KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: casey2291 on October 18, 2007, 04:05:16 AM

Title: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on October 18, 2007, 04:05:16 AM
Hey everyone,
I've been lurking around the ACI board for a month or so reading everyone's posts.  Everyone has a lot of insightful information.  On Oct. 22,  I will be having ACI and a HTO with Dr. Andrew Levy in New Jersey.  I'm looking forward to this being my last surgery on this knee for a LONG time.  I will post how things go as soon as I am able to get online after the surgery.
Title: Re: Surgery on Oct. 22-follow my progress
Post by: kathat on October 18, 2007, 07:49:41 AM
Good luck for your surgery. Don't know if ACI is suitable for me but am keeping an eye on these posts so that I can make an informed decision when the time comes for more surgery.

Hope all goes well.

Kathy
Title: Re: Surgery on Oct. 22-follow my progress
Post by: kalyjoe on October 24, 2007, 03:47:04 PM
Hope the surgery went well.  Post when you can to let us know how you're doing!!!  Good luck!   :)

Kristi
Title: Re: Surgery on Oct. 22-follow my progress
Post by: casey2291 on October 26, 2007, 03:08:23 PM
Thanks Kathy and Kristi for your kind words.  Kristi, I think you and I chatted over email last fall or so.  I have read though most of your posts regarding your surgery.  I hope things get better for you!!!

4 days post-op:  My surgery went well.  I had both the ACI and the HTO done.  I don't know the details yet as to how large my lesion was.  I will find all of that out next week when I go in for my post op visit.  The surgery took about two hours and was done on an outpatient basis.  I felt terrible when I first woke up in the recovery room.  I was extremely nauseas and ended up getting sick from the anesthesia.  They put a femoral block in my leg in the recovery room which I didn't even feel because I still half out of it and was feeling so sick.  The femoral block lasted for about 24 hours.  I was also sent home with a pain pump in my leg which stayed in for the first five days post op.  I spent the night in a hotel as my surgeon is 3 1/2 hours from my house.  I had some moderate to severe pain the first night as I didn't quite have my meds figured out yet.  I also had a good bit of pain on the way home in the car the next day.  Every bump in the road caused my knee to hurt and I ended up getting sick again on the way home despite the medicine that I was taking for nausea.  I felt nauseas for the first 24-48 hours post-op until the anesthesia was completely out of my system.  My pain has been on and off and ranges from moderate to severe.  For the most part, my pain is under control.  I usually get pain when I get up to move around or when it is close to time for me to take more meds.  The pain can be severe at times, but once I get some meds in me, I am fine.  I was taking oxycotin and percocet.  I am no longer taking the oxycotin and am just taking the percocet.  I have an immobilizer brace that I have to wear for the next six weeks.  The only time I am allowed to take it off is when I am in the shower and even then I have to keep my leg propped up so it is still straight.  I have to wear the brace while in the CPM machine but I change the flexion on it so that my leg can move with the machine.  The PA said that I need to wear the brace in the CPM because of the bony work that they did.  The CPM machine is a breeze.  Sometimes, I have some pain as the machine hits the 0 degree extension mark, but for the most part is not so bad.  I also try to make sure I have meds in me before I get in the machine.  I have to do eight hours a day in the CPM which I have been breaking up into 2, 3 or 4 hour time slots.  Overall, these first few days have been rough, but each day I see improvements in my pain and how I am feeling.  Thank goodness for my fiance who has so kindly taken care of me.  I would have never made it though these first few days without him.  He has gotten up in the middle of the night to change the ice in my ice machine, help me get in and out of the CPM, gotten me food, meds, etc.  I was uanble to get in and out of the CPM by myself for the two days.  I am just now able to do it myself.  My leg was just so heavy that I couldn't do. I took the dressing off of my knee yesterday and I have an incision that is about 6 inches long and has 25 staples.  I couldn't believe how big the incision was.  I was not expecting it to be that big.  My fiance's sister is a surgeon so I had her check out my incision and she said that it looks good.   I do have an area of redness that she thinks is brusing.  We marked it with a pen to make sure that it doesn't get any bigger.  She is going to look at it for me again sometime in these next couple of days.   I am looking at this procedure as an investment in my future and my fiance's future.  We both love doing sports outdoors and I think that this surgery is what is going to help me to return to the things that I love.   I am hopeful that by writing my progress down that it will be helpful to future ACI candidates.
 
Title: Re: Surgery on Oct. 22-follow my progress
Post by: kathat on October 26, 2007, 03:20:03 PM
Great to hear you got through surgery with no complications, and are on the road to recovery. When do you start PT? How long do they expect you to be in the brace? Are you on crutches? Are you non-weight-bearing on the leg? Make sure you keep us posted! Wishing you a speedy journey to less pain.
Best of luck,
Kathy
Title: Re: Surgery on Oct. 22-follow my progress
Post by: djs60 on October 26, 2007, 04:36:41 PM
Hi Casey,

Your post brings me back (today is 6 months since my patellofemoral ACI & TTO).

I'm kind of amazed you went right home - I was in the hospital for 3 days, and I really don't know if I could have managed at home for the 1st couple of days.

Where exactly was the lesion that was treated with aci?

Good luck & keep us posted!

djs60
Title: Re: Surgery on Oct. 22-follow my progress
Post by: casey2291 on October 27, 2007, 11:47:40 PM
Hi everyone,
My lesion was on the medial femoral condyle.  I don't know how big it was yet.  I will find that out on thursday when I go back for my post-op visit.  I am non-weight bearing for 6 weeks and will have to use crutches for at least 8 weeks.  I will start doing SLR's at two weeks on my own and formal PT won't start until 6 weeks.  I stopped taking all pain meds and am now just taking tylenol.  I got tired of feeling dizzy and gross everytime I got up to move around.  My knee does not really hurt at all when I am laying down.  I did have one bout of pain this afternoon that I took tylenol for.  It does hurt a good bit when I am up and moving around or sitting in a chair with my leg propped up.  So, I've been spending most of my time in bed.  I'm getting really antsy to get up and move about but the pain that I feel when I am up is not worth moving around.  I'm hopeful that this pain will pass really soon.  My lower calf is really swollen, more swollen than my knee so I've been using the ice machine on it which has helped.  My finance's sister who is a surgeon has been checking my wound each day and my calf to make sure that I don't get a blood clot.  She says everything looks good and that my calf is not as swollen as yesterday.  Having her around is a real relief especially when my calf swelled up so big.  I am starting to get some brusing on my calf and around my knee.  Well, back to the CPM machine. 
Title: Re: Surgery on Oct. 22-follow my progress
Post by: casey2291 on October 30, 2007, 04:21:49 PM
I have survived the first week.   I have been having severe pain in my calf when I get up and move around.  I called my OS yesterday and was told that the calf pain was normal after this kind of surgery.  They prescribed a very low dose of an anti-depressant medicine which will inhibit the nerve fibers in the leg.  I took the first dose last night and strangely enough I feel some improvment in my calf today.  Still pretty painful but I will take any small improvments.   Each day I feel a little bit better.  I'm anxious to be totally pain free so that I can get up and move about.  Even if I have to be on crutches, just moving around would make me feel more normal.  I'm getting antsy because I am pretty much stuck in bed because of the calf pain.  I am now up to 55 degrees in the CPM.  I'm still icing each day.  I use the ice machine for about 4 hours each day.  The swelling in my calf is decreasing and I'm pretty happy with the swelling in my knee.  Yesterday, I was even able to put my own sock on which I couldn't do before...oh the excitement of the small improvments.  ;)   
Title: Re: Surgery on Oct. 22-follow my progress
Post by: djs60 on October 30, 2007, 04:36:32 PM
Hi Casey,

I remember having a lot of pain in my shin area (where they took the periosteum for the graft covers) - it was particularly bad any time I stood up.  In fact, I remember avoiding drinking too much, as I didn't want to have to get up to hobble to the bathroom.

If I remember correctly, this suddenly got a lot better at about day 10.

Hang in there,
DJS
Title: Re: Surgery on Oct. 22-follow my progress
Post by: kevinnjaime on October 30, 2007, 06:05:29 PM
I am three months postop and the one thing that bothered me was not being able to leave the house on my own.  When my wife would come home from work I would have her just drive me around in the car just to get out.  I agree with djs if the pain is in the front of your calf it is probably from the grapht that they took but if it is in the back of your calf it could be a clot.
Title: Re: Surgery on Oct. 22-follow my progress
Post by: casey2291 on October 31, 2007, 07:17:48 PM
Thanks DJS and Kevin for your input.  I actually only have one incision instead of two.  My OS said that he was using a graft other than periosteum which avoids the second incision and the tissue seems to work better and be more consistent.  I'm not sure that I really understand that, but that is what he told me over email when I was asking him about the second incision.  My calf pain is a little bit better than it was over the weekend.  The med that I was put on for calf pain is keeping me awake at night.  I see the OS tomorrow and will ask if I should be concerned about a blood clot.  I got out last night for a few hours which was very nice.  My fiance took me to my house to pick up my mail and a few things.  I'm really anxious for this calf pain to go away so I can have a little bit more freedom.  For those of you who have been through this surgery, when did you start PT and SLR's?  I've been trying the past couple of days to do a SLR but I am unable to do one.  I've been trying to just squeeze my quad muscle to get it to fire. I can feel it moving so that is good.  I'm trying my best to just enjoy having all this free time on my hands.  When else do you get to relax so much?    :)
Title: Re: Surgery on Oct. 22-follow my progress
Post by: kevinnjaime on November 01, 2007, 04:36:49 PM
Casey,

I started my PT one week after the surgery and I was put on the CPM machine immediately after the surgery.  I just was taken off of the CPM my OS kept me on it for 12 weeks.  Once you are able to get the quad firing you will feel a lot better I did.  It just took about 4 weeks for me to see a difference in the strength in my quad.  Good luck.

Kevin
Title: Re: Surgery on Oct. 22-follow my progress
Post by: djs60 on November 01, 2007, 05:26:37 PM
casey,

I started outpatient PT 19 days after my surgery.  I think I had too much swelling & limited mobility to do much before then.  I used my CPM machine for 6 weeks.  I don't remember doing SLRs early on - I don't think I could.

djs60
Title: Re: Surgery on Oct. 22-follow my progress
Post by: Peg Leg on November 02, 2007, 12:50:22 AM
Hi There Casey!

My name is Robin and my defect was also on the MFC; my surgery was 18 weeks ago today.  I started PT 5 days post-op and I could not do a SLR for almost 3 weeks; so don't be too hard on yourself just yet!  Keep working those quad muscles!!  Lots of good books and movies help time to pass nicely  :D!! Take care and keep us posted

Peg Leg
Title: Re: Surgery on Oct. 22-follow my progress
Post by: casey2291 on November 02, 2007, 03:03:53 PM
Thanks everyone for answering my questions!!  I had my first post-op visit yesterday.  I had half of my staples removed and I will remove the rest of them next week on my own.  Typically, I would have to go back next week to remove the rest of the staples but since I live 3 1/2 hours from my OS, they suggested that if I was comfortable taking them out, that they had no problem with that.  Both the PA and the OS were pleased with how things are going so far.  I have four screws and one plate in my knee from the osteotomy.  My lesion was about 2X2 sq. cm.  They used horse pericardium as the graft which is why I had just the one incision instead of two.  I was told that I have a high chance of this surgery being successful based on where the lesion was on the medial femoral condyle and the size of my lesion.  I was told to work my way up to 90 degrees in the CPM, but that I don't have to go beyond 90 degrees because anything beyond 90 would not be of any benefit to me.  I will get a new x-ray at the beginning of december and then return for another visit on dec. 6.  If everything is going well, then I will get to begin weight bearing and get to unlock the brace.  The past two days, I've been having some sharp pains in my knee when I move.  I think it has something to do with my incision and not really my knee.  I'm having trouble figuring out exactly what is hurting.  My calf pain is better than it was but it is still not gone.  The PA suggested that I trying stretching it and putting heat on it.  I can tell the muscles are really tight.  So, I'm gearing up for five more weeks in the CPM and to begin doing some isometric quad exercises and hopefully in a week or so to be able to do a SLR.  The OS said that he would not expect me to be able to do a SLR for at least two more weeks.     
Title: Re: Surgery on Oct. 22-follow my progress
Post by: casey2291 on November 05, 2007, 03:11:56 PM
2 weeks post-op:  I'm having some problems with sharp pains in my knee.  I'm not sure if the pain is in the area of the graft or not.  It really feels as if the pain is higher in my knee and may not be related to the cells.  I'm not sure.  I contacted my OS this morning because yesterday, I had to significantly decrease my flexion in the cpm machine due to the pain.  I was up to 65 degrees in the cpm two days ago and yesterday I could only go to about 35-40 degrees before I was in severe pain.  I took pain meds yesterday and then was able to get to 60 degrees.  This morning the pain started at 15 degrees in the cpm and I was able to make it to 40 degrees.  I asked my OS if I should take the pain meds and push through the pain or decrease the flexion on the machine. He said to was ok to take the meds, but that I should not go beyond 65 degrees for the next 4-5 days and that I need to let him know in a couple of days how things are going.  After taking meds, I am now up to 61 degrees in the cpm.  I am hoping that maybe I have some scar tissue that is breaking up and that this has nothing to do with the actual ACI procedure.  On a positive note, my calf pain is now pretty much gone and I have stopped taking the meds for that.  It is a relief for that pain to be gone.  Now, if only this knee pain would go away. 
Title: Re: Surgery on Oct. 22-follow my progress
Post by: kathat on November 06, 2007, 01:32:18 AM
Bummer about the pain. I've had pain in my leg following surgery too. It's affected my extension and my PT is unsure of the cause, though he has expressed concern that I may have some loose cartilage in the joint. It sucks when pain gets in the way of things!!

3 1/2 hours is a long way just for staple removal! I'd do it myself too!!

How's the boredom - setting in yet? How mobile are you? What things have you found the most difficult to do?

Hope the pain settles.

Kathy
Title: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 12, 2007, 01:00:47 AM
3 weeks:  Things are going ok for me.  My sharp pains have not completely resolved yet.  It is still hurting on the medial side of the knee and it hurts when I get up to move around and sometimes in the cpm.  I still can't tell if the pain is where the cells were implanted or if it is higher in the knee.  It is hard to tell because prior to surgery, my knee only hurt when I was weight bearing.  The sharp pains seem to be worse in the morning and then again in the evenings.  I'm starting to wonder if my knee gets stiff at night and then it is sore when I get up in the morning.  And then if it is sore in the evenings after using the cpm machine all day.  Some of the pains that I get take my breath away they are so severe.  I've read a lot of the posts on here from others who have gone through this and I seem to get the impression that most people don't have any pain after the first week or so during the 6 weeks that they are non-weight bearing.  I would love to hear from others who have been through this and if this pain that I am having is normal.  I've been in touch with my OS several times.  He does not seemed concerned and has told me that it is ok to use pain meds so that I can increase in the cpm machine.  I did 65 degrees in the cpm for 5 days as recommended by my OS and the past couple of days I have increased and now I am up to 75.  Today, I was up to 75 degrees this morning without any problems at all and now this evening, I am back down to 70 because the knee is really tight and painful when I hit right around 70.  I'm not using any pain meds right now.  Instead when I feel pain while I am in the cpm, I use an ice pack and I am usually able to increase the flexion on the machine.   

I moved back home to my house today.  I'd been staying with my fiance and I decided that it was time for me to go home and be a little more independent.  I already miss having my fiance around.  He did an amazing job taking care of me and never complained once.  Tonight, I got myself some dinner and cleaned up my mess from dinner and went back to my room to get in the cpm machine and I sat down on the bed and realized that I really wanted an ice pack.  I then realized how nice I had it at my fiance's house and how it was great to have him to get me things when I needed them.  I then started to wonder if I was out of my mind for coming back to my house but, in the long run I think it will be good for my mental health to have to be a little more independent.  I was getting a little stir crazy at his house.   


Yesterday, I got out and about to go to Arby's for lunch and to the grocery store.  It felt wonderful to be out of the house.  I was so happy to be out because it was only the third time that I had been out in three weeks.  I drove my car and it didn't go as well as I had hoped.  It was akward getting in and out of the driver's seat and even though I put a couple of towels under my foot to keep my leg propped up when I was driving, I still felt like there was a lot of pressure being put on my knee.  It hurt at first and then it felt fine.  I felt kinda unsafe when I was driving just because I was so worried about my knee.  The plan was for me to drive my car back to my house today, but I decided that I didn't feel comfortable driving for an hour back to my house, so I just let my fiance drive me back and let him keep my car for the next couple of weeks.  I figured even if I did have my car, I probabaly wouldn't go anywhere.  I will just rely on others to take me places for the next couple of weeks.   I crutched all around the grocery store yesterday without a problem.  I did hit my foot on the ground a couple of times when I was crutching.  It hurt a little bit the one time that it happened, but I don't think it will do any harm to my knee.  I was quite tired when we were finished.  It is hard to stand for a long period of time because my back gets sore and my hip also starts to hurt just because the brace is so heavy. 

I'm still working my quads hoping that one of these days I am going to be able to do a SLR.  When I do the isometric quad exercises, I can feel the plate that they put in for the osteotomy.  It really kinda annoys me so I'm not sure that I'm doing as many quad exercises as I should be. 

I took my staples out on Thursday.  Actually, my fiance took them out.  I am not usually bothered by those types of things, but I just couldn't bring myself to do it.   It was not painful and my incision looks good.  My OS recommended putting vitamin E on the incision to help with the scar.

And here is something that only knee geeks can really appreciate.  Yesterday, I put my shoe on my operated leg and after a bit of a struggle, I finally got it on.  I then realized that I was all excited because I put my own shoe on and that I had a big smile on my face because I was proud of my victory.   ;D 

I'm still very confident that this surgery is going to turn out great. 

...only 24 days of non-weight bearing to go. 



 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 12, 2007, 11:09:26 AM
I'm posting some pictures of my ACI surgery.  I think the pictures are awesome, however if you have a weak stomach, I wouldn't recommend looking at them. The pictures show my lesion and the graft covering of horse pericardium. 

http://www.flickr.com/photos/[email protected]/

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on November 12, 2007, 09:22:29 PM
It's taken me forever to get back here.  Yes, we did email a bit and I was wondering what you had decided to do.  I was happy to see you posting again. 

Glad to hear you are doing so well!  And thanks for the pics.  I think they are awesome too!  One reason I'm looking forward to my next surgery is to get new pics.l  ;D  I just think it's amazing what they do now and it's great to be able to actually "see" what's going on in there. 

I agree it will be tougher for you to be at home alone.  Your fiance sounds fabulous though and I'm sure he will still be helping out.  This whole knee ordeal isn't only tough on us, it's hard on those around us, yk? 

I'm trying to think back about the shooting pains early on and I do believe I had them as well.  I remember wondering if it had failed early on because of those, so I do think it's pretty normal to get them.  Just take it slow.  You and I are very similar in activity level and I know you are anxious to get back to your normal life.  Looking back now for me, I wish I had gone a bit slower.  I know that at the time, thinking ahead to a year down the road, I thought I'd be farther along than I am now and I can't help wondering if my impatience caused a setback.  So, learn from me if you must...and try to be patient.   ;)

I agree driving isn't a very smart idea with that brace on. Just think about it, if you were in an accident even through not fault of your own, you getting out of the car like that wouldn't go over so well, yk?  I drove a bit in my brace and constantly worried about that as well.  Imagine getting out swinging that brace and getting up on crutches.   :o 

Hang in there and keep us posted on your progress!! 

Kristi

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 12, 2007, 10:44:00 PM
What fantastic pictures!! Thanks heaps. Well done on getting that shoe on. I know the feeling well!! I go to see my OS in a couple of hours and I am hoping I qualify for some form of cartilage surgery. I reckon one of my defects is in the same spot as yours. The other two are on the back of each patella and are down to bone. My MFC defect is not far off. I hope to find out the size of them today. I didn't think to ask last visit - gee, all the things you don't think to ask at these visits and then think of later! It's one of the most frustrating things about this whole specialist process. What caused your area? Mine is from patellar tilt and possible maltracking from overpronation. Keep up the good work - or rest, I should say ;)
Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 14, 2007, 03:09:10 PM
I had a disaster with the knee.  I discovered on Sunday night that the cpm machine was not set up right.  I got in the machine and I forgot to unlock my brace.  I used the machine for about 30 minutes before I had any pain and realized that something was not right and that I should have had extreme pain if things were working right.  Plus, my roommate was looking at the machine earlier that day and said to me that it didn't really look as if my knee was bending and that my leg was just moving.  So, I put two and two together and emailed my OS.  He said that what I was describing sounded weird and told me to contact the company that I got the machine from.  I contacted the guy who set me up with the cpm and he came out to the house and it turns out that it was not set up right.  The machine was set up so that it was to short for the length of my leg.  So, he lengthened it so that now my knee is bending.  When he gave me the machine, he told me that all I had to do was put the foot tray up and lay down in the machine. So, that is what I did.  He did not tell me when I picked up the machine that it should be adjusted and he did not bother to have me lay down in the machine to make sure that it was going to fit my body.   I had no idea that the machine could be lengthened so I just assumed that I was using it correctly.  So, I have missed out on 3 weeks of the cpm machine.  I was extremely upset and very annoyed that this guy did not do his job.  My OS said that there is no clear answer as to what the missed time in the cpm will do to the cells.  Now, I am having extreme pain when I am in the cpm and have to start all over with my ROM work.  I am now back to 40 degrees in the cpm machine.  Even with pain meds, I am having a lot of pain when using the machine.   The pain is right where the cells are.  I feel annoyed with myself that I didn't catch this problem earlier, but at the same time, I see it as negligence on the part of the guy who gave me the machine.  I've never used one of these machines before let alone seen one, so how would I know if I was doing it correctly.  This is such a huge surgery and now because of one guy was too lazy to do his job correctly, it may be compromised.  I would think that if you were providing someone with a machine that was going to affect their recovery that you would make sure it was set up correctly....does he not have any integrity??  I didn't like the guy from the moment I met hiim.  He was very impersonal and seemed to be in a hurry to get me in and out when he set me up with my brace and gave me the cpm machine.  Yesterday when he was at my house, I got in the machine so he could look at what was going on.  He started to adjust the machine with me in it.  He was jerking the machine around causing me all kinds of pain.  What kind of person is not gentle with another person when they have a huge brace on their knee and are obviously injured?  Anyhow, I'm kinda over the whole thing now.  I figure what is done is done and now I just have to move forward and keep positive. 

Kristi...good to hear from you again.  I'm sorry that you think that your surgery failed.  I looked at your post-op diary and saw that your surgery is on the 29th.  I hope that things are not as bad as what you think and that it is something minor that can be fixed like overgrowth.  Be sure to let me know how things go.  Thanks for the advice about being patient.  I too struggle with being patient and not pushing myself too soon.   I am going to try really hard to take things slow.  Since I still can't even do a SLR yet, I have the feeling that I am going to be forced to take things slowly.  You are so right about how our knee problems are not only hard on us, but on those around us as well.  My poor fiance has been really stressed/nervous at times about my knee.  I feel badly that he has had to go through all of this as well.  He has told me how he just can't stand to see me in pain.  I don't like to see him stressed, but I think it is really sweet that he cares so much about me. 

Kathy....How did things go at your OS visit?  Did you get all your questions answered?  What did he recommened?  I'm not sure what exactly caused my lesions.  I have my theories.  I think that it was caused by my knees being out of line (hence the HTO) and me playing sports all my life.  Plus, I think there might be a little genetics involved.  My brother also similar problems to mine.  I often wonder if I would not have played so many sports growing up, if I would not have seen any of these problems until I was much older.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: jonhark on November 14, 2007, 05:42:54 PM
I wouldn't be too overly worried about not using the CPM for the first couple weeks. My OS didn't allow me into one until Day 10 and then it was limitted to 45-60 degrees for the first 4 weeks. I wouldn't do the CPM through a lot pain. You should allow for some discomfort but definitely not pain. Also, no need for the brace while in the CPM. The machine will limit your range and it is active assisted. As a rule of thumb, don't do anything through pain with this rehab. There is absolutely no rushing anything as this is an 18 month process. I'm at 14 weeks and continue to be amazed at how things slowly progress every ten days or so. If you read through those that have had graft failures or poor outcomes on this board--a lot of them pushed their grafts too hard, too quickly.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on November 14, 2007, 06:25:26 PM
Hi Casey!  I'm sorry that you had such an inept CPM machine guy.  Seriously, I was livid reading your post.  I agree with everything you said. It's ridiculous that people don't seem to realize how their actions affect others.  At any rate, I wouldn't sweat it too much.  It sounds like you were getting some range of motion so it's not like you've kept your knee stiff this whole time.  And everyone's protocol is so different and they all have different degrees of success....try to stay positive and think the best.  I'm certainly hoping for the best for you.   :)

As to Johhark's response, I too was told to keep my knee in the brace while in the CPM machine, but I was able to unlock it.  I would follow what your OS says as he is the only one who truly knows what is the best course of treatment for you individually.  It's great to have other people on this board to share stories with and get support from, but when it all comes down to it, we are all different and nobody is going to have the EXACT same experience.  We all need to keep that in mind when handing out advice and opinions. 

And by the way...your fiance sounds like a keeper.   ;)  Good for you. 

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: jonhark on November 14, 2007, 07:04:25 PM
Kalyjoe--
If it doesn't pass the "common sense" test, why do it? What value does the brace add if your range is dictated by the CPM Machine? You should put your leg into it while straight and remove when straight as well. We all are personally responsible for our our own care. I work with surgeons on a daily basis and have first hand knowledge to how busy they are. They don't get it right 100% of the time. Unfortunately it has taken me one failed microfracture surgery and a revision hip scope to figure that out.  My point is, listen to your body and always question the medical advice/protocol you're given. Chances are it is correct, but as a patient you should understand the purpose behind everything. This board is more than just a support forum. It is a way for us to gleen what does/doesn't work well for rehab. If you think about it, there is an optimal rehab protocol for all sites (PF, Femoral, Tibia). It just hasn't been refined and agreed upon by the medical community at large. Casey--be very selective about your PT choice as well. Make sure they are well informed that this ISN'T a microfracture rehab protocol and get your hand's on Carticell's rehab protocol and follow it to the "T". The success rate for the location of your defect is 85%....you have a great chance of having a successful outcome.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 15, 2007, 01:23:36 AM
Casey,

Sorry to hear about your inept CPM guy. Things like that make me so cross. Thankfully it wasn't doing the opposite and bending your knee too much - probably would have had worse consequences.

I saw my OS the other day and my options are TKR or chondrocyte grafting, but he doesn't wish to do either just yet. He implied that my age was a factor. I can understand it for the TKR, but not the grafting. I have a way to go before I am recovered from the recent surgery anyway, as my quads are miniscule, so I have some time to discuss things further with him. My opinion would be to do the grafting then the TKR once the grafted areas break down again (about 10 years I have read). I imagine that is why he wants to delay things, as I would still be too young for a TKR in ten years time. I also won't be ready for such surgery just yet anyway. I want my kids to be a bit older and independent, and I want to save up long service leave, provided I can stay employed!!

My damage is - 1/3 of each patella is bare bone, including the ridge on the back which is a major load bearing part of the joint and usually has the thickest covering of cartilage. I also have an area of deep fibrillation (grade 6 on a 7 grade scale - my patellae are grade 7) on my right medial femoral condyle. I forgot to ask the size (still reeling from everything else!!). I am not sure of the exact location, though my OS implied that it was in a weight bearing area. The pictures he drew suggest that it is more in the trochlear groove, so I need to get that clarified - "weight bearing area" of the MFC could mean the area between the femur and tibia, or the femur and patella (in deep flexion). I am sort of hoping it is well in the condyle area so an unloader brace could help. I am sick of the aching, especially in that knee, and would like to find something that will help. I rang back later and asked for exact details of my defects to be sent to my PT, as he wanted to know. That way I can find out too, without having to remember to ask. I write a list of questions but then I am blindsided by something the OS says and my brain stops functioning!! Next time I think I'll give him the list of questions first!!

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 15, 2007, 04:12:51 PM
I contacted my OS today and told him about the extreme pain.  He said that I probably have an early adhesion on the knee.  He recommended that I use a heating pad on top of a damp cloth when in the cpm machine.  He said the best way to break this up is to use the cpm machine.  He is also going to have me start therapy now instead of waiting until 6 weeks post-op.  The pain today is not quite as bad as yesterday although it was pretty severe this morning.  However, right now the pain is completely under control with pain meds and I am using the cpm machine without any pain. 

Jonhark...I was told to use my brace while in the cpm machine because of the HTO that I had done.  I am supposed to unlock the brace when in the machine.  How is your pain at 14 weeks post-op?  Are you still in PT?  What are you able to do activity wise at this point?  My PT said that he has worked with a couple of carticel patients, however I'm not really sure that I believe him because he says he can't remember them.  But, I have worked with this PT before when I had my scope over the summer and I think he will be good for my rehab.  He pushed me a bit when I had my scope, but that surgery is so different than this one.  And when we talked about the carticel rehab he talked about taking things slow.  I've been to enough PT's for knee and back problems, that I have gotten really good at figuring out who is and isn't a good therapist.  If my current PT tries to push me more than I feel is appropriate, then I will switch PT's.

Kristi.... I'm pretty much over the whole cpm mistake and I'm pushing forward.  Even if I have an adhesion, I'm just going to stay positive and think in my mind that it is going to get taken care of with therapy and use of the cpm machine.  Are you getting ready to go back in for your scope?  Is the scope part of the clinical trial?  What is your next step if it has failed? 

Kathy...sorry to hear about your knee.  I was unaware that OS's would not do the chondrocyte grafting due to age.  My OS didn't say anything to me about my age.  I am 31 and will not be old enough for a TKR in 10 years.  I was given the indication that this should solve all of my problems until I was ready for a TKR.  What did your OS indicate would qualifiy you for more surgery?  Increased pain or increased damage to the knee?  I hope that you can get a brace that will give you some relief.  What was your recent surgery that you had?  Be careful that your PT doesn't have you doing anything to stress the knee out to much.  I have lesion on my other knee, both on the patella and the medial femoral condyle and he recommened that I don't bend the knee past a certain point. 

 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: jonhark on November 15, 2007, 05:04:38 PM
Casey--
No more daily pain for me at 14 weeks. The aching/throbbing is non-existent.

I purposely am limiting my walking and activities other than what is necessary on a daily basis. Stairs will continue to be done on my good leg until six months at least.

I am doing 20 minutes with light resistance on the bike with no pain. My PT really focuses around getting the glute med, hip flexors, calves and quads strong. I'm not attempting anything that puts patellofemoral forces on the joint (this includes any type of squatting). I have not used a formal PT for my rehab. I've been through enough surgeries to know what works and what doesn't. I suggest using a PT until you get most of your range back then save your money and set-up your plan of attack.

Don't be so sure you'll need a TKR.  If you baby this thing for the 18 months and optimize the chances of full cartilage fill-in and maturation your knee might be as good as new in a few years.

Don't be shocked or stress out about pain at the graft site for the first ten weeks. I still get it occasionally and towards the end of the day if I do too much.

I also suggest you try an upper body biking machine or something to work your upper-body. I started 8 weeks out and it really doesn't wonders for your psyche and cardio system.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 15, 2007, 05:14:39 PM
I FINALLY did a SLR today!!!!!   ;D  Two weeks ago today, my OS told me that he didn't expect me to be able to do one for another two weeks and two weeks to the date, I am able to do one.  This is promising to me because I was starting to think that I was never going to be able to pick my leg up.  Guess all the isometric quad exercises are finally paying off.

Johnhark...thanks for the advice.  I will probably participate in the full physical therapy program with a therapist.  I too have done tons of PT, but I am kinda anal about having a therapist there to work with me and make sure that I am doing things correctly.  Plus, it really helps me to be disciplined to do my exercises at home when I know that I have someone checking in on me to make sure I am making progress.  Also, my gym membership is currently on hold because I am a member of a rock climbing gym and they only have a small workout room.  So, it helps for me to be able to go to PT and have access to all the workout machines.  It sounds as if your knee is doing well.  glad to hear that you are pretty much pain free!  Keep up the good work!   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 16, 2007, 01:26:46 PM
Congrats on the SLR Casey!! It's always a good feeling when we make progress.

My recent surgery was bilateral lateral releases and chondroplasty. I had patellar tilt, which is the cause of my damage. I wouldn't worry about my PT pushing me too far - he is the one who got my OS to put me on work restrictions. I am only allowed to do 1/4 squats, no kneeling, avoid stairs. He checked out the crunching in my knees the other day and the look on his face was priceless!! They certainly crunch!! I think he's finally realising how much of a challenge my PT is going to be, as I am struggling with small steps like gutters and front door steps but I am unable to do any exercises to improve functionality. I don't really know what would qualify me for early surgery. It's yet another question I didn't think to ask at the time. I am guessing that increasing pain and decreasing function would be the biggest qualifiers. I suppose I will know when the time comes to push for more surgery.

It's encouraging to see so many of you with ACI making great progress. I am going to be well prepared whan the time comes for mine. At least I don't have to change surgeons - my OS specialises in TKRs and chondrocyte grafting, so I can keep him forever!! I got lucky there, especially in a smaller city like mine.

May your improvements continue.

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 17, 2007, 12:45:27 AM
Kathy...sounds like you have a good PT.  I hope that he can help you get your pain levels down.  I start PT on monday.  I already know my PT from working with him after my last scope and also for an old back injury.  He already requested that I get a copy of a rehab protocol from my OS so that is good. 

My pain levels have decreased significantly.  I am off of all pain meds and the extreme pain that I was having is almost all the way gone.  Only every once in awhile when in the cpm do I get a really extreme pain, but it seems to go away quickly.  I'm extremely happy that my pain is getting better.  I tried again to do a SLR, but I could do one today.  I must have worked my muscles a little too much yesterday with the SLR's.  I did about 30-40 of them yesterday.  Just another lesson to teach me to be patient during this recovery and not over do it.   :P

Here is some interesting info.  I got a statement from my insurance company which told me how much the bioservices corporation (genzyme) charged for my surgery.  The statement was for $65,271.00  I did a double take when I looked at the statement.  I'm not sure if this includes the cost of the whole surgery or just the cells.  I know that there was someone present during my surgery from genzyme so I'm not sure if that is included in the cost or not.  I'm curious to see how much everything will cost with the HTO and the surgical center costs, cpm, etc.  I was told by genzyme that if the surgery was not paid for that I would get a bill for $26,000 for just the cells alone.  I'm praying that I meet all the qualifications for my surgery to get paid for.  My insurance company would not pre-approve the surgery because it was an outpatient procedure and my lesion had to fit within specific guidelines (which I think it did) in order for them to pay.  I won't know anything until my doctor submits info to the insurance company if everything will be covered.  I was given pretty good confidence by my doctor's office and genzyme that it was likely that everything would be covered, but I still had to sign a paper stating that if my claims were denied that I would pay. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 17, 2007, 11:28:46 PM
Crap! What a thing to have hanging over your head. You'll be relieved when it's finally settled!!

You're right, I have a wonderful PT. He's really on the ball and he's nice to boot! I see some of the other PTs come out and call for their next patient, then march off without checking to see if the person is keeping up. Mine comes up to you if you are not watching for him and then waits for you and chats while walking. I reckon he learns a lot from watching some of his patients walk into the room. He certainly picked when I was having pain issues. He also spends the whole time in the room - no setting me up doing something and walking off. If he gives me an exercise he shows me how to do it then tells me how much he wants me to do it at home. I don't waste any time doing things for him that I could do at home. I hope he hangs around long enough to at least see my through ACI. I trust him to follow rehab protocol, and to look up what he doesn't know.

I reckon you overdid it with the SLRs!! That's an awful lot to do when you haven't done one for so long! Your muscles have probably gone on strike  ;)

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on November 18, 2007, 02:55:42 AM
Casey,

I just got my EOB and I was billed $49,375.00 by US Bioservices.  This is the fee for Genzyme's part in the whole procedure.  Insurance pays them a discounted amount of $22,303; which is what I was told in the beginning.  Mine was also an outpatient basis, or less than 23 hours; so hopefully this is standard procedure and your Ins. will pay.  Mine paid and they have been real butts about almost all of it so far!!  Good Luck to You!!

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on November 18, 2007, 03:50:44 AM
Congrats on the SLR!!  It's funny how the baby steps with this recovery mean so much.  ;D  I know you are anxious to get started on PT and I'm sure that will also make you feel lilke you're accomplishing something.  I also think it's great you are so comfortable with your PT.  It makes a difference if they know your history, yk?

Great to hear the pain levels are decreasing.  Time is almost flying now isn't it?   Sounds like you are on the right road...but yes...remember not to push it too hard.  Funny coming from me, I know.  But like I said...lesson learned. 

As far as me, yes I have a scope on the 29th.  It is part of the clinical trial, to compare the before and after and the progress that has been made in a year.  They'd be doing it whether I had any problems right now or not.  My knee has been catching a lot lately, so I'm really hoping there's some overgrowth or something that he can just snip and make all better.  I know, I live in fantasy world right now.   ;)  But there's no sense in stressing about what I can't change.  I just have to see what he finds and then explore my options.  I need to move forward. 

I completely understand the disgust at the cost of this surgery.  A lot of my surgery was covered in the trial, but what wasn't still totalled almost $40,000.  And that didn't include the doctors fees and all those "incidentals" they charge you for.  It really is ridiculous isn't it?   This next scope is paid for completely by the trial thank goodness.  I really hope your insurance company agrees to cover yours.  I did have to pay for some of mine and actually just finished my last payment last month.  It took me two years to pay off my portion of my microfracture in '04.  <sigh>  Who knew we'd spend so much on our knees?   :-\

Have a great week!  Good luck with PT!

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 19, 2007, 09:10:09 PM
kristi...I'm keeping you in my thoughts for the 29th!  Be sure to let me know how it goes.  I'm really hoping you just have overgrowth and not a failed ACI!!

Robin and Kristi....Isn't the cost of this surgery just CRAZY?  Robin...I'm wondering if the cost of the surgery has gone up that much in the time difference between when you had your surgery and I had mine.

Kathy...keep up the good work in PT.

I started PT today.  I didn't do a whole lot because there is not a whole lot that I can do at this point.  My PT received the rehab protocol from my OS and he is already following it and had reviewed it before I got there today.  I am only allowed to do passive ROM, so my PT did some bending of my knee for me.  I am at 76 degrees flexion and my extension is perfect.  I'm pretty happy with my flexion at this point considering I started at 30 degrees just one week ago.  My PT would like for me to get to 90 by the end of the week.  I did SLR's in all directions with the brace on and some assistance from my therapist.  I was also given some hamstring and calf stretches and I am supposed to do isometric quad exercises with a rolled up towel under the knee.  In a couple of weeks once I can start weight bearing, I will start pool rehab.  I'm a little worried about the pool rehab only because I am worried about slipping on wet tile while on crutches.  Maybe there is not tile around the pool but something not slippery.  I don't know.  My PT keeps talking about respecting the healing and taking things slow so that makes me pretty happy that he is going to be cautious with my rehab. 

I am driving my car again.  I got my car back from my fiance's house yesterday.  Driving is going just fine.  I only plan on going to therapy and no where else just because I am nervous about getting in an accident while being on crutches and with my big old brace.  Getting in and out of the car is a bit of a challenge with my leg completely straight, but it is managable. 

My good knee (if you want to call it that) is starting to rebel.  The lesion on my medial femoral condyle has been very sore these past two days.  I've been icing but I think it is just stressed out from having to do all the work while I am on crutches.  Just the thought of having to go through this on the other knee makes me sick! 

 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 19, 2007, 10:34:56 PM
I am thinking that I'll have to go bilateral when my time comes, or at least do them close together. I don't think I'd ever get around to having a second surgery. The first one would use up all of my leave from work. I have heard of someone who had one knee done and she swears she will never get the other one done because it was such a long recovery. Are you planning on doing the other knee? Will you do it soon after you have recovered or wait? I don't know how the payment system works here in Australia. I have private health insurance, and I think ACI is covered by them, but I am not certain. I am very glad we took out health insurance.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 19, 2007, 11:22:42 PM
Hi Kathy,
Right now, I don't know what the future holds for my other knee.  I had it scoped over the summer and my OS (not the same one that I have now) said that I have two small lesions under my patella and also a lesion on the MFC.  I have known about the lesion on my MFC for about 1 1/2 years now and it doesn't seem to have gotten any worse during that time frame.  It gets aggravated from time to time but usually calms itself down.  I worry that since I have misalignment on that leg, that it will only be a matter of time before it progress to a point of surgery.  The only way I will have this surgery done again is if this ACI comes out successful and if the pain on the other knee gets much worse or if the lesion begins to grow significantly. If this ACI is successful and it allows me to return to the things that I love, I would consider having it on the other knee.  I am fortunate that right now I am working in a school system and we have this wonderful thing called a sick bank and if you are a member of it, once you are out of medical leave days, you can borrow from the sick bank and still get paid.  Thank goodness for the sick bank or I would be going quite a few days without pay.  I know that it has been done, but I can't imagine having ACI done bilaterally at the same time.  I'm not tough enough to endure that.  I admire those who do it!
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on November 20, 2007, 01:06:53 AM
Casey,

So glad to hear that things are progressing well!  My surgery was the end of June, so I would be surprised if it had gone up that much; but you never know.  Hopefully it will all work out for you.  As for getting in the pool, most pool decks are concrete, but can still be slippery; just be careful!!  Once you get in, it's great!!  I could do so much more in the pool than on land.  I could work my muscles without putting too much stress on the knee and the pool walking was great practice for someone who hasn't walked normally in 15 months!! Keep up the good work and happy Thanksgiving  ;D!

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 20, 2007, 01:30:37 AM
Thanks Peg Leg.  Happy Thanksgiving to you as well.  I've been following your post-op diary.  It has been helpful to me to see how you are doing at each week of your recovery.  I think it is finally sinking in what a long recovery I have ahead of me.  Today, my PT told me that since I am off of work, that I can make rehabing my knee my full time job...and he was not joking!!!  :P
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on November 21, 2007, 12:32:04 AM
Casey,

Glad to be of some help to you; it helps me, also, to be able to write this long process down and interact with others who get it!!  I sure hope that your recovery goes much smoother than mine has!  These lazy quads of mine are beginning to wear out their welcome >:(.  Your PT is right, it is a full time job.  At least I know that I have done everything that I can to make myself better; apparently, it just has not been enough. :'(

Hang in There!  Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 21, 2007, 07:40:54 PM
Peg Leg...I hope things get better for you and that you are able to get your quad strength back!!  Let me know what your OS says after your PT talks to him/her.

Each time I go to therapy, I realize what a LONG LONG road of recovery I have ahead of me.  Even though I read up on this procedure, I think there was a part of me that thought the rehab was going to be similar to my microfracture rehab.  There is nothing similar about it.  Today was my second session of PT and it was hard work.   I hate when the PT bends my knee to work on my ROM.  Oh my gosh, today I was slowly inching my way up the table as he pushed as I was trying to get away from him.  It is so uncomfortable.  I'm struggling with SLR's.  I can only do them going straight up (and that is with some help getting started) and on one side.  Pain is preventing me from doing them on my other side and my stomach.  My leg is just so incredibly weak.   The PT worked on having me hang my leg over the side of the table today and I was close to 90 degrees which I was happy about.  He then had me use my quad muscles to straighten my leg to about a 40 degree angle.  It was tough but I did it.  I have to admit that I am starting to wonder if I made a mistake and if I was in enough pain before surgery to justify such major surgery.  But, what is done is done and now I have to just keep positive and move forward and give it my all. 

I'm having lots of trouble sleeping.  My body is so tired of sleeping on my back and I keep waking up about every two hours.  It is too uncomfortable to lay on my side with the brace on and it is sore on the knee.  Last night I slept on my stomach and it was only for about an hour but I don't think it was good for the knee because when I woke and wanted to roll back over, my knee hurt so bad that I wasn't sure if I was going to be able to move. 

On a VERY positive note, only 14 more days until I see my OS and hopefully I will get to start weight bearing.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 22, 2007, 01:19:45 AM
Oh Casey, I so feel for you. Sleep problems are so draining, and you certainly need your sleep at the moment. I am terrified of coping with ACI rehab. I really don't know how I'll decide when I am ready for it. I am currently having problems with deep, gnawing pain in my knees. I have had problems sleeping some nights, and sitting at work for 10 hour night shifts has been torture at times. My GP is a lifesaver and today he gave me scripts for several different pain killers, so I can mix and match and see what suits.  ::) One of them comes in a slow release form, so if it works then he will look at how much I am taking of the quick acting form and swap me over to the appropriate dose of the SR form. Then I should be able to sleep better, without waking up to take pills. I am praying that PT will do some good. Surely it will. I have quite wasted muscles in my legs, so there's room for a lot of improvement there. Hopefully it will equate to less pain. Certainly the pain increased as my muscles wasted. At least I hope it was that way around. It could have been increasing pain that caused my muscle wasting  :P Goodness, it must be self pity day - time for a pity party!!! I will keep my fingers crossed that you get the OK to weight bear at your OS appointment. Nothing like something positive to bring you out of a slump.
Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on November 22, 2007, 03:26:32 AM
Kathy,

Ooh a pity party, can I join in?!!!!  I have been to a lot of those these last few months!! At least you got some great new drugs, hopefully that will help you to feel better.
I sure hope that PT helps you with those muscles; I think it helps to be working on the exercises, both mentally and physically. I prefer to be proactive; even with my muscles reluctance to progress, at least I know that I've done all that I can.

Casey, hang in there and remember that each day gets a little bit better. I remember trying to get away from Jason on that table a few times, too! haha  Yesterday, I just wanted to kick him, but knew that would only hurt me more!!!!  Sorry to hear about the sleep problems, but that is pretty common after surgery.  Try lying on your right side and putting a pillow under your left leg for support.  I found this to be a pretty good way to get off of my sore back.  Good Luck, tonight and sweet dreams!

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 22, 2007, 10:50:01 AM
Peg Leg - feel free to join in!! I am happy to have some stronger pain relief, but it comes at a price. I feel really fuzzy headed at the moment and I am still aware of the aching, though it's settled a bit. I am not going to be able to take more than what I have been on previously when it comes to working or driving, so the new pills certainly have their limitations. I'll reserve further judgement until I've fiddled a bit more though. I might be able to come up with a workable combination. Even if I can stop the pain from keeping me awake it'll help.

Casey - Peg Leg has the right idea. I found after my surgery that I slept better if I piled up pillows around myself. I have a long pillow that I put under my back and one leg, then I had a pillow under the opposite knee, one between my knees, and one to cuddle. When I wanted to tilt the other direction I would use the cuddle pillow and the knee pillow to prop one side of me up, and the long pillow would take the place of the knee and cuddle pillows. The one between my knees stayed put. I still find I sleep like that when I can, as I get pain in my lower back and kneecaps when I sleep on my stomach, and shoulder pain if I sleep right on my side. I just can't seem to be able to sleep flat on my back. Try fiddling around with pillows. I have noticed at work that many people can only sleep on their backs if they have a "cuddle pillow", so try that to start with. Good luck!!

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 22, 2007, 12:19:45 PM
If we are having an "official" pity party count me in too!!  I had a pity party last night because I was just so frustrated with the knee and this whole recovery...a true pity party with tears and all.   :'(  This surgery keeps teaching me that I am not as tough as what I thought I was....maybe when it is all done and over with I will be tough.   8)   I feel much better today.  Sometimes, I think the emotions just build up and I need to let them out and then afterwards I am ready to move forward again with a positive attitude.  I guess that is just the woman in me coming out...emotional and all.  It drives me crazy sometimes. 

Thanks for the suggestions for sleeping.  Unfortuntely, I have tried using pillows and have tried using them in multiple ways.  Using pillows after my previous surgeries always seemed to work.  I think I just need to wait for a little more healing before I can roll around in bed.  I did sleep on my side somewhat last night for a little while which was nice.  I think the more I am in the cpm machine and as the flexion increases, I find myself accomodating for the tightness that I feel by lifting my butt off the bed which ends up putting a lot of stress on my back causing a sore back.  This doesn't help when it comes to sleeping either.  The good thing is that I am not working now which means that I can take naps during the daytime (in between all those PT exercies I have to do  ::) )

Kathy...Glad to hear that you got some pain meds.  It sounds like you have a lot of pain.  I still don't understand why your OS doesn't want to move forward with ACI if you are in so much pain all the time.  I hope that you have some pain free days ahead of you.

Peg Leg...Hang in there!  Let's hope that your OS has some idea of what is going on and can figure out what to do to help you.  How many days a week do you still go to therapy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 22, 2007, 12:58:18 PM
I can understand why my OS is holding off at the moment. I am still fresh out of my LR surgery and I have very weak quads, so there is no support for the knee joints. I need to build up the muscles to help support the knees, which takes time. Once I have better muscular support I should be in less pain, so my OS wants to wait to see how much things improve. Also I need to be in better condition before more surgery anyway. I can't afford to lose much more muscle. I am not sure I am ready for ACI surgery just yet either. I want to see if PT helps. Sure, the gnawing ache is really depressing at times, and is so hard to get on top of, and it doesn't seem to be improving at all, but I have a long way to go before I am ready to say I have given things my best shot. I look at how difficult the rehab is and how much difficulty many of you have with it and I know I can't go through it all just yet, especially if I go bilaterally. I want to prepare physically and mentally, as well as set things up so that I can take paid leave from work and my hubby can take leave too, to help me and run around after the kids. The longer I can hold off, the more paid leave I will have accumulated, and the less financial stress the surgery will have on the family.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on November 22, 2007, 01:27:13 PM
Happy Thanksgiving, Everybody!

My knee is as unhappy as most Turkeys are, today!!  I have also been up with pain the last couple of nights, so we should have a late hour pity party!!  I think my pain is a result of PT on Thursday, he really hurt me going after that tight patella tendon.  He also said this was the way it would be for awhile until we get things loosened up.  Sounds like he's trying to scare me off!! :'(

Casey, I am still going once a week.  At 21 weeks, I should have scaled back around 10 weeks to every 2 weeks or so, but my continued problems have prevented that.  I am still stuck at the 2nd phase of rehab because of muscle weakness and extensor lag.  My Insurance quit paying 6 weeks ago, so I am out of pocket!! :o  My PT, Jason, has become a very good friend and supporter, so I tell him he's cheaper than a psychologist.  He helps me to work through all those insane feelings we go through!  Casey, you WILL be stronger for getting thru this, just realize that you are building character and strenghth along with cartilage!!! Something that most people cannot say!

Blessings!  Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 28, 2007, 10:13:58 AM
Kathy...I keep forgetting that you just had lateral release surgery.  I can understand wanting to have strong quads and being totally prepared for ACI before you have it done.  It is a big committment and involves lots of down time.  I'm hoping that as your quads get stronger that your pain will decrease. 

Peg Leg...I feel sorry for you that you have to pay for PT out of pocket!!  Were you able to get any kind of discount from your PT place since you are paying out of pocket...like paying the discounted rate that most insurance companies pay?  How's your pain?  Is it still keeping you up at night?  It is 5:00 am here and I've been awake since 3:30 am.  I figured I might as well just get up and hop in the cpm machine and get a few hours in.  This time it is a sore back that is keeping me from sleeping.   

I had an improvement in PT this week.  I got up to 90 ROM for my knee.  I was at 76 when I started a little over a week ago.  I also went from -12 to 0 degrees for the ROM in my ankle.  I was pleased with my progress.  I am still having some pain when in the cpm machine...mostly in the last few degrees of extension.  It feels like it is right on the cell site.  It is annoying to say the least.  I also still have some sharp pain in my knee when moving wrong.  I am having a hard time determining if it at the cell site because it is around my incision, however my PT said that doesn't mean that it is not the cell area that is causing the pain because the pain can defer itself to other areas.  I can see that I am making some slight improvements in my strength.  SLR's are getting a little easier each day and I can see some improvment in the other exercises that my PT has me doing. 

Only 8 more days until I see my OS.  That means if all goes well, ONLY 64 more hours left in the cpm machine.  I CAN'T wait to ditch the cpm machine!!!!!!!!!!!!!
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on November 29, 2007, 01:48:59 AM
Casey,
Good news on the ROM improvement!! Sorry to hear you're not sleeping well, either.  My back would get so sore sometimes that it bothered me more than my knee!  About the other pain; I had pictures of my knee open during surgery, if you saw what they do to your poor leg, you would understand why you have pain!!! Seriously though, that pain will get better with time as everything heals.
As for my expenses, I do pay the discounted rate the ins. company pays.  I would not still be going every week except for the fact that I am struggling with the weak quads and extensor lag along with the patellofemoral issues.  If I hurt as bad after tomorrow as I did the last 2 weeks, I may drop down to every other week.  I am not seeing the results for the pain I am experiencing. For the most part, my pain is better.  I did have a really bad ache deep in the joint last night; but hopefully it won't come back tonight!
Good luck on losing that CPM machine and sleep tight and sweet dreams tonight!

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on November 29, 2007, 11:31:08 AM
Hey Casey,
I'll keep my fingers crossed that you get to ditch the CPM!! Sounds ghastly. One thing I definitely am NOT looking forward to! Well done on the ROM increase. Now that you've hit 90 things should fly along! It certainly is hard to figure out where pain is coming from. I get aching in my right foot, which I can only assume is referred from my knee, as I never get foot pain without knee pain, but I get knee pain without foot pain. Make sense?!

Our insurance works differently here. We pay part of every PT visit, and insurance pays part. There are sometimes limits on how much insurance will pay per year, depending on the level of insurance. With my insurance, if we use "insurance promoted" PTs then insurance pays more and we pay less - my PT isn't one of them!!

Sweet dreams guys!!

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on November 30, 2007, 01:28:40 AM
Hi Casey.  I feel for you with the back pain and the CPM machine.  Reading your posts bring back so many memories that I think I blocked out b/c I was so miserable at the time.  :-\   But...all I can say is...it does come to an end.  I despised that CPM as well by the end and was really excited to finally ditch that damn brace!  I felt like I won the lottery when I was able to sleep in a different position than lying on my back.  It seems like your time is going pretty fast and those milestones will be here before you know it.

Great job on the ROM!  You are a very hard worker and very dedicated so I'm pretty confident you are going to have great results.  Every little step forward in this process is a HUGE victory so celebrate them all. 

Hope you get a good night's sleep tonight.  I do recall that when I was having those issues, I took my pain meds just to knock me out so I could sleep.  I didn't do it on a regular basis, just when I was desperate.  But it did help. 

Keep up the great work!   :)

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 02, 2007, 12:34:18 PM
Hey everyone,

Kristi, Peg Leg and Kathy....thanks for the words of encouragment!!

I am up to 95 degrees ROM in therapy on my knee.  I've been having a lot of pain in my knee (really intense pain) when I move my leg wrong.  I have no idea if this is normal or not.  For example, yesterday, I was doing an exercise where I lay on my stomach and put a rope on my ankle and work on pulling my ankle towards my butt.  The exercise went well, but when I tried to roll over off of my stomach, the pain was terrible and I could only get part way over and then stopped and rolled back on my stomach which made the pain even worse.  In therapy, when the PT first starts to bend my knee, it hurts really bad as if there is something catching.  Once he bends it beyond the first 15 degrees or so, the pain disappears.  This didn't happen when I first started therapy.  It seems that my knee hurts worse now that I have started therapy.  I know that increased pain with therapy is normal, but I worry that it is too much for the graft so soon.  It hurts to do my SLR's and I can't do the SLR's laying on my one side because the pain is too bad.  I go to see my OS in a few days, so I am anxious to talk to him about my pain and see if it is normal.  He did tell me at the last visit that I would feel all kind of strange things, so I keep reminding myself of that.  It just seems to me that at 6 weeks post op that the pain that takes your breath away should be gone by now. 

I'm finally starting to sleep a little bit better.  These past couple of nights, I actually only woke up about two times and got to sleep in until 5:30am which is an improvement from 3:30 or 4:00 am.  I am now able to partially lay on my side for longer than an hour which is helpful. 

I go on Tuesday to get an x-ray of my leg to see how the osteotomy is healing.  I'm looking forward to seeing the x-ray so that I can see all the hardware in my leg.  I'm praying that the x-ray turns out well and the bone is healing perfectly.  I'm very hopeful that when I see the OS, he will allow me to begin to weight bear, ditch the cpm machine and let me unlock the brace.  I'm going to ask if I can get an unloader brace instead of this ridiculously huge one that I am wearing now.  I was told that I would wear some type of brace for three months psot-op and my ACI protcol says that at 6 weeks to consider an unloader brace.  Only four more days until I see the OS and only 31 more hours in the cpm machine!!!!   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 02, 2007, 09:32:08 PM
The countdown begins.....! Some other ACI posts mention overgrowth of the graft being a problem, so maybe it's the cause of your extra pain. It's great that you're getting some more sleep. Lack of sleep can be so draining. I have found it the worst part of knee surgery/problems. Good luck on Tuesday!!

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 05, 2007, 09:04:50 AM
Right now I seriously REGRET having this surgery done.  I am six weeks post-op and I have a lot of sharp pain in the knee.  It is to the point where I don't want to move because I know that any slight movement might cause a sharp pain.  I don't want people touching me because if they move me wrong, then I might get a sharp pain.  I don't want anyone sitting on my bed because the wrong movement of the bed might disturb the knee and make it move the wrong way causing sharp pain.  I can't sleep at night because when I move, I get pain in the knee.  I am supposed to go back to work in three weeks from today and right now, I can't even imagine that.  I know that everyone says that this surgery requires patience, but I didn't know that it was going to feel like this.  Lately, I feel like the pain that I had before this operation was not nearly bad enough to justify this operation and I wonder if I made a mistake and should have waited until I was in a lot more pain.  I can't seem to find any stories on here where anyone who had this operation done had sharp pain like this at 6 weeks out.  So, if anyone out there had this kind of pain, I would really appreciate them posting.  I'm not sure if it is because my quad muscles are just so weak that they can't support any movement of the knee or if something is not going right with the cells.  I would feel better if I was seeing improvment in the pain but I have had these sharp pains for weeks now.  For a short period of time they got better  and now lately they seem to be getting worse.  I go to see my OS tomorrow and I'm hoping that he will be able to give me some reassurance that everything is ok.       
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on December 05, 2007, 07:56:07 PM
Awwww...hey girl.  Hang in there.   :-[

Remember, it is only six weeks.  I know it is hard being patient (believe me...I KNOW...go back and read all my frustrations) but honestly in the grand scheme of A.C.I., six weeks is relatively early.  In fact, it is crazily early!  I believe it's normal to have any kind of pain right now.  I mean, think about the procedure they performed on your knee.  I know it's hard, but try to stay positive.  One of the worse things is not knowing....I know.  You wonder if the graft is gone.  Did it just, wipe off and all this is for nothing?  Unless you went and and did some crazy impact work on your knee (which I know you did not) that probably did not happen.  Could you possibly be doing too much at PT?  I know for me...when I was in PT...he told me that anything that caused pain to the implant site should be stopped.  It wasn't easy for me because I really wanted to progress. And keep in mind as well that the weaker your quad is, the more pain there seems to be in your knee.  At least for me that is true.  And that is frustrating b/c how do you build up your quad without causing any stress to the site?   ??? It's hard to know what's going on inside that knee.  You need to be cautious and most importantly.....PATIENT.  This surgery is totally a one step forward two steps back kind of thing.  Not easy to deal with I know.  But it is way to early to fear the worst.  I think you will feel better once you talk to your OS tomorrow.  I will be thinking about you and sending you positive vibes and be sure to post when you can.  Feel free to email or PM me if you need to vent some more.  I know I can say for sure that I know exactly how you feel.   :)

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 06, 2007, 06:37:14 AM
Oh Casey! I'm sorry to hear that you're feeling crap. Pain is just so demoralising and depressing. Hang in there and take it easy for a bit. If you hadn't had the surgery done then you'd be in a downwards spiral of pain, and the knowledge that it doesn't improve would probably have you feeling worse than you do now. You have been proactive and tried to do something about your pain, but it involves a long painful journey as part of the process. I am currently feeling worse than I ever did before my LR and chondroplasty, but I have to keep in mind that my quads have taken a major blow and that if I hadn't had the surgery then I'd still have excessive pressure under my patellae causing further cartilage erosion, and my quads probably would have bit the dust anyway due to the longstanding pain I have had. So OK, I feel bad now, but if I hadn't done anything then I'd probably be in this position and getting worse within a short space of time anyway - I was on a downwards spiral when I decided to see an OS. Now I know my tilt has been corrected and I know what damage I have in my knees so I can adapt my activities to suit.

Feel free to vent as much as you need.

Best wishes,

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on December 07, 2007, 01:56:52 AM
Casey,

I am anxious to hear from you.  What did you find out at the Dr. today?  How is your pain?  I'm so sorry that you are having such a hard time.  Please let us hear from you, soon!

Hang in There........Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on December 07, 2007, 03:04:10 AM
I've been thinking of you too Casey.  I really hope you got good news. 

And if you have a pity party, let me know because I'm sort of having one myself.   ;)

Post when you can...we're anxious to hear your news.

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 07, 2007, 04:00:05 AM
Hi everyone,

Kristi...no pity party for me today, but I've had so many lately, that I'm sure that I can empathize.  What is up?  Fill me in!

Kristi, Kathy, Peg leg....Thanks for asking how I am doing and thanks for your encouraging words and for just understanding what I am going through.  It really helps to know that other people understand!!!  Thanks for helping me to rationalize that I probably shouldn't regret having the surgery just yet.  I was just so frustrated with my pain yesterday that sometimes my ability to be rational goes out the door.  I hope that all of you are having a good knee day and that each of you are feeling at least a little better.  I hope the three of you feel free to vent to me if you ever need to.  I know that you have each helped me as I go through my recovery.   

Today was a good day!!!  I saw my OS and he gave me the go ahead to start weight bearing.  I am allowed to weight bear as tolerated and ditch the crutches when I feel comfortable (although I am to work with my PT and allow him to help me make the decision as to when I should really ditch them).  I am allowed to unlock my brace and I don't have to sleep in my brace any longer.  And I am done with the cpm machine!!  Can I say that just one more time...I am DONE with the cpm machine!!   ;D ;D My OS said that the x-rays of my osteotomy looked great.  I have to continue to wear the big immobilizer brace (unlocked now) for the next five weeks.  I asked about getting an unloader brace and I was told that I have to keep the big one because of the osteotomy.  I am to wear my brace whenever I am up and walking but can take it off if I am just sitting around the house.  I am happy with how my knee feels when putting weight on it.  I am not able to fully weight bear yet and need both crutches.  I tried to walk with just one crutch at the doctor's office, but my leg feels way too weak for just one crutch.  I am putting maybe 30-50 lbs of weight on my leg.  I noticed that towards the end of the day today, I was starting to feel a little soreness in the cell area.  The area where the screws are in my leg is pretty uncomfortable.  Not painful, just uncomfortable.  I'm hoping that with time I will get more used to the screws being there.  My OS said that there was not really any time line for ditching the crutches and to just do it as I felt comfortable.  Since my brace has been unlocked, I have only had a few sharp pains in the knee.  A big difference from yesterday, so I am very happy about that.  I asked if the sharp pains were normal and I was told that it was hard to tell what exactly was causing the pain at this point, if it was from weak muscles, the cells, the incision or what and that it was not necessairly abnormal.  My OS told me to expect pain and that I should see improvement between the 4-6 month mark.  He reminded me that we all heal differently and that at this point that I was to use common sense when recovering (i.e. increased pain and swelling means take a break).  He said that aside from going out and doing impact activities or falling or just doing something stupid that I was not likely to blow the graft.  He said that in all the ACI surgerys that he has done (somewhere around 100) that he has only had two people who destroyed their graft and that when it happens that you know it.  He told me that it was ok to do my PT exercises even if I had pain.  I have decided to sleep in my brace tonight with it unlocked at about 75 degrees.  I feel more comfortable that way right now due to the sharp pains that I have and I want to prevent myself from rolling over on my stomach which causes major pain.  Because of my poor quad control, I don't feel good about rolling around in bed without support to the knee.  My PT wrote on my progress report for my OS that my quad control and quad strength was poor.  My goal is to be off of crutches by Jan 2 when I return to work.  My PT thinks this is a reasonable goal.  I hope that it is achievable.  I am scheduled to go back to see my OS in five weeks and I am to email him an update each week on how I am doing.

 

 

       
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 07, 2007, 09:52:53 AM
Fantastic Casey!! What fabulous news!! No CPM machine, no brace at times, weight bearing - you won't know yourself! Now you can start getting those muscles working  :P I have had all sorts of weird pains since my surgery, and it wasn't anywhere near as complicated as yours, so I am not surprised it is not abnormal, though it's always good to have confirmation.

Do they remove the screws eventually as a standard treatment, or do they only remove them if they cause problems?

I have been doing OK, despite lack of sleep. We got a Xmas tree, I managed to find a heat pad despite it being summer here, and things are generally going well in my life (apart from my knees) so I have been feeling pretty good. If my knees would let me get some sleep then I'd be over the moon! I find I can't sleep on my tummy because the pressure of my knees on the bed must irritate the defects under my patellae - ouch! Generally I just get lots of pinching and aching in my knees that makes me restless. If I take pain killers then I feel just as hungover as I do if I don't take them and my knees keep me awake.

Well, must fly. Have to go to work. Blah!

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on December 07, 2007, 12:09:42 PM
Casey that is AWESOME news!  I'm so happy for you.  Oh my gosh..let me tell you...when they come pick up that CPM machine, it is the best feeling ever.  I can totally relate to your happiness with being done with it and having it removed from your home.  I really hated that part of my recovery as well.  (Then again, is there anything fun about ANY part of this recovery?) I'm so glad to hear that you are able to partial weight bear and you aren't experiencing any bad pain.  You are going to start to feel human again!  I'm glad OS was able to give you some reassurance as well; those are great odds about destroying the graft site.  That actually gives me some hope as well.  I know how hard it is to not be scared of damaging it.  The last thing we want to do is go through this again! 

As for me, I was just feeling really down last night.  I'm having a lot of pain still from the scope and can't walk right yet and have resorted to using one crutch again.  I was reassured it was all normal, but I am just so seriously sick of this knee.  Out of the past 4 Christmases, I have spent 3 of them on crutches.  :-\  It just gets old, yk?  I doubt I will still be using a crutch by then this year, but just the fact that it is so hard to shop and get what needs to be done, done....well, once in awhile it just gets me down.  I was probably naive in thinking that after this scope I'd be fine in a week, but I was comparing it to step one of the CaReS and that's how I was with that.  Obviously, he did much more this time and I wasn't expecting to be so limited again.  It's simply my own unpreparedness that is causing this.  And then to not be able to do cardio again at the gym, it affects my brain.  So...every once in a while, on a rare occassion I let it get the best of me.  I'm feeling better now.  My husband gave me a great back rub and let me cry to him last night and I'm meeting my mom for breakfast today for some TLC.   :)  So it will all be good again.  And when I focus on the fact that my knee has cartilage again and I have proof of that...well...that is INCREDIBLE!  So, I just have to take my own advice and be patient again, focus on the positives, and endure this long recovery we all have go through with this procedure. 

Have a great day and I hope you continue to progress!  Thanks for letting me vent.   :)

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 07, 2007, 10:06:19 PM
Hi Kristi,
Sounds like you've had a rough time. I think we all have days like that though. I certainly do, and it can be the silliest little thing that sets it all off! I am dreading having more surgery on my knees. Most of me wants to go bilateral, as I don't want to have to go through it all twice, but a little bit of me is terrified at the thought of it! I have a lot of soul searching to do before I have any more surgery. By the way, what is CaReS? How does it compare to ACI? I am really dreading having a CPM machine, or two!! You all seem to hate it. I don't know which surgery my OS is going to suggest first though, so I may be worried for nothing. It also may not happen for many years (I wish!!). I suppose I can just take each day as it comes.
Bye for now.
Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 08, 2007, 12:08:37 AM
Hi everyone!

Kristi....I can totally understand how you feel.  When I had my other knee scoped over the summer, I too had the impression that within a week or so I would be back to normal and when it didn't happen I was frustrated.  I'm sorry to hear that you are having a lot of pain from the scope.  Not being able to be active (like I think we are both used to) really can play with your mind, especially when you realize that it may take longer than you expected to return to activity.  I'm glad that you are mentally feeling better today.  A good cry always seems to help me.  Sounds like your hubby is understanding which is so important.  I wouldn't have been able to survive this ACI surgery without my fiance and the support that he has been to me.  Just keep in mind that this is temporary and that when you are all recovered you will have a knee with good cartilage and that has been the goal from the beginning.  This is just a temporary set back that unfortunately you have to endure.  Feel free to come vent here when you need to.  Hang in there and I will be keeping my fingers crossed that you are able to ditch the crutch by x-mas.  Maybe both of us will be crutch free for x-mas...I'm hoping!!!

Kathy...I'm right there with you in the lack of sleep department. I feel for you that you are not sleeping and having to go to work.  I hate being tired when I am at work.  I'm worried about not being able to sleep when I go back to work and how I will function.  Not being able to sleep because of the knee gets really old really fast.  How are you functioning at work?  We are getting our christmas tree tomorrow which I am excited about.  I don't get to help cut it down this year, but I'm still looking forward to it.  I am jealous that it is summer where you are.  We had 3 inches of snow on Wed. and freezing rain today....scarry when you are on crutches. 

I am SO much happier now that I am able to weight bear.  I feel like my whole world has opened up.  Not having to use the cpm machine is fantastic!!  Although, I am so used to being stuck in bed connected to the machine that I am feeling pretty bored.  I find myself looking forward to returning to work...am I really saying that?  In therapy today I was able to put 55lbs of weight on my leg without pain.  I started doing heel raises and some leg presses on the total gym.  My knee is really stiff and I feel like my ROM is not as good as it was.  The cpm really helped with the stiffness.  I have an increase in swelling so that is affecting my ROM.   I'm going to try to use the ice machine tonight.

I got to take a shower today without having to keep my leg completely straight and propped up.  It was nice.  I am now allowed to stand up when I take a shower putting minimal weight on my leg, but my OS told me to be VERY careful.  Since I am supposed to be wearing the brace whenever I am standing, I need to be careful to protect the osteotomy.  I am still using the shower chair just because I don't feel comfortable just yet standing in the shower.  I still need support of some sort when I want to turn my body, so I will continue to use the shower chair until my leg muscles are a little bit more built up.  I look forward to the day when I can shower again like a normal person.  I figure that there is no sense in taking the chance of accidently falling because of my weak quads.  It is nice to know that when I am ready for it, I can stand up and shower. 

kathy, Kristi, Peg Leg...hang in there ladies...I'm thinking about you.

   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 08, 2007, 02:37:55 AM
Casey,
I am so glad to hear that you are playing it safe. You have too much to lose to risk a standing shower or injuring yourself by turning over in bed without the brace. Easing into these things is much better. I wish more of my patients would be more like you and less gung-ho.

Work is OK. I am a nurse in a rehab hospital. I get to sit down for most of the night. Getting in and out of the chair can make my knees ache by morning, especially as it gets cold on the ward at night, which seems to make any aching worse. We have two of us per ward, for safety reasons, so we can take it in turns dozing in an armchair if we really need to. I find that most night shift workers have developed an ability to hover in light sleep, so we will wake at the slightest noise or disturbance. When we get home it's different. During the early heavy sleep that I have when I first go to bed, I have slept through our smoke alarm before, and the phone (which is next to my bed). Once the heavy sleep is over then the outside noises and other irritations (knees!) begin to filter in and it gets harder to stay asleep, or get back to sleep once awake. I am currently on work restrictions, which may result in me being independently assessed through work, to determine if I am capable of staying on night shift. I hope so. I wouldn't last an hour on my feet during the day. Part of me would like a reason to give up work, but I know it would affect so much of our lives that I don't think it would be such a good thing.

Well, gotta sleep. Bye for now. Keep well girls.

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 09, 2007, 03:26:39 PM
kathy...I'm glad to hear that you have the opportunity to sit down at work and rest your knees.  I spent some time as a graduate student in a hospital setting training to be a speech pathologist and the nurses were always so busy running around all over the place.  I guess that at night most of the patients are asleep which makes it not quite as stressful on the knees.  For your sake, I hope that you don't have to switch to day shift. 

Things seem to be going well for me.  I can now comfortably put about 80lbs of weight on my leg and up to 100 if I push it.  I put my leg on a scale and shift my weight on it to see if I can increase the amount each day.  Right around 100 is when I start to feel some pain, so I'm assuming that I am putting about 80lbs on it when walking around.  I can now take some steps with just one crutch but it is not easy so I'm sticking with two crutches for now.  Each day I see improvements in my ability to put more weight on my leg and anticipate that I will be down to one crutch sooner than I expected.  I was up and about a lot yesterday and I noticed that when I got home last night, putting any weight on my leg was difficult and I actually resorted to NWB for comfort reasons.  I am not using the brace now when sleeping.  Sleeping is such a problem for me right now.  I can sleep comfortably on my side now, but still can't move around in my sleep because my leg is so weak that rolling over and even moving without me assisting my leg is not possible.  I wake up multiple times a night with my hip hurting or my back hurting or just muscles hurting because of staying in one position for a long period of time.  I do not wake up with pain in my knee except for early in the morning and that seems to quickly resovle itself.  The sharp pains that I was having are pretty much gone.  I have maybe one or two a day and they usually happen when my leg is in full extention and even then they are not as bad as before.  What a relief that they are gone!!  I have some aching in the knee when I sit or lay with my legs completely straight so I just avoid that.  Swelling also seems to be an issue.  I have had increased swelling since I have started walking and my calf is also swelling now (I guess from the osteotomy?).  I hate icing because it is winter here and putting a cold ice pack on my knee is not fun.  And of course I have one roommate who wants to turn the heat down/off to save money.  I'm also having trouble motivating myself to do my exercises.  I hate doing those things.  I've done so many PT exercises over the past two years for knee/back problems that I want to barf.  I've got to figure out how to get motivated to do them.  Even though I want to ditch the crutches badly and you would think that would motivate me, it isn't it.  I only did my exercises twice yesterday.  I was thinking that if I increased the reps of each exercise when I actually do them, then maybe I could just do them twice a day instead of three times a day. 

Last night my fiance and I went out on a date which is the first time we have been able to do that since my surgery.  It was fabulous and so nice to be out, even though I got lots of stares from people.  We went out to eat and then to look at Christmas lights.  When we went out to eat, we were waiting to get our table and I caught one lady staring at me and I kindly smiled at her and looked away.  Later when we left the restaurant, I caught the same lady staring at me again.  This time, I stared back at her and suprisingly it took her awhile to look away.  Crutches and a big old brace sure do attract attention.  But, I don't care, I was just happy to be out. 

I picked up a new prescription yesterday from my OS.  I asked him if he could prescribe something stronger than tylenol  but that was not a narcotic.  He prescribed ultracet.  After reading the info about the drug, I'm not so sure I want to take it.  It says that it can be habit forming which is not what I wanted.   I have not tried it yet for pain because my pain has been very tolerable these past 24 hours, but there are those moments when I would like to take something for pain and tylenol doesn't cut it.  I'm not sure that I understand why ibuprofen/anti-inflammatory meds are not an option after ACI surgery.  I understood why after my microfracture, but I don't understand the science behind it for this surgery. 

Off to do my exercises!  :P
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 09, 2007, 09:49:46 PM
Hi Casey,
I wouldn't worry too much about the Ultracet. Use it if you feel the need. I take Tramadol (Ultracet is Tramadol and Acetaminophen/Paracetamol) and I have had no problems with it. I actually find it's hard to take too much of due to it's side effects. I get very nauseous if I take too much. We use it a lot at work and have much less problems with it than other narcotics, so far as dependency. Just be aware that it contains Acetaminophen (Paracetamol) so you cannot take it within 4 hours of anything else containing Acetaminophen, and you can only have a maximum of 4g Acetaminophen per 24hours. Tramadol is available here in a slow release form, and my GP will give it to me once I have an idea as to how much Tramadol I take over 24 hours - that way I might get better sleep.

If I had to switch to day shift I think I'd leave work. Though I'd give things a fair go first. Being a rehab hospital helps keep it quieter at night. Our ward is geared to people almost ready to go home. they are the sort of patient who has been ill and lost condition and just needs a bit of intensive physio before being able to cope at home. So for the most part they are independent. Night time consists of giving bedpans, giving pills, taking blood sugar levels, assisting people to get up to the toilet (mostly just standing there to make sure they are safe), and emptying urine bottles. I was on a spinal injury unit, where we had to turn patients every three hours, and it was quite heavy. I requested a move from there before my surgery, as I was struggling physically, as well as being mentally drained. Now with my restrictions I can't go back there.

It's funny what people stare at. You'd think braces and crutches would be common enough not to warrant that much attention, but some people are just plain nosey!

I wonder if your swelling is due to the increased movement from weight bearing and flexion. Things may be getting a bit irritated, as they haven't worked that way in a while. I imagine it will settle down soon. The other night I was dreaming that I was out with my family and we were walking up and down a steep hill. My knees were getting more and more painful and, in my dream, I got out two walking sticks and hobbled around with them. I woke up to find myself on my stomach with my knees pressed into the mattress - they were killing me! Just the pressure on them was enough to start them aching big time.

I know what you mean about the exercises. I increased my reps in order to drop the amount of times I did my exercises, as I was struggling to fit them in with work and everything else. I don't think it has made a difference. I don't see much improvement in my quads, but my calf muscles are getting stronger, so it's not the change in exercise regime. I think it's knee pain causing quad inhibition. I'm not quite sure how to overcome that. I try to contract my quads here and there as a gentle way to strengthen them, but they are very resistive. Oh well. I'll get there in the end.

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: djs60 on December 10, 2007, 03:18:45 PM
HI Casey,

The reason some OSs don't want their ACI patients to take ibuprofen or other NSAIDs (non-steroidal anti-inflammatory drugs) is that NSAIDs (at least in theory) can interfere with cartilage growth.  My OS doesn't want me to use any NSAIDs until 9 months postop (I'm now 7.5 months out).  It hasn't been much of an issue for me, as I really don't have any pain now.  Hang in there - things will get better.

djs60
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 11, 2007, 12:36:30 AM
djs60...thanks for the info about the NSAID's.  My OS didn't tell me how long after surgery before I could take them again.  I'm glad that you mentioned that your OS doesn't want you to take them until 9 months post op.  What kind of activity are you able to do at 7.5 months out?  I'm glad to hear that you don't have much pain. 

Kathy...thanks for the info about ultracet.  That makes me feel better to know that it is not that easy to get addicted to it.  I took it last night at bedtime and again in the middle of the night and it is the best that I have slept in awhile.  I actually stayed asleep for 5 hours before I woke up.  It definately helped with the aching muscles.  I'm sorry to hear that you are also having trouble sleeping.  When I was using the cpm machine, I used to wake up frequently thinking that I was in the cpm machine and I felt like my leg was moving in the machine and I was not in it.  It is weird what our minds can due when our bodies are not working correctly.  Is your PT using e-stim on your quads to help them?

Today I used just one crutch all morning long.  I was extremely encouraged by this since I was just given the go ahead to weight bear four days ago.  My knee was painfree when using one crutch.  My PT watched my gait as I walked with one crtuch and he said that it was pretty good and that I was walking heel to toe.  After therapy, I had to go back to two crutches as my leg was just too tired after all the therapy exercises.  Since therapy, I've been having some pain around the kneecap which is also preventing me from using just one crutch.  My PT also said that my quad muscles were starting to feel better.  I have to start spending a couple of hours a day with my leg completely straight because I am starting to lose some extension because I've been keeping my leg bent almost all the time.  So, overall, I feel as if things are going really well and each day I see progress.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 11, 2007, 01:17:27 AM
Well done Casey! Each day seems to be bringing you more improvement. Good to hear you got some sleep with the new meds. I just wish they didn't make me so tired when I take them. I am sick of feeling tired all the time. I do have my good days, don't get me wrong, but I feel like I am constantly tired due to lack of sleep of the effect of pain meds. I think I need to be more careful about what I eat and maybe take a multivitamin or something, just to help perk me up a touch. I must admit, when you do permanent night shift you seem to get sleep obsessed, and sleep or lack of sleep dominate your life. I look forward to having a different job one day.

My PT hasn't used e-stim. I am hoping he sees some improvement when I see him next week. I have been trying the bike in short spurts, to decrease the irritation to my knees. I haven't made it into the pool yet, as I just haven't had time. I prefer things I can do at home. I am persisting with as much exercise as my knees can tolerate, and have gone back to little amounts of exercise often (rather than one or two big efforts daily). I feel pretty good at the start of the day now, once the morning stiffness is over, and I don't limp until I have been up for a while. My right quad is what does me in. It still trembles with sustained contraction and doesn't have much strength or endurance.

Good luck with the extension stuff. Hopefully you can regain what you've lost and stop any further loss. Gee, all the things we need to look out for with our knee problems! It's enough to give us headaches for the rest of our lives!

Keep up the good work.

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on December 12, 2007, 12:59:51 AM
Hi Casey. Sounds like you are doing great.  That is so encouraging.  It really helps to move forward and using one crutch instead of two is quite a feat considering you've only been given the WB okay a few days ago.  I really think it makes a huge difference having PT during your whole recovery period.  By the time I was allowed to do PT, my quad was so atrophied, it took quite some time to get it back.  Keep up the good work!   ;D

The Ibuprofen thing.  Dare I say I have no memory of not being allowed to take it after my surgery?  :-\ I took Percocet for that first week at least and for quite some time after that just to sleep at night, but I've been taking Ibuprofen since I stopped needing that. Now I'm all curious as to why I wasn't told to stop it or if I was, if I just don't remember and maybe I did start later?  But I know there is no way I stopped taking it for 9 months or even 6 or 3.  I'm going to pull out my post op instructions from last year and see what they say.  It's so interesting to see the different protocols we all have isn't it? 

As for people staring, I totally know how you feel.  You can do what I did last year: I decorated my crutches.  I figured if I was stuck on them through Christmas, I might as well make the best of it. And since people stare anyway, might as well give them something fun to look at.   :o  I went shopping over this past weekend by myself and it was pretty aggravating.  I still have to use one crutch or else I limp horribly and put too much pressure on my calf and I swear, people are so rude!  You wouldn't believe how many people didn't bother to hold doors for me or even move out of the aisle (if they were standing there talking) when they saw me coming.  I was so tempted to accidently "bump" them as I went by, but I didn't. I finally finished what I needed to do and came home pretty frustrated.

Kathy, CaReS is similar to ACI but it uses a  3D scaffold that OS can fit in the depth as well as the area of the defect.  It is also "glued" as opposed to being stitched.  This is supposed to make recovery quicker and it's supposed to reduce the complications you see in normal ACI.  My OS so far is encouraged by what he's seen as far as it being a better option for articular cartilage damage, but it's certainly not the cure all we all are hoping to find.  If you are interested, you can read more about it in the link on my first post of my thread here. 

Good luck to both of you!   :)

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: djs60 on December 12, 2007, 09:26:12 PM
Casey & Kristi,

On the NSAID thing, I don't think all OSs tell their patients not to take them post-op.  As I wrote above, they  can in theory interfere with healing, but I think that info is in vitro lab stuff, and hasn't  necessarily  been shown to be a problem in people.  I'm guessing that the reason my OS told me not to take them for 9 months is that by 9 months, one hopefully has good graft fill.

In terms of my current activity, I ride a stationary bike 3 or 4 times a week for 25 minutes at moderate resistance.  I have been going to the gym 2 or 3 times a week to do some weights with my legs.  I still have quite a bit of quad atrophy on my operated leg.  My PT (i'm no longer doing formal PT) had thought it would take a year to get the quad back to normal. I don't think I limp at all at this point, but I do notice weakness in the leg going up and down stairs.

Regards,
Dan
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 15, 2007, 10:13:08 PM
Hi everyone,

Things are still going good for me.  I was given the go ahead to weight bear one week and two days ago and I am officially down to one crutch when I am walking around the house.  I still take two crutches when I go out just because I might come across steps and plus I can get around so much faster with two crutches.  Also, it helps to remind people to stay clear of me.  My knee has very little pain.  The only pain that I feel is if I put too much weight on my leg.  It is not quite ready to take the full weight of my body.  However, I am able to take a few steps completely crutch free.  I limp horribly when I try it but at least it lets me know that I will soon be able to walk crutch free.  My hip muscles have been bothering me more than anything.  My PT says that it is from weak glute muscles.  My hip muscles ache and they keep me awake at night.  It seems that no matter what position I lay in at night they hurt.  Tylenol seems to help but does not completely solve the problem.  I continue to see improvements in the overall strength of my leg.  I still need to assist my leg to move it at times, like when putting it in and out of the brace and moving in bed.  My biggest complaints at this point is that I am still having a lot of trouble sleeping and that my hip muscles hurt.  I have noticed that getting back into a daily routine is very tiring.  Spending 6 weeks in bed took a big toll on my overall stamina.  Just going to therapy tends to wear me out and I want to take a nap when I get home.  I'm not sure how much of this is due to lack of sleep and how much is due to my body adjusting to a new routine.  I am still planning on going back to work at the first of the year.  Because I have to walk a lot at my job, I have decided to go back for half days for at least the first week.   

Dan...thanks for the info about anti-inflammatories.  I think I will ask my OS at my next visit to see when he clears me to take ibuprofen.  I can't believe how long it takes to rebuild the quad muscle.  My PT also told me that it would take 6 months to a year to get my quad back.  How long did you do formal PT for?  My PT keeps telling me what a long rehab I have and that I will be in therapy for awhile.  I'm ok with going to therapy because it keeps me motivated to do my exercises at home.  I'm surprised that you still have difficulty with stairs.  I had no idea that it would take that long to get back to doing stairs normally.  I hope you continue to see improvement!

Kristi...Sorry that you had an aggravating shopping experience.  It is amazing how people either stare at you when you are on crutches or completely ignore that fact that you struggle to open a door or get through an aisle.  Now, that I can get out and about, I have been to several stores where I have been trying to open doors and just look ridiculous because it is difficult to do and no one bothers to help.  However, I have run into several very nice folks who have opened doors for me.  I guess it will only make us better people because we will know to jump at the chance to open the door for someone who needs it.  How is your knee progressing?  Have you been able to ditch that crutch yet?  Good idea about decorating the crutches...I might just do that!

kathy...The ultracet makes me very tired as well.  I couldn't stand how tired it made me so I quit taking it.  It seemed to linger in my system for a good 12 hours after I took it.  I hate being so tired.  You should ask your PT if e-stim would be beneficial for you.  Maybe that would help your quad.

Hope everyone is doing well.

     
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: djs60 on December 16, 2007, 03:17:16 PM
Hi Casey,

I did formal PT for 5 months (although at the end I was just going once a week).  At that point, my insurance co. cut me off (although I was really at the point then when I was ready to fly on my own).

My PT told me one year to get all of my quad bulk/strength back (which is amazing, since I lost it all in a month!).

To clarify, I can do stair pretty normally, but I am aware of the weakness I have in my left quad when i'm doing stairs.

Dan
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 19, 2007, 08:08:21 PM
Tomorrow will be two weeks since I was given permission to weight bear.  I'm down to no crutches and I'm quite happy about it ;D  I will still take one crutch with me when I am about and about.  Yesterday I used one crutch on and off and today I have not used the crutch yet, however I can tell my leg is pretty tired.  I may need the crutch this evening.  I am at 90 degrees active ROM and 98 passive.  I have not really made any progress with my ROM in the past two weeks.  I was at 95 degrees two weeks ago. My PT got in touch with my OS to see if he could start doing some type of manipulation on the knee to help with flexion.  OS cleared for some manipulation techinques but not others.  My PT would like for me to get at least 5 more degrees of flexion in the next five days.  Today I got an e-stim/TENS unit to use at home to help with the quad muscles and pain.  My knee feels good.  A little pain if I put too much weight on it.  My gait is not so good.  I have to work on bending my knee as I am keeping it pretty straight when I walk and I am also to work on thinking about walking heel to toe.  Apparently, I look like a "zombie" when I walk with my straight leg.   :P
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on December 20, 2007, 01:42:33 PM
Wow! 2 weeks already! That time has flown. Supposedly once you have got beyond 90 degrees flexion the rest is fairly easy to come by, so I hope it doesn't continue to be a long hard slog for you. Hopefully manipulationg will help. How's the strength progressing? Mine has come to a standstill, at least in my right leg. I still cannot get a strong and steady quad contraction. The muscles quake and quiver every time I contract them. My left quads contract well but have poor endurance, but I think I have had some improvement, though very slight. My PT has said that I am probably not going to progress beyond my current exercises (great, how boring!), and that my main aim now is to not go backwards. One worry is that now my patellae are in a different position (from the LR) the cartilage damage might spread  :P The damage I have now is what my PT called a "significant amount". I don't really want more!! I might be joining you on the ACI road sooner than expected! My PT was surprised I haven't been offered more surgery already, though he is under the impression the damage is too much for grafting and that I am an ideal candidate for patellofemoral resurfacing. I am less sure. My OS mentioned grafting, so I assume it IS an option. I am not so sure about PFR as I have read that its not overly successful, and where do I end up if it fails? They can't just remove it, and the only surgical option it leaves me with afterwards is total knee replacement. At least with grafting I don't end up in a worse situation if it fails, and I can still have various other surgeries afterwards. Hmm. I hope my OS can help explain it all better and give me some advice. I am happy to continue as I am for the moment, though I had hoped for better endurance. If I don't do too much then I don't ache excessively, and I have good ROM and sound ligaments. I am worried about surgery making things worse somehow. The LR surgery didn't improve things much and just bumped off the last bit of strength in my quads. I don't know if it was a good trade off!!

I hope your improvment happens quicker than mine!!  ;D Happy walking!

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on January 02, 2008, 03:35:20 AM
10 weeks post-op:  Yesterday, I ditched the crutches for good.  I can now go out in public without taking a crutch with me.  I have trouble with steps but as long as there is a railing, I am ok.  Curbs are still a challenge and I need to hold onto someone if I come across a curb.  I don't think my leg is strong enough to hold my body weight on steps yet.  I have very little to no pain in the knee when walking.  If I do too much ROM work, then the cell site gets sore and sometimes gets sharp pains.  I have been doing lots of ROM work.  I had a week off of PT because I went out of town for the holidays, but as of last week, I was at 90 degrees active and 100 degrees passive.  So, I have only gained 5 degrees in three weeks time.  My PT mentioned that if I don't have some improvement by next week when I see my OS that he will talk to my OS about possibly getting me a dynasplint to help with ROM.  So, I have worked really hard this week on my own, hoping to get an increase in my ROM.  I see my PT again tomorrow and am anxious to see if I have made any gains.  I'm not interested in getting a new brace, especially since I have not even ditched the big old immobilizer brace yet.  My OS wanted me to keep him updated on my progress via email.  I emailed him this week informing him of my progress.  Based on the description of my progress he said that everything is developing normally and that my flexion is a bit of a concern, but not unsolvable.  Sleeping is getting a little bit better.  Now that I am gaining more and more strength in my leg, turning over in bed is easier.  I can now fully move my leg on my own without me having to assist it.  I still have to sleep with a pillow between my legs mainly due to the swelling in my knee which is uncomfortable without a pillow.  I am still waking up at night with pain in my hip but I'm taking tylenol for it which sometimes helps and sometimes does not help.  I was planning on returning to work for 1/2 days tomorrow but there was some miscommunication between me and my surgeons office so now I will not be returning until after I see my OS on the 10th. 

Kathy...I'm glad to hear that you are weighing all your options when it comes to surgery.  For me, my OS decided on ACI because if the ACI fails then I have the option of having OATS.  It is important to know what options you have if surgery fails and also to keep up on if your cartilage damage is spreading.  My lesion grew 50% in one year which is why I pursed ACI.  I'm glad you are thinking through your future options thoroughly!  Did you ask you PT about using e-stim on your quads?  Why does your PT think you won't progress beyond your current exercises?  Is that because of pain?  I have had a really hard time getting my quad muscles back in my "good" knee from my scope over the summer.  I will admit that I don't work on them much, but I did prior to my ACI and still couldn't get them to where I would like them to be.  And I don't think laying around in bed after my ACI helped them much either.  Now when I try to work on them, it just aggravates the knee, so I have not been doing anything to work them.   Good luck with those quad muscles!
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on January 02, 2008, 11:18:54 AM
Hi Casey,

Good to see you back. I hope you have a good Christmas and New Year. Great to hear you ditched the crutches. Bummer about the flexion though. How are you going with day to day activities and general endurance with walking? What about driving? My biggest concerns if I have surgery are about getting the kids to and from school and having enough paid leave to rehab fully without financial strain. The other thing is how to go about having both knees done - both together, or staggered; how much to stagger them by; which one to do first. Decisions, decisions!! That's assuming that the areas haven't grown and put me out of the running for ACI surgery.

I am sort of where you are with stairs and steps. It's a huge effort to get up a step, and going down is a matter of semi-controlled falling!! I usually do it sideways one step at a time using my right leg to step down. Rails are a must and a stick as well is even better. Curbs aren't too bad if they are average size as I can step out long going up and down so I don't have to bend as much in the knee and can use some of my hip muscles too, though I still have to stop and hesitate unless I am fresh. Muscle fatigue makes my knees buckle, especially going down a step.

My PT doesn't think I'll progress beyond my current exercises because I just cannot build up enough quad strength to put more loading on the knees. As it is I am struggling to maintain my right knee. If I miss a day of exercises then I notice a difference the next day! The left has sort of made some gains, but not nearly what it should have for 3 months of PT. I admit I am not the best at religiously doing my exercises, but I see gains in some things that don't match the gains in others - the calf raises I am supposed to do have improved well on my left leg and it is the exercise I do the least of, as I do it last and it gets dropped off the end or done in a hurry if I am pushed for time. I do as many SLRs as I can fit in but I struggle every time to get the reps done. It is probably the knee aching that inhibits the muscles. I have seen a bit of improvement in the endurance of my left, so I am pushing to get more if I can. I figure that even one good leg is an improvement. I don't know how I'll go if I get ACI on only one leg when the other isn't reliable. I have found out that I have some sick leave up my sleeve, so the ACI route may happen sooner than expected, but I am still playing with the idea of conservatively managing things for a while, just to see where it gets me. I have discovered how to keep the aching to a minimum (by avoiding longer than an hour on my feet) and it may result in improved muscle strength if I can keep the aching at bay and push the PT. My one problem is how to cope if I want to do more than my knees can handle, so I'll have to explore options with my PT - whether walking sticks or crutches could help keep some load off so I can do more than sit around the house all day. I may yet make some gains in PT which reduce the need for surgery or make recovery much quicker. Here's hoping!! I don't see my PT or OS until mid-Feb, so I am going to keep my feet up as much as possible and push the exercises in the meantime.

Good luck with the flexion. I hope the break relaxed you enough that you can make some gains there. May you gain enough quick enough to steer clear of another splint!!

Kathy.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on January 05, 2008, 12:40:05 AM
Well, I am still not making any gains in my ROM.  :'(  I am still measuring at 100 degrees passive flexion ROM.  Which means I have not gained anything in the past week and half and I have only gained 5 degrees in the past four weeks.   :'(  I did gain 5-6 degrees active ROM so I guess all the ROM work I did this past week was at least worth something.  My PT started his re-eval of my knee today so that he can write a progress note for me to take to my OS when I see him next week.  He said that he will put something in his progess report asking my OS if a dynasplint would be beneficial.  He also wants me to ask my OS about it.  I SO don't want to get another brace especially when I am just about to hopefully ditch the immobilizer brace.   I am worried that the dynasplint will be uncomfortable and painful.  I understand that it will be worth it if this is what will keep me from having to have a manipulation procedure.  My PT also mentioned that if my OS feels that the cells and the osteotomy are healing well, that he may have me go back on pain meds so that he can bend my knee further in therapy.  I'm not real sure how well that will go over especially since pain meds tend to make me sick sometimes.  I'm already fearing that I will get sick at therapy and besides I don't know how I would drive myself to and from therapy if I am on pain meds.  I keep going back to the fact that the cpm machine was not set up correctly for the first three weeks and I am now wondering how much affect that had on my diffculty with regaining my ROM.  As I struggle to get my ROM, I am getting pretty bitter towards the guy who set the machine up wrong...again, where is his integrity?   ???  So, I guess I will just wait until the 10th and see what my OS recommends and then go from there.  I'm still having a lot of trouble with my hip muscles and they are still keeping me awake at night.  I had to take percocet last night just to get some sleep.  Even with the percocet, I still had some pain.  My PT has looked at my hip flexion and muscles and said that there is some weakness but he thinks that the pain is probably the result of how I am walking.  I am still walking funny, kinda limping, kinda wobbling from side to side a bit.  I've been working on it and it has gotten a lot better, but my gait is still off.

Kathy....My endurance with walking is probably pretty poor.  I have not tried to do any type of extended walking.  Since my gait is still fair-poor, I figure that extended walking can't be good, especially since my gait is aggravating my hip and also an old back injury.  So, I'm still taking it easy. I'm hoping that once I ditch the immobilizer brace that my gait will improve.  I have no problems with driving except for that dang hip which hurts if I drive for too long.  I responded to you in another thread about some stuff.  I can understand your concern about how one leg will hold up if you choose to do ACI on one knee at a time.  My OS told me that I probably would not cause any more damage to the lesions on my "good" knee, but that it would most likely get aggravated from having to take the brunt of weight bearing for a long period of time.  He was right about it getting aggravated.  Hang in there and keep me updated on how you are doing. 
 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on January 07, 2008, 09:02:18 PM
Made some progress!!!  :)  I measured at 105 degrees active ROM today and 110 passive.  Finally, I am seeing some progress with my  ROM.  I know I am still way behind where I should be for this point of my recovery, but I'm just happy to finally see something.   Will see what my OS has to say on the 10th. 

Worked on my gait today in therapy.  My gait is still way off and I'm finding it difficult to retrain my body and my mind on how to walk correctly.  Even with my therapist guiding me, I still couldn't quite get my gait to normal....will keep working on it.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on January 07, 2008, 10:13:01 PM
Hey Casey, well done!! Slow progress is better than no progress.

What does your PT have to say about your gait? Is it better to use aids and have a more normal gait, or is it better to ditch the aids despite a poor gait? Mine deteriorates as I get tired and I am wondering if it's better to use aids (crutches or sticks) to help keep a more normal gait, as well as to unload the knees a bit more so I can stay on my feet longer without aching. I am also concerned that if I don't make an effort to normalise my gait then I may have trouble with it after ACI surgery, or any other surgery for that matter. I think I'll have to add it to the long list of things I must ask my PT when I see him next.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on January 07, 2008, 11:17:28 PM
Kathy,
You will have to let me know what your PT says about the gait issue.  I have read on these boards that it is better to be using a crutch/cane to keep gait more normalized.  My PT had me try a cane at therapy one day to see if that helped my gait and mentioned me using one for a week or so.  But, he never really came to the conclusion that I should do that.  Other than that he has not said anything about going back to one crutch to keep my gait more normalized.  My gait has improved some from when I first ditched the crutches, but it is still pretty poor.  I guess I am not bending my knee when I go to swing my leg through the motion of walking...or something like that.  My PT said that once I ditch the brace, I may need to just endure the pain that normalized walking causes to help me learn how to walk correctly again.  Not looking forward to that.  Trying real hard to walk normal, but just can't seem to do it.  I would imagine that the more we work on normalizing our gait the better.  I don't want my mind to start thinking that walking like this is ok.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on January 08, 2008, 02:29:34 AM
Casey,

My PT wanted me off crutches and cane asap to help build my weak quads, but my gait was so bad and caused me pain, that I finally went back to 2 crutches for a weekend, then 1 crutch for a few days. I was around 12-13 weeks before I could drop them completely.  I eventually went to an unloading brace, which did help me finally get into full extension, which helped my gait a lot.  Hang in there!!

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on January 08, 2008, 06:59:19 AM
Hey Guys!

I thought I was doing so well last night at work. I was trying to concentrate on walking better but then my boss came through the door and said "You walk just like Delia - it must be a knee thing". Delia happens to be a nurse who has recently had bilateral TKRs!!! Great for the ego - NOT!! I think it's a stiff knee/weak quads sort of problem, which then worsens when aching becomes part of the mix. I have really good flexion but my knees seem to have a touch of stiffness to their bend. I don't know. I'll have to get PT to look at it. I gotta wait till Feb 12th though. My PT is not big on lots of appointments! (For which my finances thank him!!)

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on January 12, 2008, 12:49:41 PM
Almost 12 weeks post op:  I saw my OS 2 days ago.  I got to ditch the big immobilizer brace.   ;D  ;D ;D I was given a new brace that is much smaller.  I am to wear it whenever I go out abd I am allowed to go without the brace when walking around the house if I choose to.  My OS was not too concerned about my flexion.  He said that he would like to see me around 115-120 and to keep working on it in therapy.  I am at 110 right now.  He was concerned about my extension.  I preveiously thought my extension was good.  I was under the impression from my PT that I was only 1 degree off from full extension.  However, I learned from my OS that there is a difference between having full extension when lying on a table with my leg flat on the table verses being able to fully straighten my leg out in front of me from a sitting position.  So, I am getting a dynasplint to help with my extension.  If my extension doesn't improve in the next three to four weeks, then my OS wants to scope my knee to snip away any scar tissue that is preventing me from being able to straighten my knee.  My OS also seemed to think that my extension problems are causing my limp.  He said he was unsure if my extension issues were a result of the cpm being set up wrong.  I finally went back to work yesterday. I am doing half days for the first week just to let my knee get used to all the walking around that I have to do and also to let my body readjust to working.  My first day back went really well and my boss was very accomodating which was nice. 

kathy....sorry to hear about your limp.   I can't wait to get rid of my limp.  I have gotten called several names which I know people are teasing when they say them, but it really annoys me. 

Peg Leg...how is your knee?  Are you making any progress in PT now? 

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on January 14, 2008, 11:32:09 PM
I'm making good progress on my flexion now.  I am at 113 active and 123 passive.  All those wall slides that I have been doing everyday are paying off.  I saw my PT today and he seems to disagree with my OS on the extension issue.  He feels that if I can almost get full extension when lying on a table that my inability to get full extension when sitting in a chair and straightening my leg is due to weak quad muscles.  He doesn't think that the dynasplint is going to do anything for me.  Does anyone else have any input on this?  Does this sound like a scar tissue issue or weak quads? 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on January 19, 2008, 03:04:38 AM
Casey,

My guess would be weak quads.  I have been dealing with this for a long time, now.  I can get into full extension when walking, but not when doing a SLR.  My PT firmly believes that the quads are the culprit.  Hopefully, the e-stim will help us both out.  Turn that thing up girl!!                                                                                                                                                     

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on January 20, 2008, 07:46:05 AM
Casey,

I must agree. If you can actually get the leg straight then there is nothing blocking it from straightening and it is just quad strength that is stopping you from actively straightening it from a sitting position. It's good to hear that you are making progress anyway. I'd crank up the e-stim and see how it helps.

I found out that my limp is from avoidance of buckling - I take my weigh slowly and carefully through my right leg and then quickly flick my left foot through to take my weight before I have to bend my right knee too much. When I get tired then I shift to a more stiff legged gait as both legs then ache and are more likely to buckle. Apparently it is not a concern and will correct itself once my quads get stronger. Here's hoping!! I reckon I should push for e-stim! I feel like I am going nowhere fast with my quads!!

Good news about the brace, Casey!! Despite the extension, you are really making progress, and it's great to see! Well done!

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on January 22, 2008, 02:19:47 AM
Peg Leg and Kathy....thanks for the words of encouragement! 

Kathy....the gait problems drive me nutty.  I am so anxious to get rid of my limp.  I find it really hard to concentrate on how I am walking and am doing everything I can to actively think about walking correctly.

Peg Leg....I think of you now when I go to do my e-stim and keep telling myself to turn the machine up and that if you can turn yours way up, then I can too.   ;) 

I got my dynasplint a few days ago.  It is not nearly as bad as what I had anticipated.  My PT still thinks that I need one for flexion and not extension.  I am seeing gains in my active extension so he might be right.  The dynasplint has not been painful, although it gets uncomfortable after a couple of hours.  I was told to wear it 6-8 hours at night while sleeping.  I have not slept in it yet as I've been trying to get 4-6 hours in during the day.  It is so much like my immobilizer brace that I don't want to sleep in it. Tonight will be the first night that I will try to sleep in it.  It does bother some muscle up close to my hip when I put a pillow under my heel while wearing it.  This is what I was instructed to do, but the first time I did that, I was in so much pain after two hours in my hip that I had to take pain meds.  Without the pillow, it feels much better with just a little pain in my hip.  My gait seems to be getting a little better or at least I think so.  I'm not sure that my PT would agree with that, but both my fiance and I think that I am not favoring my good leg as much.  I'm getting concerned about my flexion.  I don't feel like it is making the progress that I would like to see.  Most of the time, I feel like I can bend to about 90 degrees.  I get more in therapy but that is after warming up and stretching out.  I am working on it a lot, but this past week, I feel like I have hit another road block.  I guess I have to remember that it is a slow process.  My knee feels good.  I don't have much pain in it at all.  I have no pain when walking.  I get an occasional sharp pain here and there if I move wrong or something.  Some of my PT exercises are painful, but I think that is just because my knee is not ready for them yet.  I am pleased with how my knee feels and think that once I can get beyond my ROM difficulties that things are going to get even better! 

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on February 03, 2008, 02:09:01 AM
Casey,

How are you doing?  How is your flexion coming along?  Are you still using the e-stim? Any improvement in the quads? 

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on February 04, 2008, 04:50:41 PM
Peg Leg...Thanks for asking how I am doing.  How is your knee doing?  Any change in your quads?  how is your pain?

Today I am 15 weeks post-op.  I am at 128 degrees fexion when my PT pushes on my knee and 120 on my own (all after stretching the knee out).  It feels more like around 100-110 throughout the day. It still feels quite stiff, but I can tell that it is not as stiff as it was just a couple of weeks ago.  I have been using the dynasplint for extension each night and on the weekends when sitting around.  I have pretty good extension in therapy.  My PT has not measured it recently but I think it is pretty much straight.  I know that I do not have my few degrees of hyperextension back yet.  I am still unable to fully straighten my leg out in front of me when sitting.  My limp is definately better than it was a month ago, but it is still there...ugh!  I HATE my limp and would really like to get rid of it.  My PT wants me to do pool therapy on the days that I don't see him, but I can't find a pool in the area that doesn't have funky open swim hours.  Most of them are during the day when I am at work or 5:30 in the morning.  I still have a fair amount of swelling in my knee and I'm still wearing my brace when I am at work or out and about.  I'm extremely anxious to ditch the brace, get rid of my limp and get full ROM back.  Previously I was having some difficulty with my knee kinda buckling inward when standing and walking. This is improving as my quads get stronger, but I still don't look quite right when standing.  I switched braces to a bigger brace that I had from my microfracture surgery as my smaller brace was causing some funky swelling.  My PT likes the bigger brace better because it keeps my knee from pushing inward and forces me to keep the knee straighter.  I'm still working on my quads and can see improvments during therapy as exercises that hurt a couple of weeks ago are not painful anymore.  I have also been slowing increasing the amount of weights that I use during therapy.  I can not see any visable change in my quad muscles but my PT says that I have more control of my quads now and they are are finally not flickering when I contract them, so that is good.  He also said that my quads are not coming back as quickly as we would like.  I try to use the stim machine at home when I remember, but I must admit I have slacked off a bit this week.   I have developed some sort of new pain on the outside of my kneecap (not on the side of my knee where the cells were implanted) which is rather annoying because it is causing pain during therapy which is preventing me from completing all of my exercises due to pain.  My PT is not sure what the new pain is and thinks it might be related to my muscles getting tired at the end of the day as I mostly feel it after a day at work or when I am at PT (which is after work).  I have little to no pain where the cells were implanted.  I don't have any pain when walking and the only time I feel pain where the cells are located is sometimes during therapy if I try an exercise that my knee might not be ready for yet.  For about a week, I was getting sharp pains around my incision site about once or twice a day, but those are gone now.   I get some random pain in my screw site from time to time which is annoying but I am not worried about it since I know that the screws can come out if needed.  My PT thinks that I will not have to have surgery to deal with scar tissue problems which is great news.  I am supposed to keep in touch with my OS by email, but I will wait another week or so to allow the dynasplint to keep doing its thing.

I'm definately learning that this is a LONG process to full recovery.  I have some days where I feel good that I can see some sort of progress and other days where I am really frustrated that things seem to be moving so slowly.  Despite the ups and downs of this recovery and just how long it takes to recover, I still feel pretty confident that the cells are doing well.  I am driven by the fact that I will soon have a knee that is almost as good as it was before I injured it and that with time I will be back to doing the sports that I love.  Even more so, right now, I would be happy just to take a walk around the neighborhood.  :) 

I hope everyone is making good progress in their rehab!! 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on February 20, 2008, 07:12:20 PM
18 weeks post-op:  Still making progress.  Slow, but steady.  ROM continues to come back slowly.  I do not have full flexion yet.  I have full extension on my own, but do not have hyperextension on my own yet.  I still have a fair amount of swelling in my knee which may be affecting my flexion.  I am still limping, although it seems to get a little bit better each week.  I think within the next month I will be walking normally (or at least I hope so).  I am still walking with a bent knee as I can't fully straighten it on my own when walking.  I still have an extensor lag but it has definately improved over the last month.  I continue to use my dynasplint for 2-3 hours a day.  I am no longer using a brace.  I quit using it for the most part last week.  My knee feels pretty good.  I continue to walk without pain.  I get the occasional sharp pain when I move wrong, but I'm not worried about that.  I tried a session of pool therapy this week which aggravated the knee a little, but it calmed down.  I am down to two sessions a week of PT and I will start working out at the gym on my own once a week and once or twice at the pool on my own.  I found a pool that has reasonable hours.  My OS said that things sound reasonable and that I need to continue to keep pushing it in therapy to get my strength back.  I got fitted for custom orthotics this week to help with my knee buckling inward which will hopefully help my gait.  I was cleared by my OS to bike on the road, but have not tried it yet.  Going up and down stairs are still difficult and I need to hold onto the railing, but I am able to do them now without the brace which is good.  I am using the biodex at PT and a couple of weeks ago, I could only get my leg to push 12 lbs and now I am up to 20-30, so I am making progress, it is just SO slow. 

Yesterday, I found out that my insurance company rejected the claim for my cells from carticel, so now I get to go through the appeals process.  They said that it was experimental and they won't pay for it.  I also found out that they rejected the claim for my stim machine of which I was told by the company who gave it to me that it was covered.  Apparently, the insurance company also considers the stim/tens unit to be experimental.  So, now I get to pay the bill for that.  Guess I will be sending the stim machine back ASAP.   Sometimes, I wonder if the people who make all the decisons in the insurance companies would have the need for a procedure like carticel if maybe then they would change their mind about what is experimental and what is not!  I would never wish knee problems on anyone, but the idea that insurance companies are just out to make money and not get people better drives me crazy sometimes. 

 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on February 26, 2008, 03:06:23 AM
I took a 30 minute walk yesterday and paid for it today.  All the muscles around my knee were sore today.  I was able to walk pain free except for one sharp pain when I tried to fully extend my knee when walking.  That was the first long walk that I have taken since my surgery.  My knee was just slightly sore today with some very mild aching for a little while.  My leg got tired the last 10 minutes or so of the walk.   My PT measured my extension today and he thinks that I can discontinue use of the dynasplint.  I have +3 extension on my own so I am good to go with my extension.  I will email my OS and see if he agrees that I can discontinue use of it. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on February 28, 2008, 03:57:32 PM
Well, my OS stills wants me to use the dynasplint until the swelling in my knee decreases.  I don't exactly understand why I still need to use if if I have full active extension.  I have persistent swelling that is affecting my ability to achieve my end range flexion.  My OS prescribed an anti-inflammatory for me to take for two weeks.  If the anti-inflammatory does not decrease the swelling, then he wants to scope my knee and clean it out.  I'm a little torn about having a scope, but a friend of mine who is a PT assured me that it would not put me back that far in my recovery and that it may actually speed things up. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 03, 2008, 01:03:31 AM
4 months post-op:  Rode my bike outside today for the first time since my surgery.   ;D ;D I had to make the bike seat a little higher than usual to accomodate my ROM difficulties.  The knee did great!!  I had no pain when riding.  I went on several hills and rode for about 35 minutes.  I do have some increased swelling which I assume is normal since I was pushing it on the hills.  I was able to tell a difference between the quads on my ACI knee and my good knee.  My good knee was definately compensating some for my bad knee as I could feel the burn in my good knees quads.  It felt great to bike outside!  It really helped my mental state to know that I am heading in the direction of returning to the sports that I love. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on March 03, 2008, 06:06:52 PM
Awesome News, Casey!!  I 'm so glad that you were able to get outside on the bike; it's really uplifting for our moods to be able to do something physical that we love!!  Keep up the good work and keep us posted!

Peg leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kathat on March 04, 2008, 11:09:43 PM
Fantastic news Casey! I can understand how much it would have helped you mentally. We all need boosts like that from time to time.

I am wondering if your OS wants you to keep up the Dynasplint because the swelling might cause you to lose your extension easily if you are not vigilant, so he wants to play it safe and ensure you keep the extension you have gained. I had issues with pain not long after surgery, and it only took a few days of pain on extension for me to lose some extension, due to not extending fully because of pain. It was so quick to occur, so I can see why your OS might want to be cautious. Hopefully it won't be for too long. Keep up the good work.

Kathy
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 08, 2008, 12:33:32 AM
So, I've come to my own conclusions as to why I am still limping.  I have discovered that when I am walking I bend my knee (I've been walking on a bent knee for two months now) but I do not straighten my knee (meaning pushing my knee back so that it is straight when going through the whole motion of walking. So, I've been trying to go through the whole motion of walking and pushing my knee back so that my leg goes straight.  When I push my leg straight, I get a REALLY sharp pain around my incision.  This is the same spot that I have been complaining of since week two or three.  For the past two months, I thought that I was limping due to weak muscles and that I wasn't kicking the lower part of my leg out enough when I was walking and that was preventing me from straightening it and now I don't think so.  The straightening is not occuring at the knee and not below the knee.  I don't have hardly any, if any, extensor lag anymore so my muscles have gotten stronger.  I think that I have some scar tissue in there that is causing me some problems.  The pain does not feel like it is on the bone where the cells would be.  Anyone have any idea what this might be?  I'm don't want to practice walking correctly because of the fear of the pain.  I'm really kinda afraid that my knee might buckle and I will fall because the pain is quite severe.   I have to email my OS in a couple of days to let him know how my swelling is doing and I will let him know about the sharp pains then.  I'm not sure if the anti-inflammatories have done much for the swelling.  Some days it looks a little better and others not so much.  My PT will measure my swelling on monday to see if there has been any change.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on March 08, 2008, 08:24:31 PM
Hey Casey!  I'm way behind, but since we are getting a blizzard and we're pretty much snowed in, I've been able to get caught up on your progress. 

Sounds like you've had some ups and downs, but mostly ups. I can totally relate to the limping; I STILL do that, but I do it more since they did the scope in November than since my actual surgery.  I'm anxious to hear what your OS says about it.  I've had some issues; I'll post in my thread when I'm done here to update.  I partially attribute the pain I still get to the fact that I don't walk correctly.  I really think I'm irritating my knee and by the time I finally do walk normal, it hurts because of the limping.  Does that make sense?  It sounds similar to what you are experiencing. 

Great news on riding the bike.  Isn't it a HUGE mental boost to be able to do something "normal" in the course of all this?  Hopefully you'll be back to all your favorite activities before you know it. 

Keep up the good work and keep us posted.  I will try to check in more often.   :)

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 12, 2008, 06:30:38 PM
Well, there were no changes in my swelling and my knee is even a little more swollen in one spot than it was two weeks ago.   I have spoken to my OS and he thinks it is time to scope my knee.  He said that this is the time period for overgrowth.  I will get a new x-ray this week and I am scheduled for surgery on Monday the 17th.  I'm very ready to get it scoped so that I can move forward in my recovery and hopefully get rid of this stinkin limp.  But, I am still as nervous as I was for every other surgery.  You would think that after three knee surgeries, I would not be nervous, but I am.  I know that a scope is a simple procedure and that it will be nothing like the ACI/HTO, but somehow my mind doesn't process it that way.  I'm anxious to see what he finds in my knee and if my cartilage is growing well!! 

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on March 14, 2008, 04:17:43 PM
Good luck on Monday Casey!  We'll be anxious to hear what he finds.  I hope it's nice new cartilage.   ;D  Hopefully, he can just do some cleaning up in there and you can get on with your progress. 

I'll be thinking of you!

Kristi

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Goju on March 14, 2008, 05:56:21 PM
casey,

i had an aci with fulkerson osteotemy july of 2007 by doctor levy also. don't be alarmed by having to get scoped. i had to do it at the 4 month mark too, and so did a friend of mine, also a patient of dr. levy. the swelling still remains slightly with me and i am 8 months post op. the limp will disappear in time. i went through the whole, "its taking to long" frame of mind and it just gets in the way mentally. relax, it will happen. just give it time. good luck
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: jonhark on March 14, 2008, 06:34:59 PM
Casey or Gobu--
Any warmth with your swelling?

I don't have swelling but do have warmth. Your so right. This is really a time thing.

Jon
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 15, 2008, 11:09:09 AM
Kristi...thanks for the words of encouragement.   I too hope he finds nice new cartilage!!

Goju...thanks for sharing your experience.  It is very helpful.  How does your knee feel now?  Any pain?  What are you able to do activity wise?  How long was it before you lost your limp?  I will try to take your advice and relax.  :)

Jon...I have some warmth with my swelling.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 18, 2008, 07:15:40 AM
5 months post op:  Had my scope yesterday and my OS said that my new cartilage looks FANTASTIC!   ;D ;D ;D ;D ;D ;D ;D ;D ;D  My OS cleaned up scar tissue on the lateral and medial side of my knee. I have not spoken to him yet to get any specifics of the operation, but he told my fiance twice yesterday that my cartilage looked fantastic.   ;D I will find out more info today when I speak to either him or his PA.  I will start back to therapy right away.  This was my first operation out of 4 where I actually woke up in pain, but all the pain has easily been controlled with pain meds.  Most of the pain seems to be where the incisions are.  I am not using crutches and could have walked right out of the surgical center without them.  I did need them to get up the steps yesterday, just as an extra support. I get to take the bandages off today and am anxious to see how much swelling is present and how much of a limp I still have.   I'm looking forward to moving forward in my rehab.  So far, the recovery from this scope has been a walk in the park compared to the ACI/HTO surgery. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: djs60 on March 18, 2008, 02:06:35 PM
Hi Casey,

That is great news - hopefully treating the adhesions will cure your limp.

Keep us posted,

Dan
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: David3 on March 18, 2008, 03:31:06 PM
Great news Casey!!!  Having had a similar message to yours after my scope only a few days before you, I know how much this means. The new world record for smiley faces is deserved!!  Hope this boosts your progress.

David
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on March 18, 2008, 08:14:42 PM
Casey,
That is super news!!  You're going to walk down that isle without a limp; I just know it!!!!! ;D ;D

Peg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: celinenj03 on March 18, 2008, 10:08:59 PM
YAY! I'm so glad to hear it Casey! Scopes are no big deal unless they are actually doing something other than a clean up. I'm so happy for you. I can't wait to hear all your progress from here on. You should whiz right through now.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 18, 2008, 11:16:03 PM
Hey everyone,
Thanks for rejoicing in my good news with me!!  I took the bandages off my knee today and it looks really good.  It is just a little bit more swollen than when I went in before surgery.  I don't have any brusing and I can already tell a difference in how I am walking.  I am still limping, but I can feel that something is different.  I'm thinking I might need a bit of gait training after limping for the past two months.  I saw my PT today and he measured my ROM at 115 on my own which means I have lost 10 degrees but he said not to worry because the swelling is going to affect my ROM.  He also said that the swelling in my knee feels very fluid like where before the surgery, it felt more hard.  So, that was also good news because now I should just have to wait for the fluid to drain from my knee over these next couple of weeks.  I am working on simple ROM stuff and simple quad exercises.  I did some of my same exercises at the gym today that I was doing before surgery.  Of course, I did them with less weights or resistance, but I could tell that I have lost some quad strength, but I don't think I took a huge step backwards.   A lot of the exercises my PT cut out for now until I can gradually add them back in.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 19, 2008, 05:58:31 PM
Went back to work today and already I have had three people tell me that I am walking better than before my scope and my scope was just a little over 48 hours ago!!  It is very exciting to be getting these types of comments as the comments directed towards my limp were getting VERY old.  Gosh, I love being able to report good news on this site.   :) ;D :)
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on March 21, 2008, 10:08:46 PM
Wow Casey that is AWESOME news!!!!  I am so happy for you girl.   ;D  I just know you are going to continue to make great progress and be "normal" soon.   I'm glad to hear you are doing so well after your scope and you already notice a difference in your limp.  Did you ever think walking normal would be such an amazing thing to rejoice in?  LOL!

Keep us updated.  It gives me hope. 

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 28, 2008, 04:05:29 PM
Well, I am 12 days post-op from my scope to remove scar tissue.  I have an infection in one of my incisions.  :(  :( :( I just contacted my OS office and got a script for an antibiotic.  I have until Monday for it to improve and if I doesn't then I have to go in for an appointment.  Very bizarre b/c I had my stitches removed two days ago and everything looked good.  Yesterday, one of the incisions started to bleed a little bit and I just barely touched around it and a bunch of pus came out.  No redness or swelling at the incision area.  Very gross, I know!!!  The thought of an infection kinda freaks me out because I don't want to have to go back in for more surgery to get the knee cleaned out due to infection.  However, I am so pleased with the improvment in my gait.  ;D ;D  I think it is almost totally normal with just a small limp.  The more I walk on it, the more I notice that I limp, but I am ok with a limp if it is due to my muscles being tired or from being on my feet for too long.  I do not have my ROM back yet which is worrysome to me, as I am fearful that I am forming more scar tissue already.  My knee is very stiff and I still have some swelling.  I wonder if I am just expecting too much too soon after my scope.  I keep comparing it to my previous scopes where I had no trouble getting my ROM and no stiffness at all.   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: David3 on March 29, 2008, 02:11:58 PM
Hi Casey,  Sorry to hear about your infection - hope the antibiotics get it under control quickly.

I am 15 days post-scope for removal of scar tissue. Don't know whether this will put your mind at rest, but I also have swelling and am recovering ROM more slowly than I had expected. I had naively thought that I would recover as quickly as I had done after my biopsy scope, but this is clearly taking longer. Maybe just the nature of the beast? However, the swelling is improving gradually, as is ROM. I'm now at about 125-130 degrees flexion and am seeing an improvement every 3 days or so. I'm keeping activity level low and icing several times a day, as well as massage and patella mobs. I'm also cycling 30 mins a day, at very low resistance, all as advised by my OS. I'm now expecting another few weeks before swelling is gone. The good news is that the pain and lumpiness from pre-scope is all gone. 'Inside' my knee feels fine. I'm still very optimistic that my knee will feel good once the swelling subsides.

David
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: celinenj03 on March 30, 2008, 06:39:45 PM
Sorry about the infection, I hope it clears up fast, I'm sure it will be fine.

When I went in for my scope, I had FULL flexion and even then it took me about 4 weeks to get it back again and I don't have real scar tissue issues so I would imagine it would take a good 6 weeks for the knee to calm down. I think all that saline in there too takes time to work out.

I always found too that doing the stationary bike very gently each day helped to improve my flexion. I would pedal with no resistance for about 10 minutes to loosen the joint up then do wall slides immediately following while the knee was warmed up. I did this about 5-10 times a day!

You are still quite early days of scope for full ROM to come back, so hang in there!
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on March 31, 2008, 01:34:19 AM
Casey,

I've been thinking of you and hoping the infections is responding to the antibiotics.  I'm glad that you have had so much improvement in your gait; I remember how rewarding it was for me when I FINALLY lost the limp!  When I had my scope in Dec.,the Dr. cut a lot under my kneecap, and it took me 4 weeks or more to feel better.  Keep us posted!!

Peg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on April 04, 2008, 04:42:07 PM
Hi everyone,

Thanks to those of you who shared your experiences about your recovery after your scopes!!

Well, after a worrisome week, changing antibiotics, and a four hour trip to my OS, I think I am pretty much out of the woods for having an infection deep in my joint.  My OS thinks that the infection is a superficial skin infection.  Thank goodness because he said if I got an infection in the joint that it would destroy my cells.  I am to take the antibiotic until Monday, go off of it and email my OS twice next week to let him know how it is going.  I was given specific things yesterday at my OS visit on what to watch for in case I have an infection in the joint.  I've had a lot of increased pain this past week where I had to take percocet and even though my OS did not appear concerned about increased aching and stiffness, I think in some way it was related to the infection.  Each day since I have started a stronger antibiotic it feels a little bit better.  I was limping a lot the past couple of days, but today I am starting to walk better again (still not quite normal yet) and things don't feel quite as stiff, although the knee is still quite stiff.    I am getting some sharp pains on the medial side of my knee which I don't know what exactly they are and my hip is apparently weak again after the scope because it has been killing me.  At least I know that the hip pain is just muscle weakness and nothing to worry about.  In therapy two days ago I had active flexion of 130 and passive of 138.  This was super encouraging to me because that is the best that I have had since my ACI surgery.  I finally feel like achieving full ROM is an achievable goal!!! 

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: David3 on April 04, 2008, 09:48:18 PM
Good news that the infection is under control Casey.  And good news on the ROM too!  I'm rooting for you to continue to make progress!

David
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on April 09, 2008, 07:31:05 PM
Yesterday was three weeks post op for my scar tissue removal and I am quite pleased with the knee!!  The increased pain that I had last week has subsided and today my knee feels more like normal than it ever has since the original surgery.  My ROM continues to improve every few days and I am getting closer than ever to full ROM.  All aching and sharp pains are gone (at least for now).  I'm walking better than last week and I am starting to be able to walk somewhat fast...still have that "slight" limp.  I walked almost a mile over the weekend pain free which was a huge success for me.  I stopped my antibiotics today.  OS wants me to stop the antibiotics to see how the knee responds without them..  I am no longer concerned about infection.     
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: zoeygrl on April 13, 2008, 06:08:40 PM
Hi Casey, my name is Mary Ellen and I had my HTO and carticel transplant two weeks ago.  I have read through all your posts with great interest.   I haven't had any problems with my knee and leg at all. :)   I guess I'm very lucky.  I stay in my cpm 6 hours a day and am up to 80 degrees, I sure hope it's set right! After reading your post, I may call the woman who set it up for me and ask her to come back to make sure!  No pain at all, I'm just taking Tylenol on occaison.  I've been to the pt twice and he gave me excercises and a stim machine that I use to keep my quads contracting, I hate it but it helps.  I've been out a few times crutching around but no driving for me for another 6 weeks until I'm able to wait bear.  It's my right knee so I'm completely dependent on everyone for everything! 

I am sorry to hear of your secondary surgery and infection.  My surgeon says he won't go in again unless I have problems...sounds to me like the problems started after you begin to weight bear? 

I am very interested in your recovery and look forward to reading more about your situation.  I am 47 years old and my boyfriend has been really great though he is encouraging me to do more for myself.  I can shower by myself now as I have a shower chair.   I can't get out of the house by myself at this point due to the leg brace and I'm a bit scared I'm going to fall.   All in all, I have very little pain and no swelling other than at the transplant site.  I have a bit of shin pain where I guess they did the osteotomy.  I feel really good and hope to go back to work part time by the 2nd week in May.   

Thanks for your posts, reading all of this is just great! 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on April 15, 2008, 02:10:07 AM
Today my PT videotaped me walking on the treadmill to evaluate my gait.  He took video of me walking in my socks, my shoes without my orthotics, and my shoes with my orthotics.  He discovered that my right hip (NOT my operated leg) is weaker than my left hip and that my left ankle (operated leg) has about half of the ROM of my right ankle.  So, we are going to work on correcting these things and hopefully that will correct that last little bit of my gait that is still off.  The knee feels great.  I have had some increased swelling these past four or five days, but I think it is because I am starting to do more on it.  My PT said that it may be months before it is all gone and I may still have swelling at one year post-op.  PT also said that I am turning the bend in the road....it feels really good to hear him say that and to agree with him!!

Mary Ellen...glad that my posts were helpful to you.  It sounds as if you are doing fantastic!!!  I'm glad to hear that you don't have pain and that everything seems to be right on track.  I remember all too well being stuck in the house and being dependent on my fiance for so many things.  I'm glad that your boyfriend is doing a good job of taking care of you.  Having someone like that to help you out makes recovering much easier.  I hated my stim machine as well.  When I found out that the insurance company was not paying for it, I gladly sent the thing back.  If you are renting it from your insurance company, be sure to double check to see if they pay for it.  My insurance company told my PT that it was 100% covered only to find out three months down the road that they wouldn't pay for a cent of the rental.  Fortunately, the company that I rented it from, gave me the rental for free.  Keep up the great progress!!!
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on April 15, 2008, 06:13:08 PM
Spoke with my OS today via email to update him on my knee is doing now that I have been off the antibiotic.  Found out some info.  He said that 5-9 months is when I will see the most improvement and that it is important to remember that the cells continue to improve for up to three years...wow, I thought it was 18 months.  I am to wait 3-6 more months before I can even consider rock climbing (which was not really a surprise to me) and I need to wait until all the swelling in my knee resolves before I can try any hiking (which at this rate may be awhile).  So, I will just keep plugging away at my current exercises and hope that the swelling decreases soon!!
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: David3 on April 30, 2008, 06:24:13 PM
Hi Casey,   

Interested to hear how things are going after your scope. Is swelling still continuing to subside? ROM getting better? No signs of any recurrence of scar tissue?

David
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on April 30, 2008, 06:58:26 PM
David,

I posted my progress over in your post-op diary, but I figured I might as well post here as well.

I still have some swelling in my knee that increases and decreases with activity.  I have not seen much change in my swelling since my scope and to me it is still pretty swollen.  I have increased my time on the elliptical to 25 minutes and I am now walking on an incline on the treadmill for just a few minutes at a time.  No pain in the graft area when on the elliptical or treadmill. After about 7 minutes of incline walking on the treadmill, I start to limp just slightly and that is when I stop.  I get occasional pain if I move wrong or if I try to do the elliptical two days in a row.  I may feel some soreness, but nothing that is significant and it always goes away overnight.  I have had some pain on the lateral side of my knee which is not even close to my graft.  I'm not sure if that is scar tissue or the mechanics of my knee being altered due to swelling.  I am close to full ROM passively and am about 10 degrees off from full active ROM.  Still have a slight limp.  I'm happy with my progress at this point. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on May 12, 2008, 01:57:16 PM
I found out that Blue Cross/Blue Shield has decided that they are going to pay for my ACI procedure.   ;D ;D ;D   The claim for growing my cells was denied the first time.  I appealed it and the medical reveiw board approved it.  I anticipated a much longer battle to get it paid.  This is a huge relief!   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on May 12, 2008, 03:26:20 PM
Casey,

That is great news!! I am sure you are very relieved!  A good early wedding present  ;)

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: celinenj03 on May 15, 2008, 06:46:46 PM
YAY! That is a big relief! You don't need that extra stress/worry. So how many days until the big day!!!! Maybe you could start another thread and keep us posted. We need good stuff to look forward to!!! Weddings, new babies, etc. It gets kind of hum drum around here sometimes so any thing you can share please!!!! ;)
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on May 23, 2008, 03:55:27 PM
Well, less than a month until the big day!  I am getting married June 20th and can't wait.  I saw my OS yesterday to try and resolve some pain unrleated to the ACI before my wedding.  I've been having pain on the lateral portion of my knee right along the edge of my kneecap.  OS thinks it is patellafemoral due to muscle imbalance or the osteotomy putting some extra pressure in that area.  I am going to try a brace and celebrex to see if I can get it calmed down before the wedding and while I am away on my honeymoon.

As for the ACI, I am now 7 months post op.  I have a little bit of swelling.  My limp is pretty much gone, although I do still limp some after working out or sitting for an hour or more.  The limping doesn't last long and seems to quickly resolve itself.  I still feel like there might be just a little something off in my gait although my finance says I'm walking completely normally.  The graft area feels pretty good.  I overdid it recently as I was moving and had to do a lot of stair walking.  That aggravated the graft area and I got several sharp pains every day for about a week.  However, it calmed down and I am back to being completely pain free.  My OS said that the random pain is still normal at this point.  I am now able to walk on the treadmill at the highest incline level for about 8 minutes before I start to tire.  I am up to 30 minutes on the elliptical and can now do the elliptical more than one day in a row without any pain.  I can easily walk several miles.  My OS just cleared me to "try" some light hiking on level terrain.   I intend to be very cautious at first and test the knee out to see how it feels.  I do still have some difficulty with stairs which I'm sure is due to my still weak quads.  I am still shy of having full active ROM, but can passively achieve it.  MY OS's PA said that it will mostly likely come with time.  I see improvements each month with my knee.  Still happy that I had the procedure done!!!   
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on May 27, 2008, 06:31:48 PM
I took my first short hike yesterday since the surgery.  I walked for about 20 minutes on a trail that was mostly flat, but also had a few hills.  I hung onto my finance when going up and down the hills, mostly because my leg is still weak and I don't want to risk reinjuring myself.  The knee felt fantastic.  It did swell some and is still swollen today, but the swelling is not accompanied by any pain.  I plan to wait a few days and then go out again for a longer hike, increasing my time each time if the knee responds well. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: zoeygrl on May 29, 2008, 02:02:49 AM
Hi Casey, I know your wedding is coming up soon and I wanted to say thanks for how much you've inspired me on this board. I am now 9 weeks post op HTO and ACI and feeling pretty good.  I too am a hiker and can't wait until I get back to hiking.   I havent been cleared to do too much more than walking weight bearing as tolerated and have much swelling and pain in the evenings. Once my OS clears me I'll be doing pool therapy and more pt.   I hope I'm hiking in 6 months!   

Anyway, congrats on your upcoming wedding and stay in touch!   

zoeygrl 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: celinenj03 on May 30, 2008, 07:14:47 PM
You gals are doing great! It's nice to hear such good results as I am a "pending" victim. haha.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on July 14, 2008, 02:26:08 AM
Congrats, Casey, on your wedding!! I'm glad to hear that it went well and that your knee behaved!  Sounds like your honeymoon was a lot of fun (at least the part you shared with us knee geeks ;D)!!!!!!!  Let us know how it goes with those screws and whether they have to come out or not.  Take care and don't be a stranger!!

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on July 25, 2008, 04:17:37 PM
Peg Leg...thanks for the wedding congratulations!  How is your knee doing these days?  Is the recovery from your recent surgery as long as ACI?  I HOPE NOT!

zoeygirl....Thank you for the wedding congrats.  I'm glad that my post-op diary has been helpful to you.  how is your knee doing? Are you completely crutch free now?

9 months post-op:  I am generally happy with my knee at this point.  I was able to do some hiking on my honeymoon.  One day we did about 4 miles of hiking.  It was broken up into several short hikes.  Another day, we hiked along the coast line in sand.  And another day, we walked along a bunch of broken lava rocks.  Overall, it did really well.  I would get occasional sharp twinges of pain, particularly when I was on lava rocks.  And when I say occasional, it really was pretty infrequent.  My knee definately swelled, but the swelling has since decreased.  Sitting on the plane for a long time was uncomfortable after awhile and caused swelling, but nothing major.  I did find myself limping after awhile on the hikes.  I was not in pain.  I think my muscles were just tired.  We did lots of walking in sand and I had no absolutely no pain.  My husband notices that when we go out for walks around the neighborhood that I start off going at a good pace and slowly my gait and pace decreases.  I typically don't even notice that my gait has changed. 

Even after a month of not formally working out, I was able to jump fully back into my workout routine within a week of returning from my honeymoon.  I can still tell that my gait is not quite right and my knee still turns in a bit.  After watching my wedding video and seeing that I am still limping a bit,  I talked to my PT about helping me with my gait and he suggested that I have a gait analysis done.  One where they use electrodes on your legs and feet and do a really thorough investigation of what is wrong with your gait.  I have that scheduled for next Thursday (given that insurance decides to pay for it).  Both my husband and I have noticed that since I've been wearing shorts, a lot of people stare at my leg.  I'm not sure if they are looking at my scar or my poor gait....probably both.

I can still tell that there is a good bit of weakness in my leg.  It is visible, as well as I can feel it.  I still have trouble with stairs, but see improvements each month in my stair walking. 

I've been having some pain in my knee where I think the screws are located.  If I work out too much, they get pretty sore.  I have thought about having them taken out, but I'm just not ready quite yet for more surgery.

Hope everyone is having a good knee day!       
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on July 26, 2008, 01:23:31 AM
Casey,

It's so good to hear that things are going well for you! It would be interesting to see the results of the gait analysis. I've noticed the same thing with people staring at my leg when I walk.  I assumed it was my big honking scar they're looking at, but it may be my limp!  You also mentioned feeling pain where you "think" your screws are; there's no doubt where mine are as you can see 1 and feel both!!  I have really skinny shins, so no where for them to hide!

As for the recovery from my AMZ and LR, I was told to expect about 6 months of therapy.  My PT says we are rehabing from all of my surgeries and not just the latest, due to the muscle wasting and the limping I've done for almost 2 years. True to form, my quads are being very slow to recover. I'm biking and swimming everyday and doing my PT exercises,so hopefully those quads will shape up soon! The really good news is when I finally get my strength back, I won't have any limitations with the Carticel!! ;D Yea!!!  I'm 13 months out from ACI surgery, and I have no pain in my MFC at all;  for that i am thankful.

Keep us posted on your progress; I miss hearing from you!

Peg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: MegTX on July 26, 2008, 06:29:22 PM
My gait's pretty ok... I limp some when I'm tired.  My husband tsks at me when I start limping.  :)

If I'm wearing shorts, people do tend to stare at the scar.  I've taken to wearing bermuda shorts and capris... the bottom part of my scar (below the kneecap) wasn't under much stress and it's healed to be not as visible and people tend to not see it as much... but if I'm exposing the kneecap and the area above it... that part was under tension with the CPM and healed much wider and is still pretty red.  It draws attention and I get stares.  Most of the time I don't care, and I've ended up doing a lot of explaining that no, I didn't have a knee replacement ... it's why I'm messing with some henna 'tattooing' and seeing about covering it up with something a little prettier. ;)
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on August 07, 2008, 04:01:50 PM
Meg...My scar sounds just like yours.  The bottom part of my scar has turned white and looks pretty good.  The top part is still purple, although in the past month I have noticed that it is starting to look better.  I too wear bermuda shorts sometimes, but I also have shorts that are not bermuda shorts so my whole scar shows.  Sometimes, it is kinda fun to see who will stare at my scar....I know that it is just a natural reaction.  I work out at my PT clinic so it is mostly just patients and former patients at the gym.  I have made quite a few friends because people see my scar and want to know what I had done.     

Peg Leg...sounds like you are doing good.  I'm so glad to hear that you don't have any pain on the MFC!!  I bet you are really looking forward to having a "normal" knee again.  How long until you can start doing more things on your knee after your recent surgery? 

My gait analysis was a waste of time.  It was all computerized and it compared knee flexion, knee extension, hip rotation and force between the two legs.  Anything that was plus or minus one standard deviation from the norm was considered to be within normal limits.  Everything came up as normal for me except the rotation of my ACI knee which turns inward.  The test was done by an engineer who help design the gait analysis technology.  A PT came in at the very end of the test.  He looked at the results on the computer and said that everything was normal except for the rotation of the knee which he said was done to me on purpose by my OS when the osteotomy was done.  I was glad to hear that everything came up normal, but I asked him about my concerns that my gait is still slightly off and that I am still getting comments about my gait.  He just told me that the computer says that it is normal and that anything beyond that is between me and my OS or me and my PT.  He did not bother to actually watch me walk, he just went by what the computer said.  I was rather annoyed because I thought that they were going to really figure out what is causing my gait to be a little bit off.  Instead, they just went with what the computer said.  I understand stardard deviations quite well and I know that just because a result falls within the 'normal' range, that doesn't always mean that there is not a problem.  Oh well.  My PT is going to look at the report when I get it and see if he can't get to the bottom of my problem.  He suggested that maybe my problem is muscle fatigue.  It was kinda funny because the evening of my gait analysis, I had a friend over and my friend said to me "How is your knee because you look like you are walking kinda funny?"  I just had to laugh. 

I have noticed a big decrease in swelling lately.  I looked at my knees the other day and saw both kneecaps quite visibly. 

Still plugging away at my exercises to get my strength back. 

     
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: kalyjoe on August 07, 2008, 09:12:34 PM
Casey, it sounds like you guys had a great honeymoon.  Congrats again!!! 

I can totally relate to the gait thing.  I'm so sorry to hear tuat the analysis was  a complete waste of time.  I was anxious to see what they said.  My husband and good friends often comment on my gait as well, but I tend to point my toe outward as opposed to inward.  Even running today, I did that.  For me,  a lot of my gait issues is my hip.  My right hip is so much tighter than my left. When I take the time to stretch out my hip and really focus on relaxing it, I walk fine.  I really think it's a habit for me more than anything.  Maybe it's the same with you?  We tend to protect our knee for so long and we don't trust it.  It's hard to be able to do that. So we fall into the same routines.  I find that when I do walk abnormally, THAT is when I have the pain. I'm sorry you are still having issues with that, but it sounds like you are really progressing well!  Good for you!   :)

Keep us posted!

Kristi
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on August 25, 2008, 02:13:32 AM
10 months post-op:  My knee is doing great.  I rarely have pain in my ACI area.  I hiked a couple of miles today on pretty uneven terrain and my knee did fantastic.  I had one or two twinges of pain which I would assume is normal at this point when walking on uneven ground.  I have absolutely no pain in my ACI area for activites of daily living.  My husband and I walk 1-2 miles a night and my knee never hurts.  I continue to see improvements each month.  I am swimming now and am able to swim a mile without any problems with the knee (freestyle and breatstroke).  I've noticed that getting out of the pool by just pulling myself out of the water on the side of the pool is very hard on my hardware from my HTO.  It is not painful, it just feels very weak in that area.  I'm starting to be able to see quad muscles again and my calf muscles are finally starting to look decent again.  My PT routine is starting to get easy and I've been able to increase my weights in the gym.   My leg still gets tired, typically after working out or if I walk more than 2 miles.  Usually, I can tell when it is tired because my gait starts to fall apart, not due to pain, just my muscles being tired.  I still have a little bit of swelling and my knee still swells with too much activity.  My only complaint at this point is that my gait is still slightly off and I still get comments from friends and co-workers that I am still limping a little.  I just don't know how to get rid of the limp.  It is not due to pain and I don't recognize when I am doing it.  I'm really starting to see that all the hard work that has gone into rehabing my knee has been worth it.  I'm anxious to see how my knee does when I return to rock climbing (which will hopefully be soon). 

Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on September 22, 2008, 01:25:54 AM
11 months post-op:  Today I did some easy rock climbing.  Overall, my knee did great!  I did three easy climbs and was very careful not to twist or pivot the knee.  I had two moments where I felt the slightest bit of pain and the pain was fleeting.  My knee was slightly sore when I was done but the soreness was gone before we finished our 10 minute hike back to the car.  I was very pleased that I was able to do some easy climbing.   

I had a slight set back about three weeks ago.  I slipped and got a really sharp pain on my graft area.  the knee swelled and I had to take a week off from working out due to sharp pains on my graft.  All seems to have calmed down now expect for some pain that is not on the graft area.  I'm not sure if I have have done something else like torn my meniscus or not.   the pain is not that bad so I am willing to live with it for now. 

I am still limping a little and still seeking out someone to help me with my limp.  I have had four people comment to me this past week about my limping.  It is slight but enough that people are still noticing it.  I'm getting so tired of people asking me if I am limping!! 



Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on October 23, 2008, 11:17:42 PM
12 months post-op:  I saw my OS today.  I went to see him because my knee never seemed to feel quite right after I slipped about two months ago.  I kept having inconsistent pain and was unsure if I damaged my cells or something else in my knee.  After examining my knee, my OS thinks that my pain is due to my plate from my ostetomy.  He is unsure if I did something to the plate when I slipped.  I am very sore in the area of the plate and he thinks that is what is causing the pain in my knee.  He wants me to get a new x-ray to see if the screws or anything have shifted.  He also wants to take my hardware out.  He said that he thinks from examining me that my cells are fine.  I was not sore when he pushed on my bone where my cells are located.  Thank goodness!!!  He also does not think that I have torn my meniscus or damaged anything else when I sliipped.  So, I am going to go ahead and have the hardware removed in December.  The recovery will be about a month.  I will be partial weight bearing for a week and then I must protect the knee for the first month post op so that the holes in the bone where the hardware is located can heal.  Then, I am free to do whatever activities I want.  It sounds like I will have to wear a brace of some sort for awhile after the hardware removal. He is also going to scope the knee at the same time so that he can take a look at my cells. 

Activity wise I have been kinda careful about what I have been doing just because I was unsure what was going on with my knee.  However, I rock climbed this past weekend and I was able to do some moderate level climbs PAIN FREE.  It felt fantastic to get back to the activity that I love.  I also hiked three to four miles the same day that I climbed.  The hiking involved lots of hills and I did not have any pain while I hiked until the very end of the day and then my knee started to feel a little sore.   My knee was sore for a few days afterwards, but now I suppose the pain was due to my hardware.   

About three weeks ago, I saw another PT to see if I could get rid of my slight limp.  The PT evaluated my gait and reviewed the video of my gait analysis that I had done in July.  He discovered that I was not fully extending my knee when I walk.  So, he worked with me for one session and made sure that I could do it correctly.  He sent me on my way and I practiced on my own and within a week or two, I was walking normally.  I am no longer getting comments that I limp.  It feels good to have finally ditched the limp!!



 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Peg Leg on October 28, 2008, 02:35:02 AM
Casey,

Hey Friend!! I am so glad to hear that you are getting back to the things that make you happy!!  That is great news.  I'm sorry you have to have another surgery, but hopefully it will eliminate your pain.  I am 16 months out from ACI and I only occasionally have pain in my implant site.  Because of my Osteotomy 10 months later, I have not been able to get back to the things that I love.  I am doing more in the gym, but I seem to have increased pain, and am forced to take something for the pain.  This past weekend, I went to an awesome party and danced quite a bit. I woke up Sunday to a lot of stiffness and more swelling than usual and pain.  So, I obviously cannot ramp up my activities too much!  I was so happy that I could even dance like my old self, that the pain after is ok., you know?  I was finally doing something that I loved and my hubby poopooed on my parade by getting upset that i was doing damage to my knee.  It's hard to understand how freeing it is to be able to do something that you hyaven't done in 2 whole years. Anyway, I am happy for you and your progress and I hope this hardware removal is a small bump in the road for you! Keep up the good work!!

Peg Leg
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 20, 2008, 05:00:41 PM
Hi Peg Leg,

Good to hear from you.  Sorry for my delayed response.  I'm sorry to hear that you are still having trouble with your knee.  Does your OS think that your pain will decrease with time as the osteotomy heals more or is the osteotomy fully healed? I'm glad that you could dance and enjoy yourself even if you had some pain the next day...it does feel good to get back to doing things that we enjoy!  I am always struggling with the fact that I can't do everything that I want due to my non-ACI knee.  I feel like I am always going to have to limit my activities to an extent.  My husband too worries about my knee.  He even told me the last weekend when we were out hiking that he thinks he worries more about my knee than I do.  He is always helping me when we go up and down hills. I am glad because I do still need his help on hills when hiking.  It is nice to have someone to cling too for stability.  I guess we should be glad that they care and are looking out for us.  After reading some stories on here about how some spouses treat their loved ones with knee problems, I would much rather have a caring overprotective husband than one that gets mad and annoyed with my problems.  I hope your knee is feeling better.  Keep in touch!! 

 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on November 20, 2008, 07:27:39 PM
13 months post-op:  I finally got up the nerve to try jumping on my knee.  I did it and had NO pain while I was jumping.  It was actually quite thrilling.  A few minutes after I did it, I had some pain, but I walked it off in a matter of a minute or two.  I think the pain might have been related to my plate and screws and not my new cartilage but I'm not sure.  In a few weeks, I will know how my new cartilage really looks when my OS takes my hardware out. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on December 16, 2008, 08:22:00 PM
14 months post op:  Good news!!  I had my scope yesterday along with getting my hardware removed from my osteotomy and my new cartilage from my ACI looks good.  :) :)   So, it turns out that the pain that I was having was due either to the hardware or scar tissue.  My OS removed a big band of scar tissue and I think that was what was causing all my pain.  All the months of rehab have been worth it to hear that my new cartilage looks good.  I will have to take it easy for about two months so that my bones can heal from the hardware removal and then I am free to do whatever I want.  I have not ever really pushed the knee because I was always a little afraid that my cartilage got damaged when I slipped a couple of months ago.  What a relief to know that I now have healthy cartilage in my knee. 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: SamB on December 16, 2008, 08:36:47 PM
That's great news!  I love hearing success stories from people that have already gone through this.  Have fun with your "refurbished" knee.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on February 13, 2009, 02:27:24 AM
16 months post op:  I thought I would check in and report just how well my new cartilage is doing.  This week I did some rock climbing and really pushed the knee by twisting it, taking really high steps on it and pushing off of it with my full weight.  I had no pain and I felt like I was back to my old self when climbing.  I am very thankful to my surgeon, Dr. Andrew Levy and his great staff for all that they have done for my knee.  I highly recommend him to anyone who needs ACI. 

I am still having some trouble with my knee.  I think that I have grown scar tissue again for the third time, but hey at least my ACI is doing great.  :)
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: Room 101 on February 13, 2009, 05:04:19 PM
Posts like these are really motivating  :)

Thanks for checking in!

Room 101
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: momhanaway on February 13, 2009, 08:29:11 PM
I agree, thank you for taking the time to post your successes.  My daughter is awaiting her surgery date and is home today. I was reading this to her.  Very motivating!
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: zoeygrl on April 12, 2009, 03:56:29 PM
Hi Casey!  I haven't been on here for the past few months and I'm very glad to hear you're doing so well.   I am scheduled to have my hardware removed on Thursday the 16th of April and I am so looking forward to it.  I'm 13 months post op from the HTO and ACI.   I'm glad to hear that went well for you.  I'm hoping to get back to hiking this summer and fall in Yosemite!   How is your knee doing now since your last post?   

Mary Ellen in KY
Title: Re: ACI and HTO on 10/22/07-It turned out good!
Post by: casey2291 on September 13, 2009, 01:56:49 AM
Almost 2 years post-op:  Overall, my knee is doing good.  I am able to rock climb, ice climb, hike and bike.  I do not have any pain with my activities of daily living.  My knee is not 100% but I am happy with it.  I am able to walk/hike about 3-4 miles before my knee starts to get a little sore (not sore enough that I need to stop but I do feel it a little).  I wear a brace when hiking and rock climbing because I have discovered that twisting my knee when hiking on uneven ground and when rock climbing causes it to get a little bit sore.  Wearing the brace allows me to hike and climb pain free.  I am able to work out at the gym without any pain.  My knee still swells when I overdo it but the swelling always goes away in a day or two.  I do have to be somewhat careful that I don't do too much activity on it consecutive days in a row.  For example, I may be able to go out for a long hike but may have to wait 4-5 days before doing something strenous on it again because it will be a little sore afterwards.  I have not really tried running on it just because I have problems on my other knee and I want to preserve my knees as much as possible.  I can however run for short distances (from my car into the store when it is raining) without any pain.  I can also jump pain free.  My knee doesn't feel perfect and it probably never will but overall I am happy with the results.  I think I went into this surgery thinking that my knee would be perfect afterwards and I would be able to return to a high level of sports.  My knee might not be up to par for competitive sports but I am out there doing the things that I love and I will take that any day over not being able to do those things.  Six years after my initial injury and four surgeries later, I finally feel like there are no more trips to the OR in my future.   :) 
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: courtem10 on September 14, 2009, 06:45:54 PM
That's great to hear, Casey. It sounds like you're knee has made excellent progress. I'm so impressed that you are able to do all those activities with no pain. It's a bummer you can't run though, because that is the main activity I am looking to get back to after I am healthy again. But it seems like you have additional problems and that is preventing you from running, so I guess it's a different situation. Anyways, keep us updated if anything changes or improves further.

Courtney
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: casey2291 on March 04, 2010, 04:54:15 PM
2 years, 4 months post op:  I finally got up the nerve to run on my knee on the treadmill.  I finally felt like my knee was ready for it.  I am taking it easy, walking for a few minutes and running for a few minutes (at a slow pace).  My knee is doing great!  I have NO pain when running and I ran almost a mile yesterday.   I have just a little pain when I get off the treadmill, but I am able to walk it off within a few minutes.  I am so excited to be able to run again!  I'm not sure how far I will push it in regards to running because I have little lesions on my non-ACI knee that I want to be cautious about.  I must say that even at 2 years out I am still seeing improvements in my knee.  I now find myself running up and down stairs, skipping steps, without even giving a thought to the knee.  The knee is not perfect and I doubt that it will ever be perfect but I am willing to accept a little bit of pain here and there.  I had an incident a couple of months ago where I aggravated it but a little celebrex calmed it down and it has been great ever since.  The farther out I am from the operation, the happier I am that I went through with it.  I really doubted that I would continue to see improvements beyond 1 year, let alone 2 years but yet I'm still seeing improvements.  All the pain and hard work of rehab was worth it.
Title: Re: ACI and HTO on 10/22/07-It's going to turn out great!!
Post by: crankerchick on March 04, 2010, 05:11:07 PM
This is a very encouraging post! I'm glad things are still going well and thanks for coming back to post. Long term follow up is something that is sorely missed around here. It's so helpful to hear when people are so far out from surgery and still problem free and even better, still improving. Thanks for the post.