The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: ivischwartz on February 10, 2007, 05:42:07 PM

Title: ACI Surgery Jan 3 07
Post by: ivischwartz on February 10, 2007, 05:42:07 PM
I just had ACI surgery Jan 3, 2007 in Cincinnati, Ohio. The OS was Angelo Colosimo, and the PT is Troy at Novacare. I had a 2x3 cm chondyle lesion midway between front and back. No other damge. Caused by deep bone bruise on femur during karate training - probably from hyper-extension. I am 40 year old male of medium to medium-high activity level. I am just beginning to get off of CPM, and weight bearing will begin next week. So far, all seems to be going according to plan except for (1) pain at full extension during leg lifts, and (2) slight infection at surgery sight.  More posts to come....
Title: Re: ACI Surgery Jan 3 07
Post by: LadeeStingray on February 11, 2007, 01:22:11 AM
Hi ivischwartz,

Glad to hear all is going well for you.  Keep us posted on your progress. 

Title: Re: ACI Surgery Jan 3 07
Post by: bioprof on February 11, 2007, 02:26:01 PM
Welcome.  It's good to hear your recovery is going well.  Your comments regarding the cause of your lesion intrigued me, because I also had an incident that caused a deep bruise to the medial part of my knee.  I was playing baseball (fast-pitch hardball) and took a hard foul ball off of my knee while batting .  About 2-3 weeks after that, I started having pain deep in my knee, which eventually led me to my OS and arthroscopic surgery for a slight meniscus tear.  Up to that point, I had no knee problems at all.  During the procedure, the OS found a medial condyle and a trochea lesion which were the real cause of pain; the condyle defect was directly under the site where the baseball hit.  The OS suggested there may be a connection between the lesions and the original injury, but it stated it was unlikely.  After reading your post, I'm not so sure the two incidents are not related.  It would be nice to know, because if the lesions were a result of trauma and not just wear and tear, I would be less worried about my left knee which remains pain free but has gone through all the wear and tear of my surgically repaired right knee.

I wonder if anyone has read anything about the connection between acute trauma (e.g. deep contusions) and cartilage lesions.  If the trauma doesn't directly damage articular cartilage, does the swelling and inflammation from trauma somehow lead to cartilage degradation?  Or does the trauma from an acute injury make an already existing lesion worse?

Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on February 16, 2007, 11:02:44 AM
Into week 6, and all still seems to be going well, albeit slow. I have finished CPM machine and am beginning to transition off of crutches. I moves to one crutch yesterday and will consult with PT this morning about same. The pain I have on weight-bearing is at same location as pain pre-surgery, but based on other posts in this forum, this seems to be relatively normal (?) at this stage. Infection at incision site being treated with oral antibiotics and seems to be resolving.

Bio - regarding your question on specific traumas leading to ACI-need, I can only give you two point of information I have received in this regard. One -my OS indicated his belief that a deep bone bruise can cut off the blood supply to the cartilege, and if this deficency lasts long enough, the cartilege can die and then flake off. The second one comes from my PT who indicated that the OS' interpretation is a respected theory, but the science has not yet determined this connection and the whole area of bone bruises is not yet well understood. So, now you know what I know.

I am not doing much therapy on my own, which means I am only really getting a once-a-week session in. The only significant thing I am doing at this point is continually straightening my knee and gently pushing it to go completely straight. I am anticipating that once I am completely off crutches, I can get back into the gym 3-4 times per week and really begin focusing on the muscle-building portion of rehab, but this still remains aspirational at this point.

Title: Re: ACI Surgery Jan 3 07
Post by: bioprof on February 18, 2007, 10:49:47 PM
Thanks for passing along the info on bone bruises and cartilage breakdown.  I really want to believe this is what happened to me, but as your PT indicated, we'll have to wait for the science.  BTW, I need to clarify something in my previous post.  I had ACI surgery on my LEFT knee, not the right knee - how could I have possibly forgotten???
Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on February 23, 2007, 03:26:39 AM
Most Important Things I Have Learned From KneeGeeks:
1. There is a way to find other ACI people (seems like no one I see during the day has ever heard of it, nor had I)
2.  Week 8 - it is OK to have pain which feels like a bone bruise in the same place as before surgery - this does not mean you still have a problem.
3.  Using the electric stim machine is extremely helpful - even if you are too lazy to do the proper rehab.
4.  Ups and Downs through the process are normal and to be expected.
5.  The link to the Carticel Rehab Manual

Thanks, KneeGeeks!
Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on February 28, 2007, 01:29:29 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: ACI Surgery Jan 3 07
Post by: ivischwartz on June 08, 2007, 12:49:15 PM
5 months out. Occasional pain at surgery sight, but not often and only when weight is put on leg in particular way. All seems to be gettign better, except.......

This f'ng limp. Doesn't seem to be due to pain. I am walking on treadmill about a mile every morning, and my legs are just starting to regain significant strength. My insurance money ran out on rehab, so now I am basically adrift. I am starting with personal trainer, and I have Carticel Rehab Protocol brochure which I will follow.

Any comments appreciatied.
Title: Re: ACI Surgery Jan 3 07
Post by: LadeeStingray on June 08, 2007, 03:40:28 PM
Glad to hear you are doing so well.   As for the limp ....if u figure out how to get rid of that please share with me.  Ive never been able to get rid of mine after surgery.  I can say the good thing is I no longer notice myself that i am limping, someone usually points it out to me.   So for me atleast there is an upside ... one day u wont notice it anymore.

Hang in there !

Title: Re: ACI Surgery Jan 3 07
Post by: bioprof on June 09, 2007, 12:07:30 PM
Your 5 month mark is an important personal milestone, but it's important to keep in mind that in the big ACI picture, each day, each month and even each year is a small step toward recovery.  I'm as "guilty" as any for being impatient, and at times overly pessimistic about my progress.  But after 11 months of ups and downs (read my thread) I've come to the realization (with a little straight talk from ACI'ers here, my OS and PT) that "full" ACI recovery is closer to two years than 1.5 or less.  This is especially true for those 35+ years.  Naturally, the promotional literature (at least for Carticel) emphasizes the remarkble potential of ACI, and downplays the reality - i.e. recovery time, pain, etc.

Your limp (and pain) will likely fade SLOWLY - so slowly that coworkers, friends, family and even you won't mark the milestones.

Here's to recovery - step, by step, by step, by step...

Title: Re: ACI Surgery Jan 3 07
Post by: Peg Leg on June 14, 2007, 03:43:27 PM

I had microfracture Oct. 24th, and i still limp! My PT was as frustrated by this as I was.  He had started to wonder if it was a habit, though I continued to complain of pain and muscle weakness, and then I had a scope in Apr. and it showed that my defect was almost double in size!  I kept repeating that the pain I felt was bone pain, now he never questions me!!  I am having ACI 2 weeks from today(yikes!!) :'(.  I am thankful for KG and finding people who have been through some of the same things I have.  People are always interested and sympathetic in what I am experiencing, but they really have NO IDEA what it has been like!  Good luck to you!

Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on August 29, 2007, 12:22:20 AM
The latest from ivi:

8 months post op. I think everything is on track. There have been some ups and downs, but progress seems to be trending in positive direction. Leg strength is back. Still limping, but I am attacking that problem in particular fashion. Hope it works. Some pain twinges in the joint once in a while (about once a day) when knee moves in particular way. I am looking at it as I am 1/3 through 24 month rehab, but feel like I am 60% recovered. Just need to stay steady without pushing it. Very hard for me because of type A personality, but trying to keep eye on the long picture.
Title: Re: ACI Surgery Jan 3 07
Post by: kevinnjaime on August 29, 2007, 05:07:03 PM
Great to hear that you are doing so well.  It helps to hear people that are more far alone that me.  I am six weeks post-op and progressing well but still slow.  It seems too slow for me but I know it is a slow rehab.  Is your limp noticable or is slight?  Just wondering. 

Thanks for all of the posting.
Title: Re: ACI Surgery Jan 3 07
Post by: downtownsjb on August 30, 2007, 07:30:53 PM
Glad to hear that all is going well!!!   I had my ACI 5 days after you & I still limp too.  Pain sounds about the same too.  I've had several setbacks-I had the knee scoped at 3 months for lost range of motion due to scar tissue & I actually go in tomorrow to have my screws removed since they are backing out BUT I still feel overall that this will all be worth it!

I agree with the 1/3 way thru & 60% recovered.  The rest will come with time!
Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on September 15, 2007, 01:47:32 PM
Checking in -

The degree of my limp changes during the day. Sometimes, it is almost gone, and sometimes it is pronounced. Sometimes, I think it gone, and someone asks, "why are you limping?" I think some of it is real, and some of it is habit.

I need to find some info on whether pain at this 8 1/2 month mark is normal. I guess I should go see my ortho just to assure me I am on course. I will probably do some research and check Carticel site first.

Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on October 04, 2007, 12:32:43 AM
9 months and good progress to report. I have played 27 holes of golf over the last few weeks, and NO knee pain. I am working out like crazy (for me anyway) and still building leg strength. Limp is fading, fading, fad....   Still occasional pain in the knee when I move a certain way, but overall, happy with the progress. My mindset is now to build overall leg strength for the next two months. I have ortho apppointment in about 4 weeks.
Title: Re: ACI Surgery Jan 3 07
Post by: Peg Leg on October 04, 2007, 02:49:43 AM
That is great news!!  So encouraging for us who are still struggling thru the early months;  keep up the hard work and keep working on those quad muscles!!

Peg Leg
Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on November 26, 2007, 02:34:23 AM
About 11 months out. Occasional limp, occassional pain when I move in a certain way. Both limp and pain are being less frequent. I cannot perceive of any changes day-to-day, but I can perceive of progress every few weeks when I reflect. I have started light jogging on a treadmill for 5 minutes at a time. The rest of my relatively frequent workouts are non-impact. Leg strength is good at this point and becoming more complete throughout the leg.

I see ortho this week. My biggest questions are (1) how much should/can I be pushing, and (2) what is the risk at this point, i.e. would graft delaminate if I do something stupid and set me back to square one?
Title: Re: ACI Surgery Jan 3 07
Post by: Peg Leg on January 06, 2008, 01:52:39 AM
How are you feeling since you've passed the big one year mark?  What is your activity level and are you experiencing any pain at all?  I would love to hear how you are!

Peg Leg
Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on April 01, 2008, 02:56:14 AM
Just reporting in...

15 months out. Very little pain, but an occasional twinge if I move in the wrong way. Slight limp....STILL. My self diagnosis is that I am about as good as I ever expect to get. I can work out a lot with weights, circuit training, eliptical, bike. I have given up any expectation of getting back to karate, tennis or downhill skiing. I am going to try mountain biking and next winter,perhaps cross country skiiing.

I am 42 years old, in pretty good shape, better than most, not as good as some. My mantra now is working out smart rather than working out hard. I no longer push it too hard, and if something hurts or feels funny, I just stop and move on to something else.

Am I glad I had the ACI surgery - 100% yes. Am I bummed I hurt my knee in the first place and cannot return to the same activity level - yes. Will I find other things to fulfill me - yes. Do I know what they are at this time - no, but I am ever searching.

My impressions on this site (since I am unlikely to return often) - this is an excellent one-of-a-kind resource. Many of the contributors have very serious multiple problem issues for which ACI treats a part of the problem. Some of these contributors will scare away people unnecessarily. Some people are overly optimistc type A who do not seem ready for what this surgery entails.

This was a life changing experience which is not for the impatient or undisciplined. The road to recovery is long, and you need to be psychologically strong and diligent. You have to find a good PT who is specifically familiar with this surgery and the rehab protocols which extend over 12+ months. You can get back to good, but I sincerely doubt anyone who goes through this really gets back to 100%.

Everyone's body is different and given the extreme nature of this procedure, will react differently. Cells grow as fast as cells grow - pushing your rehab is stupid, futile and will not make the cells grow and shape any faster. If you do everything right, there is still a chance something will go wrong in the recovery process. If you do not do things right, I cannot see how you will succeed.

That is what I know. I hope this thread will help at least one person who is similarly situated to me some day. Peace!

Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on November 16, 2008, 03:40:19 PM
22 months post surgery, and I am feeling better and better. Even my limp is getting better (finally!) Based on the carticel pamphlet, I had 18-24 months of rehab in mind, so this is about right. I have been working out a lot and doing a fair amount of mountain biking - activities which do not involve twisting the knee and shearing forces.

Most of the posts are from people thinking about surgery or having just gone through it. My question involves trying to connect with people in the same stage as myself. Specifically, I am thinking about taking up tennis again, but am very nervous about the twisting action. Thus, I am thinking about getting a knee brace to avoid any twisting if possible. Does anyone have any experience??
Title: Re: ACI Surgery Jan 3 07
Post by: Gibbon35 on November 17, 2008, 10:59:13 AM
Hello hello :)   Just a quick message. Im about 13 months post op from a fem condyle MACI, and just started hitting the ball over a net with my partner again (she is a tennis coach). I have to be honest and say that things are slow. I dont accelerate hard or cut hard, but just get some feeding to slowly build things up. Its quite good to work on that ever required technique. I do use a brace, but its a Don Joy ACL brace as i had this when I initially tore my ACL. No swelling or soreness apart from the muscles when the person the other side makes me work for it :)

Good luck.

Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on April 01, 2010, 01:02:28 AM
3 1/3 years post-surgery. I used to live on these board, but now rarely think about it. Well, I thought about it tonight and thought I would swing through!

My conclusion remains my surgery was a success. I never got back to karate, categorizing it as too high risk. No skiiing either. But, I am mountain biking, working out a lot and even playing tennis. I get an occassionaly twang in my knee, but my other non-surgery knee hurts sometimes as well.

I am very very thankful this procedure exists, very thankful my insurance paid for it, and very thankful I apparently found the right surgeon. In the right cases, this definitely works!

Title: Re: ACI Surgery Jan 3 07
Post by: kralldaddy on April 01, 2010, 09:07:25 PM
Great news to hear positive feedback about the procedure.  I am one week post op and looking forward to the 12-24 month rehab is scary, but I'm glad to hear you have returned to some heavy activies and see the sucess of the procedure.  I injured mine playing basketball and think I'm going to hang up my hoop shoes for good, but still want to keep an active life style.  (biking, light running)

Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on April 10, 2017, 03:58:56 AM
10 years out. 51st bday yesterday. All still well! Just saying.
Title: Re: ACI Surgery Jan 3 07
Post by: dal_knee on April 10, 2017, 04:26:42 AM
That's great, thanks for your update.

Do you know what was the original grade of the chondral lesion ?  Like grade 2, 3 or 4??

Can you comment on current maximal activity levels and/or types?
Title: Re: ACI Surgery Jan 3 07
Post by: ivischwartz on April 11, 2017, 11:51:15 PM
Not sure about grade. Was approx 1x 2 cm oval lesion.  Activity level: work out 2 -3 times per week at gym with trainer. Frequent walker: 1-4 miles per day.  Can golf but stay away from skiing, martial arts, and generally any sport really. Will occasionally limp if leg muscles tired, but goes away once rejuvenated.