i thought i'd damaged the implant.

Regards

Rod
Title: Re: 4 weeks down the long ACI road
Post by: DJF on February 26, 2007, 12:00:36 AM
ACI guys

I am now 5 months post op.  I have good days and bad days.  I still walk with a limp.  On bad days I have a fair amount of pain right on the damaged area (Trochlea).  On good days, I can walk almost normal. 

How are you guys doing in comparison?
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on February 26, 2007, 01:54:19 PM
ivi-

I had two lesions/defects; MFC and trochea - each about 2 cm x 2 cm.  As you may know the recovery schedule is based in large part on the number and severity of lesions.   I was NWB with crutches for 12 weeks, and gradually went to FWB after about 2 additional weeks on 1 crutch.  My biggest pain issue was and continues to be the MFC repair site.  My knee can get sore all over after PT, but the MFC area can get sore after a few hours of normal activity.  With that said, I'm experiencing less pain/soreness at 6 mon than I did at 4 mon.  I've  been seeing my OS every 2-3 mon.  I'll see him again next week and will give an update.

I was walking with a noticeable limp and pain for at least 1 mon after going FWB.  As Rod has stated, the goal of a painfree, normal feeling knee is probably longer than many of us expected - but the "fine print" for ACI does state that full recovery and cartilage stability can range between 12 - 24 mon (months sounds better than 1-2 years, doesn't it?).

Rod, I'm curious about the remaining "hole" in your cartilage.  Does your OS expect this to fill in, or is it something that will be "addressed" later?

Mike
Title: Re: 4 weeks down the long ACI road
Post by: ivischwartz on February 28, 2007, 01:28:49 AM
I am just starting FWB and at this point, it feels like it did just before surgery except with severely weakened muscles. Feels fine, feels fine, and then WHAM - shooting pain. I am at 8 weeks and will just keep on trucking trying to be smart. I was prepareed for the 18-24 months, but I guess it did not register that this meant 18-24 months of pain. Not sure what I thought this meant - Duh.
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on March 05, 2007, 01:18:59 PM
Just a quick update following my 6 mon post-op visit with my OS....

He was generally pleased with my progress - but did note that we really needed to get my much atrophied quads back into shape soon.  In his PT order, he recommended that I stop all step over/down routines because he thought thye may be aggravating the trochela repair - especially with my weakened quads not providing the stabilization needed to hold everything in place.  He ordered elliptical/stairmaster work instead - suggesting that it would emphasize quad strengthening without the impact of step downs.   Interestingly, my PT doesn't have an elliptical or a stairmaster, but I'm lucky to have access to them where I work.

Did a lot of walking at a very big dog show and a nature hike on snow-covered trails this weekend - all preceded by 3 consecutive days of PT - and yes my knee is sore as hell!

Mike
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on March 06, 2007, 07:19:28 PM
Glad to hear you're progressing well.  Are you doing any sort of strength training for your quad? 

Hope you're knee is feeling better now!!   :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on March 07, 2007, 12:13:44 AM
Thanks Kristi.  I did 12 minutes each on the elliptical and stairmaster today.  The first 5 minutes were pretty tough with a lot of soreness - after that things felt a bit better.  As I sit here, my quads, etc are fatigued and I have some soreness in the joint, but it in a weird way my knee feels better, sort of like muscles feel after a heavy workout.  I believe that this new set of exercises with the machines is going to really help with strengthening.  I must admit that I've lost some enthusiasm for my PT's facility - given that it only has one cardio machine - a treadmill.  I'm also a bit disappointed that my PT didn't use better judgement by avoiding step down/over exercises, which my OS said were not appropriate at this stage.

I'm curious to know about the facilities that others here are using.  What type of machine equipment have they been using that has been beneficial in their rehab and when did they start using it?

Mike
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on March 07, 2007, 02:52:12 PM
My PT facility is pretty sad;  it really has no machines at all.  When I had my microfracture the one I went to for that was much nicer with every cario and stregth training machine imaginable and what seemed to be a very knowledgable staff.  But due to insurance changes, I couldn't go there for this one.  ::) For me personally, I go to my gym to do my PT.  I'm using the bike and have been given the okay for the eliptical, but still have that fear of my knee "giving" so I haven't tried it yet.  I also walk on the treadmill and do a lot of strength training work like squats, lunges, leg press, leg curl,  and the cable machine.  My quads are almost back to normal and I really attribute that to my knee's improvement.  It makes sense that you need those muscles to support your knee, yk? 

My PT also had me do step up/downs, but I quit doing them because they did cause so much discomfort in the implant site and I really don't think that at this stage it's a smart thing to be doing.  The pain I felt doing those were much different than the pain of pushing yourself in PT.  I know we've addressed this before, but it is discouraging that there are so few experienced PT's out there for this type of surgery.  It really makes me lack confidence in them and I really feel all alone in my recovery.

Well, good luck to you and keep us updated!  Glad to see you are moving forward!  :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on March 08, 2007, 01:04:31 AM
Hey Kristi,

Thanks for the info on your PT.  Just for clarification...are you doing all your rehab on your own?  Do you consult at all with a PT or only with your OS?

Mike
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on March 09, 2007, 09:44:52 PM
I see a PT once a week and then workout the rest of the week on my own, but I'm thinking of discontinuing even the one visit because she really has nothing more to offer.  I'm walking pretty normal now and basically working on continuing to build my quad muscle.  That's stuff I can do by myself.  I won't do any more than my OS told me to do and I don't go back to him now until May...my six month followup.   And since my PT facility has little to offer in the form of strength training...it seems okay to move on.   :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on March 14, 2007, 07:42:15 PM
I'm sorry to report that I had a significant setback this past week.  This has to do with my earlier post about my surgeon recommending elliptical work.  I did about 20 minutes (2 sets of 10 min) last week - I was tired and a bit sore right after, but nothing major.  The days following, however, is when things went downhilll fast.  I've had a LOT of pain throughout my knee - including at the implant site and aroung the patella.  It's been so bad the last few days that I've been walking with a noticeable limp.  Though my PT today said he thinks the pain is mostly due to tendonitis and bursitis, I'm very discouraged, concerned and frustrated.  It's seems like 6 months of hard work have gone for naught.  I'm hoping things calm down in a few days - but I've also learned an important lesson:  Surgeons are good at surgery, but lousy at PT.  I've since heard this from several, including my own PT who told my surgeon to "stay away" from his patient's PT.
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on March 14, 2007, 08:39:53 PM
I am so sorry to hear about your setback.   :'(  I think all of us on here can appreciate your frustration and disappointment at something like this.  Hopefully it's just something you'll have to rest for a bit and now you know what NOT to do.  I know for me, the thought of doing the eliptical seriously makes me cringe and although my OS has said I could do it, I won't.  You've just confirmed that I am right to ignore that advice.  I agree the OS doesn't always know what is best for us from a PT point of view and it is hard to know who to listen to all the time. I think the best indicator is our knee.   

I don't think your last six months of hard work were for naught.  I know right now things look bad but try to hang in there and don't give up.  You've always seemed to have such a good attitude on here and I'm sure that will work in your benefit.  I'll be sending you good vibes and positive thoughts.   :)

Keep us posted. 

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on March 15, 2007, 12:44:29 AM
Thanks for your words of encouragement Kristi - keep those vibes coming.  Two days ago, I seriously began regretting not going for the "hardware" option.  At least I wouldn't have to worry so much about whether those damn cartilage cells were growing or not!  Today, after heat, ice, massage, ultrasound and ICF at PT, my knee is starting to feel a bit better - ibuprofen and ice at home are also helping.  I hope everyone reading this takes your advice seriously and weighs the advice of their PT or OS against their own good judgement.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on March 19, 2007, 11:50:31 AM
I think you really have the added benefit of having a good PT who seems to be committed to your recovery and knows what he's doing.  You've definitely got that in your favor.  I hope things are feeling a bit better and you're able to get back to where you were.  Don't give up...hang in there.   :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 03, 2007, 06:55:37 PM
I'm sorry to report it's a sad, sad day for me...I found out yesterday that an MRI revealed that at least one of the two carticel grafts performed on my left knee has failed.  I have been experiencing increasing pain, stiffness and muscle weakness for about 7 weeks - particularly after my elliptical fiasco that I reported on this forum.  Needless to say, I'm devasted.  It now appears that all the pain, and hard rehab work I've gone through has been for naught.  I'll know more this Friday when I meet with my OS to discuss the MRI and my options. 

Those of you who have followed my experience through this thread will recall that I had some "unusual" experiences soon after my surgery that caused me concern.  I'm now wondering if these issues may have contributed to the failure.  I've scheduled an appointment with another OS for a second opinion.  I'll keep you posted.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on April 03, 2007, 07:50:25 PM
I'm so sorry.   :'(  This is certainly not what I hoped to hear from you.  You  may never know exactly what caused this failure.  It is so frustrating to not have a sure cure for this problem!   Good luck at your appointment on Friday and let us know what the OS says.

Hang in there. 

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: David3 on April 03, 2007, 08:10:19 PM
Mike, 

I'm so sorry. I was certainly concerned for you when I heard of your set back in mid-March since your symptoms of a sudden increase in pain occurring a couple of days after an increase in activity seemed identical to my case, albeit that mine was a failed microfracture. Please keep us posted on what options lie ahead for you.

Stay determined that you're going to beat this.

David
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 08, 2007, 04:02:32 AM
Thanks David and Kristi for your words of support.  They really were helpful.  I met with my OS on Friday and there is still some room for hope - hope that all is not lost.  After reviewing my MRI films, he doesn't think the graft completely failed.  In fact, he said that besides a slight irregularity in one part of it, that it looked fairly normal for 7 months out.  Best case scenario is that the edge of the graft has some bone hypertrophy that needs to be "ground down."  Slightly less desireable is that the edge of the graft has lifted and created a rough edge which is causing the pain.  I won't burden you with all the other possibilities - suffice it to say that they are ordered in decreasing degrees of desirable outcomes.  The next step is to go in with a scope and see what's going on.  That's scheduled to happen on 4/30/07.  If it's just hypertrophy or a loose flap, then it will be taken care of during the procedure.

While I'm still very nervous and naturally expecting the worse, I do have a bit more hope.  I'll keep you posted.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: LadeeStingray on April 08, 2007, 06:57:49 AM
Mike,

So sorry to hear about your set back.  Ill be thinking of you on the 30th with fingers crossed.

Ladee
Title: Re: 4 weeks down the long ACI road
Post by: DJF on April 11, 2007, 02:44:45 AM
Damn Mike.  That is very bad news.  Were you feeling okay prior to the stairmaster work?  My pt has very strict orderd:

1 - No stairmasters
2 - If it hurts at all under the patella, quit.

I may have missed it. but what machines were you using?

I can't imagine how you feel, but hang in there.

Don
Title: Re: 4 weeks down the long ACI road
Post by: DJF on April 11, 2007, 02:58:25 AM
My routine at this point.  I am 6 months post op Trochlea repair and TTT.

10 minuteson a stationary bike
3 sets of 10 reps two legged on a palatte machine
3 sets of 10 reps with the bad leg on the pallate machine using 1/2 of the weight of the two legged version
3 sets of 10 reps leg curls two legged using 30lbs
3 sets of 10 reps leg curls using my bad leg and 15 lbs

I then move to a BioDex machine
http://www.lifetecinc.com/products/product.php?id=1179

We set the machine to move from about 65 degrees to 0 degrees.  (knee bent some to stright out)

The machine will put as much resistance as I put preasure on it.  I can watch a graph of the resistance and try to make the lines stay in a certain strength measurement.

The Biodex is the only machine that has been able to make my quads sore and not hurt my knee.  I wanted to get one for myself, but the $40,000 price tag made is a little expensive.

Still, I am sore for about 3 days after my 1.5 hour workout.

I still get sore late in the day especially if I walk alot.

I get sore if I sit at my desk all day also.

+++++++++++++++


Mike,  Keep us posted on what is happending with you. 

Don
Title: Re: 4 weeks down the long ACI road
Post by: djs60 on April 11, 2007, 05:50:32 PM
Mike,

I hope it's just a bit of bone that is causing the irregular appearance.

Best of luck on 4/30!

Dan
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 12, 2007, 12:33:42 AM
Thanks all for the words of support.

Yes, Don, I was feeling a helluva lot better and making farily good, albeit slow, progress before the *&%#$ elliptical machine.  You can go back and read my post about that fateful day - but basically my knee quickly went down hill to the point that I had to revert back to doing PT stuff that I was doing at the start.


I saw another OS today for a second opinion.  Not surprisingly, he knows my current OS and even called him for more information about my case prior to my visit.  My OS was very supportive of me in getting another point of view.  The second OS took a look at the MRI and agreed that both grafts have filled in, though he agreed with my OS that it did appear that there was some irregularity near the edge of the MFC graft.  He also recommended taking a "second look through the scope."  It turns out this new OS has actually done more ACI's than my current OS, averaging abut 15 - 20/year.  He said more than a few of his patients have limped through the 6-9 month post-op mark and still recovered fully. That was encouraging to hear.  I really liked him and his office staff (significantly more organized and professional than my current OS's office).  I do have a sense of regret in not finding him from the start.

All said, I'm a bit more optimistic than a few days ago.  My surgery's been rescheduled for 5/9/07.   I'm in the ironic position of hoping for bone hypertrophy - only in the surreal world of ACI...

Mike

Title: Re: 4 weeks down the long ACI road
Post by: DJF on April 14, 2007, 01:44:16 AM
That's good new Mike.  I sorta wish my OS would go in a take a look also.  I have a sever catch in the joint when I do my leg extensions.  It's like popping your knuckle really hard over and over.  Thing is my surgion has already tried to smooth everything out.

Keep us posted on your findings and we'll keep our fingers crossed.

Where are you that you find a doc that does so many Carticel implants?

My surgion has only done about 9 before mine.  He is in a practice that does quite a few though.

Later
Don in Houston
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 14, 2007, 12:50:17 PM
Hi Don. My PT never seemed to be concerned about the popping during leg extensions, passing it off as irregular patella tracking due to my weakened quads.  Of course, your popping may be in a different place.  I'm in Michigan.  The second OS's name is Joeseph Guettler out of Performance Orthopedics.
Title: Re: 4 weeks down the long ACI road
Post by: DJF on April 14, 2007, 06:24:41 PM
So Mike,  You still have the cracking doing leg extensions?  Does it hurt?
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 16, 2007, 03:34:01 PM
I've not been doing leg extensons regularly since "the event" that led to where I am now.   But when I do try to do them there is popping - more like cracking - and soreness/pain.  The pain doesn' seems to be deep, but rather within the supporting tissue - i.e. muscle, tendons, etc.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: TallPaul on April 17, 2007, 01:39:52 PM
Hi Mike

First of all I'd like to say thank you very much for sharing your experience. I may well be undergoing ACI myself (or rather MACI hopefully) so reading expereinces such as yours is fantastically useful. My fingers will be crossed for you early next month when you're scoped, I very much hope it's the best case scenario.

I'd like to quiz you a little on your setback if that's ok? Clearly you believe it was the elliptical and/or stairmaster that caused it. Can I ask how convinced you are? And whether your OS is equally convinced? Is there any possibility that it was step downs that caused it (i.e. the damage had already been done by the time you switched and it was just coincidence that you were doing elliptical exercise when your knee flared)? I'm trying the rehab as best I can from my 9/06 op and have now settled into a PT routine of cycling, stretching, cycling, controlled lunges forward/backwards, streching, elliptical, stretching, hamstring curls, clams (for glutes), cycling, stretching. I know there isn't a huge amount of variety in this, but I've settled down to these as they tend to be the most effective w/o causing inflammation. I do occassionally do other things e.g. step ups, singles leg squats, but not as regularly. How do you think the elliptical caused the damage given the lack of impact? Is it just a question of pushing down whilst knee is somewhat flexed?

Paul
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 18, 2007, 02:00:30 AM
Thanks Paul.  I've certainly benefited from others who've posted here, so it's good to know I've paid a little back.  I wish you the best if MACI is in your future.

You ask a good question.  I've said it before, one of the most agonizing aspects of ACI is not knowing what the hell is going on "under the hood."   The fact is, this procedure "works" more times than not - though the published studies (i.e. Sweedish study, etc) do show an uncomfortably high frequency in the "no improvement category."  Anyway, to your question...I do not know for certain that the elliptical caused anything, and I think there is a very good chance that there was already an underlying issue (i.e. overgrowth, undergrowth, graft delamination, etc).  We'll find out on May 9.

Ironically, I've been walking without pain for the last 4 days and my knee has been feeling significantly better.  I called my PT and asked him about doing therapy, given that my OS said don't bother.  He was emphatic about continuing PT - stating that to lose the 8 months of progress I've made didn't make sense, especially with another surgery in less than a month.  I agreed, so we're firing up PT again this Thursday.

I'm curious.  Are you working with a PT now or have you developed your own routine.  What advice would you give others when it comes to following your gut and own comfort level when it comes to PT?

Mike
Title: Re: 4 weeks down the long ACI road
Post by: David3 on April 18, 2007, 03:14:39 PM
Mike, 

Great to hear that your knee has improved over the past few days and that you're walking pain free! This is good news indeed!

I've been following your thread with interest - in some ways I think I'm following in your footsteps with a failed microfracture and then most likely moving on to ACI (to be confirmed this week). I can therefore definitely add my name to the list of people who have benefited from your posts.

I see from your signature that your ACI implant was performed about 10 months after microfracture. Did your OS say anything about how long it is advisable to wait after microfracture before having ACI? I had an e-mail exchange with Dr Minas' office about my case (although didn't end up going there due to the 6-9 month waiting list) and they mentioned in their response that they would not contemplate doing ACI within 6 months of microfracture. I'm therefore assuming that there is a minimum time, presumably to let the sub-chondral bone heal. Maybe the longer the better? Any insights?

David
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 19, 2007, 02:45:43 AM
Thanks David.  Good luck with your ACI eval.

I don't recall my OS discussing a minimum waiting period following microfracture.  There may be medical reason as you stated, but there also may be an insurance issue at play.  That is, insurers may not approve another procedure until the failure of the first procedure has been verified.  In the case of microfracture, I believe it takes at least 6 months to evaluate its success or failure.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on April 19, 2007, 01:14:26 PM
Good luck to you Mike.  Glad to hear that it may not be as bad as you originally thought.  I'll be anxious to hear what your OS found when he actually got in there.  I think going back to PT will help you immensely too...mentally at least.  And I'm sure your PT will be somewhat conservative knowing the situation.  This is definitely a "one step forward, two steps back" recovery and I know how emotionally taxing it can be.  You've got a great attitude though I know that plays in your favor. 

I go back for an MRI tomorrow because I've had pain the past few weeks.  Hopefully it's not something major. 

Keep us posted!   :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: TallPaul on April 23, 2007, 10:53:00 AM
Hi Mike,

Glad to hear things are looking up again somewhat.

In answer to your question about my PT, I'm on my own at the moment, except for a occassional sport massage (the no pain no gain type! - it really helps). However, everything in my routine has at some point in the past been advised by a PT. The exercises I listed are my staple exercises that I fall back on. The happier my knee is when I'm exercising the more likely I am to add a few other exercises advised by PTs. It's a constant compromise between not overdoing it, and not just doing the exercises that I 'like'. When my knee gets angry I tend to fall back to cycling only, fairly high reps, low pressure. I couldn't recommend that more. It actually helps reduce the inflammation. My theory is it helps the refresh (if that's the right word?) the synovial fluid.

Paul
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on April 25, 2007, 11:35:15 AM
Thanks Kristi.  You're right, starting PT again did give me an emotioinal boost - at least I felt like I was going forward rather that sliding backward. 

How did your MRI go?   I guess I should take a look at your thread first to find out.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: Rod G on May 05, 2007, 08:12:39 AM
Hi Mike,

Good luck with your scope in May and i hope it goes well for you.

Regards

Rod
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on May 10, 2007, 08:59:08 PM
Just checking in to see how your scope went.  Hope you're recovering nicely. 

Update us when you're able.   :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on May 15, 2007, 03:38:16 AM
Thanks Rod and Kristi.

The actual scope procedure went fine...That is when it finally was done six hours later than when it was originally scheduled that morning.  It turns out that my OS was preparing to speak at a conference in Lansing MI when his first patient was being prepped for surgery at 8 am in the hospital 100 miles away.  The story is that my OS's staff forgot to clear his schedule and booked surgeries on the two days he was to be away.  By the time he arrived at the hospital, he only had enough time to do half of the schedule surgeries - mine was the last.  By the time they wheeled me in, I had been nearly 20 hours without food or drink!  Those of you that have followed this thread from the beginning will note that this latest fiasco is only the latest I've dealt with concerning this OS and his staff (read below).

I don't have many details about what my OS found - he was reluctant to talk to me as I was coming out of the general anesthetic.  He did talk to my wife (who is not well versed in anatomy or ACI).  I will know more details when I meet with him this Friday for a post op, but it sounds like a good news-bad news situation.  The good news is that my two grafts have filled in.  The potentially bad news is that it appears that each has only filled to about 80%, which of course mean that 20% of the area hasn't filled in.  Now, whether that means that it hasn't YET filled in or that it will NEVER fill in, I do not know yet.  I do know that a small edge of each graft did release and fray some.  This was "cleaned up" along with some scar tissue.  I also know that some small tears in my meniscus were also "cleaned up."  How these tears occurred and how extensive they were I do not know yet.

The incomplete graft fill does have me concerned and will be the focus of my meeting with the OS.  I suppose I will never know for sure, but I can't help but think that the experience I had with my immobilizer brace (no one - not any of the nurses, the PT staff or physicians new how to put the brace on) the day after my ACI surgery 9 months ago and my OS's decision not to use it may be a factor in the issue with the graft damage.  The good news is that while my knee is still stiff and swollen, I'm walking with much less pain than before the scope.  Will see if this lasts.

I'll post an update after my post op visit this Friday.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on May 16, 2007, 09:21:17 PM
20 hours with no food or drink??  Good God.  If that had been me....it would have been ugly.  I get grouchy if I'm hungry for a few minutes.  I'm sure my poor husband would have really suffered sitting next to me that whole time. <shudder>  I think I'm going to tell him about it tonight just to see the look of terror in his eyes.   ;D   I'm really sorry you had to endure that.  It's really unfortunate that you've had to deal with so much from your OS.  What a moronic office staff. 

Glad to hear that you are walking with less pain.  I hope that has continued.  It's also great news that your grafts have filled in, although I'm sorry that they are not completely filled in.  I'm anxious to hear what he has to say about this and if that is normal.  I hope it is just an ongoing process and they continue to grow.  I'll be glad to hear you report on your followup visit.   Good luck!  Are you still doing PT?

Kristi
Title: Re: 4 weeks down the long ACI road - Update
Post by: bioprof on May 22, 2007, 03:27:30 AM
Thanks Kristi.

Funny, I was looking at the emoticons (the smiley face icons above the message box) and thinking that ACI'ers are likely to experience every one of those emotions in a day!

I saw my OS last week Friday as planned (and only a 50 minute wait to be seen by him!).  I must say that I came away feeling much more encouraged about my progress.  It turns out that the grafts are 85% filled and have good thickness and texture for this stage of the recovery.  I was really struck (and I have to admit just a bit emotional  :'(when he showed me the before and after photos of the two repaired areas.  Where there was once a jagged rough-edged lesion, there was now shiny, smooth white cartilage - of course he contrasted this new "baby" tissue with my "old" aged cartilage that surrounded it!

The downside was that he had to trim some of the graft edge (on both areas) that had separated from the base and formed a flap.  These flaps were likely causing the catching and pain that really hindered my PT.  I have to say that there has been a significant improvement in pain and movement, even though the knee is still stiff and swollen from the scope.  Under the flaps were the areas that didn't fill.  Thankfullly, both areas were less than the diameter of a pencil eraser (the original lesions were about 3 cm in diameter) and were not in the main weight-bearing areas.  [Deep breath] I asked him if these were going to continually erode and enlarge so that I would eventually be back to where I started.  He didn't think so, stating that the repaired areas would eventually be strong, resiliant tissue with good "shoulders."  Will see, but I'm certainly more optomistic than I was 2 weeks ago.  I have a 1 month post-op in June.  I'll keep you posted.

Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on May 24, 2007, 01:51:35 AM
Sounds like you are doing really well Mike.  Glad to hear it.  It's certainly very promising to be able to "see" that new cartilage growing there.  Gives us all hope I think.  I'm not exactly anxious to get my one year scope in November, but I am anxious to see the resulting pictures and (hopefully) that new cartilage in my knee. 

I hope you continue to improve.  Good luck!   :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: thkaa on May 27, 2007, 04:45:56 AM
Hi Mike,

Congradulation to your good progress. I think the best news you told us is that the newly formed cartilage is in healthy condition and normal thickness. I really hope that you can see your great improvement in the coming months and update us from time to time. I don't think it can improve in short time but eventually you will see it. I feel much better now since the micorfracture was done two years ago. I can't say that it improves steadily. Yet, there're many many ups and downs. I couldn't tell why there is often downs followed by ups which made me really frustrated and disappointed. I went through them and at least I can walk to swimming pool, go out to meet my friends now. I can't say that it's perfect. At least I couldn't do so before surgery but I can do so now.

Be positive and you'll achieve your goal.

Sammy
Title: Re: 4 weeks down the long ACI road
Post by: Peg Leg on June 21, 2007, 02:42:50 AM
Bioprof,

It is comforting to hear of your good report!  I am scheduled for Carticel surgery on June 28th.  I had microfracture in Oct. and had no improvement; my defect actually got bigger and another was found under the patella.  We hear so many horror stories, that it is great to have you report your good news to us!  It does encourage me, and lessens my fear, somewhat!  Good luck!!

Peg Leg
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on August 20, 2007, 10:18:04 PM
It's been months since I've posted here.  I apologize for my inactivity.  Been very busy with work and house renovations.

Tomorrow marks my one year ACI anniversary :P.  If you've followed my journey, you know it's been a roller-coaster of a ride - still is.  I completed my regular PT appts two weeks ago (1 month short of a year).  I'm no where near where I want to be, but I am riding a bike, doing stairs with almost no pain and even jogging (akwardly) along side my 7 yr old daughter as she rides her first 2-wheeler bike.  The biggest issue is my atrophied quads.  They're stilll signficantly weaker and smaller than my nonsurgical leg, but they are gradually strenghening.  I'm doing wall squats, leg extensions and bike 3x per week.  Some days I feel like I'm going to get back to playing baseball (still a fantasy right now) and other days I have doubts as to whether I'll be able to swing a golf club.

My OS has been very encouraging but also very forthright, stating that it will be at least 18 months before I'm ready to get back to competetive sports.  I'm eager to get back, but also a bit apprehensive about the wear and tear on my other 45 yr old joints.  This has been a really tough issue with me.  Do I gear it down and play golf (and be bored to death) or give it a go and hope the glucosamine, etc does its magic.

I'll post again soon.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: David3 on August 21, 2007, 02:59:36 AM
Appreciate your posting Mike. I had, in fact, been wondering how you were doing. Your account certainly helps me prepare mentally for what lies ahead - it sort of struck a personal chord since I am now exactly.... "4 weeks down the long ACI road"..... and, like you, have a 7-year old daughter who is out on her bike alot. I may not be jogging beside her this year, but I am going to get there.

Hang in there - we've all read countless times that there is still alot of improvement to come between 1 year and 2 years. Best wishes, and please keep us updated.

By the way, how's plain old walking? Pain-free, limp-free?

David
Title: Re: 4 weeks down the long ACI road
Post by: kalyjoe on August 25, 2007, 04:32:32 AM
Hi Mike.

Glad to hear you are progressing and moving forward, even if it is slower than anticipated.  I think it's great you are running next to your daughter.  One of the things I have missed the most going through all this is just the simple things like chasing the kids and jumping on the trampoline with them.  So that is definitely encouraging to hear you are able to do that even if it is a bit awkward.  I hope your quad continues to improve; the muscle strength does make a difference in how the knee feels; I know that just from personal experience.

I wish you continued success on your recovery.   :)

Kristi
Title: Re: 4 weeks down the long ACI road
Post by: bioprof on September 02, 2007, 12:13:09 PM
Thanks Kristi, and David.   Good to hear from you.  I hope your rehab is going well.  Walking is usually pain free - but that depends on what I did a day or two before.  Last week I did a 5 mile bike ride over some hilly trails.  My left leg muscles were screaming at the end and my knee was toast for about 2 days...soreness and even some pain over the MFC repaired area.  This still bugs me, but I've learned to live with it, trying to embrace the idea that full recovery is still some months away.

Mike
Title: Re: 4 weeks down the long ACI road
Post by: ivischwartz on September 15, 2007, 01:58:09 PM
Just checking in -

Bio - It sounds like you and I are in similar positions in age, activity level, and injury. I am at eight month mark. I am relieved to hear about the 18 month prognosis - I started out with this in mind, but you allow yourself to forget the timeline as you begin to make progress - sloooooow and steady wins the race (I hope). Some days I anticipate getting back to an active level at the end, other times, I just envision getting in shape without the active sports.

Right now my mindset is to focus on getting my body into great shape within the 18-24 month mark, and then evaluate. I have begun thinkg about sports which do not cause as much knee torque, but I have never been thrilled with any repetitive motion disciplines like running or biking. I have enjoyed working with a personal trainer because of the new things they bring to the table all the time, but this is expensive. Thoughts so far include spinning, aerobics and winter cross country skiing (not sure how much knee torque is involved). Still just thoughts for now....