KNEEtalk

The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: LILS on February 19, 2010, 04:50:20 AM

Title: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on February 19, 2010, 04:50:20 AM
Hello,
    I will be having my ACI surgery soon and will be given 2 weeks off for convalescent leave. When I go back to work after that, I will be sitting strictly at a desk all day. I don't do any lifting or anything strenuous at my job. My questions are: Is 2 weeks enough time to be off, even if I will be sitting at a desk or is that too soon to go back to work? Will I need to find something to prop my knee up all day at work? Will it be okay to wait to use my CPM until evening, since I will be at work all day? I've just read that recovery is rough the first FEW weeks and that's from people that are at home the first 4 weeks. Has anyone here gone back to work within 2 weeks after ACI surgery? I will be completely non-weight bearing for my right knee for 6 weeks. Sorry for the questions, but my OS isn't too informative and is hard to track down everytime I have questions. I'm in the military, so I don't have a choice of what OS to use. Thanks for any help!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: SevenofNine on February 19, 2010, 09:58:14 AM
Hi Lils,
I'm at Day 17 post op today & there is no way I would contemplate going back to work; yes I have a desk job but consider the following from my current experience:

*getting to & from work - with it being your right leg, this could take 6-10 weeks before you can drive;
*I ice my knee 4-5 times a day;
*I mostly have my leg elevated except when I'm doing something to self care - I live alone;
*I do sets of exercises daily - not anything drastic at this stage but will increase with time

My OS gave me 6 weeks leave to start with but I'll no doubt extend this as formal physio will kick in soon;I have accumulated a lot of sick leave as like many on this site I was fit & active so rarely got sick - just saved all my sick leave for my worn out cartilage hahah. Crutching is hard work ;D Sorry I can't comment on CPM as it's not mandated here in OZ.

Best of luck with your op & keep us posted ;)
Cheers,
7of9
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Rennschnecke on February 19, 2010, 10:26:01 AM
Hi Lils

2 weeks sounds early to be going back to work but I think some people have done that on a part-time basis. :-\  Check out posts by Erin, who has recovered successfully.  Also look up ArmyJohn (?) and check out the leave time he had.  There are also others from the military who have posted on the board.

You need to talk to your OS and find out what they would recommend for following their rehab protocol.  I have heard that some people are on the CPM for 12h a day, in which case there is no way you'd be able to do that and be at work. :o  My OS was kind and told me to do 3–4 h a day but I also had a bundle of exercises to do as well to maintain muscle.

If you are NWB for 6 weeks, you may find it easier to be in a wheelchair when at work as it's tempting to WB.  You may also consider negotiating adjustments to work if you really need to go back.  I think that some people negotiated home-working to avoid boredom. ??? I found that I just couldn't manage laptop and CPM at all.

I would think the best place to start is to tackle your OS.  They would recommend the appropriate time off and your workplace should honour that.  I think the problem is that many people don't understand ACI and think that it's straightforward to recover from knee surgery (e.g. meniscus ops).

Sorry you've had to deal with this.  Best of luck with sorting out work etc. :)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: ajschnelk on February 19, 2010, 03:12:48 PM
2wks will definitely be early, but not impossible if your  job is not all that demanding.  Are you having anything else done at the same time?  I had aci with an AMZ and i did two 1/2 days at 3.5wks post.  I probably could have gone back sooner if it weren't for the AMZ pain.  I went back full time just a few days past 4wks and it didn't seem too bad.  I was NWB for 6wks but started driving around 4wks.  I am at a desk most of the time as well, so i was able to prop the leg and ice throughout the day pretty easily.  I would then go home and use the cpm for the rest of the night...usually 6-7hours.  However, if possible, I'd try to take at least 4wks.  Best of luck!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on February 20, 2010, 01:34:22 AM
Thanks for all the advice everyone. ajschnelk: No, I'm not having anything else done. My OS is actually the one that said I only get 2 weeks off for this procedure. He did tell me I have to stay in the hospital overnight for pain management; that alone scares me. My job would be fine with me taking more time off, but since I'm in the military, we can't just take off work. We have to be on leave. I had to burn up all my personal leave, when my daughter was in ICU for 1 1/2 months. When I had my microfracture and ACI harvest, I got 2 weeks off and that was a scope. It just seems weird that I will only be off 2 weeks when I will have an incision running down my knee. This is the same OS that did the mfx and harvest. As far as driving, I planned to drive right after my 2 weeks, when I have to go back to work. I hope that won't be forbidden, because there will be no one to drive me to all the PT sessions. My husband will be at work. As far as pain, at 2 weeks, should I be good to go without narcotics? The sad thing is I work in the same hospital as my OS! I can't see being doped up at work. LOL. Unfortunately, I won't be able to work from home. SevenofNine: Crutching was a nightmare for me last time. Last time I was NWB for 6 weeks, I FELL multiple times :'(; that's posted on this site too  :-[ . I think I will use one of our wheelchairs from work this time. It's so embarassing, since I work there. Oh well, we will see. Rennschnecke: I will try to find the posts you mentioned. Thanks again everyone!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Rennschnecke on February 20, 2010, 01:53:51 AM
Lils, you may be OK to go back to work at 2 weeks, but you'll probably be aware that everyone recovers differently so can't say whether or not you'll still be on narcotic painkillers.  I am still on them at 8 months but I'm an unusual case.

Would it work to go back to the OS and discuss further?  You would probably feel better knowing what you could do if you really were not up to going back at 2 weeks.  There would be enough case histories here to back you up.

All the best  :)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on February 20, 2010, 02:38:16 AM
Thanks, Rennschnecke. I think I will discuss the 2 week thing more, because I just can't see it. Or I can just go back to work at 2 weeks and then have a screaming/crying fit everyday. I bet they would send me back home then. It would be bad for business (the hospital) if they didn't. I don't think my OS would want his other patients to see me in the halls everyday screaming in pain  ;D. That might scare his patients away.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: ajschnelk on February 20, 2010, 03:07:48 PM
I was off all meds at the 2wk mark, and that was with an AMZ... but like Renn said, everyone heals differently. 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: kralldaddy on March 01, 2010, 09:29:44 PM
I'm am pondering the same issue.  2 weeks seems like a long time to me too and I'm really struggling with anything longer than that.  But as I've seen from other posting and input from the Dr. the better you stick to the rehab plan the better the results. My issue too is driving as it is my right leg too and I too sit at a desk most of the day, but I can't be wacked on pain meds and be productive at work. 

best of luck.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 02, 2010, 03:07:53 AM
kralldaddy,
     I was just worried that 2 weeks wouldn't be enough time. I will see how much pain I'm in at the 2 week mark. If I'm in a lot of pain, I will just take an additional week off. Luckily, I get paid no matter what, so that won't be an issue. My husband works at the hospital with me, so he can drive me worse comes to worse, but I HATE relying on other people. It will suck no matter what being on those crutches again for 6 weeks. I don't know who is planning on driving me to all these physical therapy appointments. My husband has a job to do too, so I can't rely on him all the time. Hopefully I will be allowed to drive at the 2 week mark, even if that means I will have to ditch the pain pills. I guess time will tell.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: etrusc0 on March 02, 2010, 07:24:05 AM
Two weeks is rough.  It can be done.

I did it.  My wife dropped me off at a coworkers house in the morning and we drove in together for two weeks until I felt more comfortable driving myself.  Definitely prop the leg and Ice as much as possible while there.  I also sit at a desk - still trying to find a way to carry a cup with crutches.  :)  Then when I got home I would fall asleep on the floor with my leg attached to the CPM.  It was rough, but each week gets easier.

Good Luck.

Mark
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Rennschnecke on March 02, 2010, 10:10:57 PM
Hi Lils

I read somewhere on this board that some PT places can organise medical taxis for you.  I'm not in the US so don't know about this service.  I guess it also depends on where your PT is as well.  I'm sure something can be worked out as you won't be the first one in this position.  It's just nice to know beforehand though isn't it?

All the best
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 04, 2010, 02:19:20 AM
Hi etrusc0: Thanks for the info. I feel better knowing others have done it. I've already worked out who will carry my morning coffee for me at work.  ;D. I did that the last time I was on crutches too. I felt guilty about it, but I got over it.

Hi Rennschnecke: Thanks for the taxi suggestion. Unfortunately, my PT is on our Air Force base and they don't have taxis. Some bases do, but not mine. The PT facility is only about 1/4 of a mile away, but I had to go 3 times a week last time. Yes, it would be nice to have everything planned out, but I know it's not always realistic. I just hope I can drive at the 2 week mark, so I don't have to inconvenience anyone, as well as myself. Unfortunately, it's on my right knee, so I'm not sure if I'm allowed. I don't have my pre-op appt with the OS until Monday, so I have many questions and driving will be one of them. Thank goodness for this site for all the good info.
Title: 2 WEEKS OFF AFTER ACI/HTO SURGERY? METAL PLATE THINGY TOO?
Post by: LILS on March 09, 2010, 03:40:36 AM
Okay, I had my pre-op appointment today. I was told I'm getting a HTO along with the ACI, which I wasn't told about until today. I've never even heard of an High Tibial Osteotomy. He even talked about some metal plate thingy (not the medical term  :)) that he will be putting in. He also said one of the head honchos of Genzyme is personally flying my cartilage down and will assist/watch my surgery. I have no idea what that's all about, since I think I was too in shock from the metal plate thingy to even ask why he was coming to "help set everything up". Does anyone know when you get a HTO if the metal plate thingy is standard? He said my defect (cartilage loss, not alignment) was pretty significant (silver dollar size). Am I really going to be hurting after all of that? Back to my original question before I knew about the HTO: Is 2 weeks off enough time after the surgery, now that more info has been revealed? More importantly, will I set off airport security metal detectors with that metal plate thingy? That's a little humor, cuz I'm a little freaked out about the new info. I did make sure I asked for a toilet seat riser though; that was a priority  ;D.

Do you think an AMZ is about the same as a HTO, pain wise? I was reading ajschnelk's reply and trying to gauge where I might be at at about 2-3 weeks. I know everyone is different though.......
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 09, 2010, 04:33:03 PM
Hi Lils...Logging in from the US.  So forgive me some of your terms are a little foreign to me..not sure what an AMZ is.

I had a TTO and ACI on Feb 3rd and am now 5 weeks out. I have two friends here who have also undergone the same procedure, one even works for Genzyme and was part of the team working on the Carticel for awhile.

The good and bad news:  1 had complications and was out 8 mos, 1 was back at work within 2 weeks.  So yes, it can be done.  Luckily I was able to get a total of 8 weeks off.

I was completely off my pain meds by the end of week 2 and most by the first week and 1/2.  I never even took the full dosage allowed.  But here's the catch, I kept my leg elevated and iced constantly so I was able to keep the swellling down. 

You could probably get away with going back after 2 weeks but if you can squeeze out more I would go for the maximum you could.  The faster you get the swelling down the faster you will heal.  Also, PT can take up a lot of your time.  I am on the cpm 8 hrs a day (for total 6 weeks - so one to go!) but also add on an additional 2-3 hrs a day for stretches to get my ROM back. 

I've essentially given up muscle retention for the moment as I tend to swell more than others and just acheiving ROM back has been a challenge.  Getting that back is the most important for two reasons if you don't get it back early you may never get it back and development of scar tissue could cause you to have to go back in to clean it out.

Anyway..I would be more than happy to detail out how things have gone for me to date.  Also despite living alone I've found that when in trouble you may have more friends than you think and so many folks have offered their help...either dropping off food, driving me to PT or just keeping me company. 

We'll all help get you thru this!
Cheers!
Christine



Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 10, 2010, 01:28:46 AM
Thanks Christine for the insight. I've never heard of an AMZ either. I've just seen some people mention them along with having ACIs. I looked it up and it stands for anteromedialization. Don't ask me what it means though. I've never heard of TTO either. I had to look that up and I still don't know what it means  ???. Did they cut a part of your bone also? The farthest I got with learning about the HTO of my surgery is they cut out a wedge of bone and add a metal plate/screws to keep pressure off the defect side of my knee. That's about all I got out of researching that. I've had many months to research ACI and I pretty much get the idea, but when they sprung the HTO part of it on me yesterday, I'm somewhat lost. My OS tried to explain, but it didn't quite compute. I like to read people's blogs on their day to day experiences with their surgeries. It helps me see things that I may not have thought of. Anyway, I got my toilet seat riser today, so I'm pretty happy about that  ;D . Glad your surgery went well and I hope your swelling/ROM gets better. I plan on posting my experience after my surgery on here too, just to give the next "newbie" some info/guidance, as everyone has done for me. 1 week to go.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: ajschnelk on March 10, 2010, 05:09:02 AM
You may want to check out the  "Changing the forces through the joint" section of this forum to find out more about HTO, TTO, TTT, etc.  I had and AMZ along with my ACI back in December.  I didn't have alignment problems, but was done to offload the patella to increase the chances of the aci being sucessful.  Many people have just a HTO, TTO, TTT, etc. before a cartilage defect forms due to aligment problems. 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 10, 2010, 03:12:08 PM
Hey LILS..

An HTO and TTO are essentially the same...breaking and realigning a part of the tibia to better align your knee and thus reduce the pressure on your joints.  Although they are in probably slightly different areas, I believe the only real difference may be how they reattch them.  With the TTO, I only have 2 screws (no plate). 

The big thing with a HTO/TTO is that they are cutting into bone, which initially can be much more painful than other procedures.  The good news is that there are excellent new drugs out there  8)  Make sure you ask for a pain blocker after surgery, although I assume most OS' in this age probably already do it automatically.  It is an injection that essentially will block most pain or significant feeling for up to a good 24 hrs...mine seemed to have lasted a bit longer even.

I mean I actually woke up from surgery feeling absolutely great...just a little groggy.  And if it wasn't for the nurses coming in my room every 10 minutes I would have slept like a baby!

The PT protocols I believe can be somewhat different with an HTO/TTO too.  I am touch down weigh bearing only and can not begin SLR (straight leg raises) until after the first 6 weeks.   

The one real side effect of a TTO is that the area around the break is forever sensitive or at least has been on me.  I.e. careful not to bang that area on a chair or table.  Your neighbors will hear you from miles away...
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 10, 2010, 03:15:02 PM
Hey LILS ...

One more suggestion before going in....check your cupboards for all the miscellaneous necessities you shop for on a regular basis and stock up.  That way you don't have to worry about shopping for awhile. 

Also, see if you can get your OS to get you an icing system called 'game ready'.  It made a big difference for me. 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Rennschnecke on March 10, 2010, 10:52:12 PM
Sorry to put a dampener on things but not all surgeons arrange for a nerve block to be given.  Some people also report running out of pain meds sometimes.  It's never happened to me as my GPs just write a script whenever I as, but it's probably worth checking to ensure you don't need ER.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 13, 2010, 02:56:05 AM
Thanks everyone for the great advice/info. I'll check out some of the HTO info. I will be getting a nerve block for this surgery; had them the last 2 surgeries also. I work in the hospital that I will be getting the surgery in, so they take very good care of me. I have always gotten a private room when I've stayed over night, since I know the majority of the people that work there, which is cool. Hopefully, I get one next week, since I have to stay overnight for pain control. I probably just jinxed myself and will be in a room with a loud, whiny patient. Speaking of whiny, I am still scared to death that I am going to fall again like I did after my last knee surgeries. I have super anxiety about that.

Anyway, I have an ice system called Polar Care 300. I had it from my last surgery. I didn't know such a thing existed; it's pretty cool. I will have enough pain meds and if by chance I run out, I'll just send my husband to get more. He works in the same hospital as I do. Since pain meds were brought up, does anyone have preferences on that? In other words, has anyone had better luck with one med versus another? I'm mainly talking about the initial pain meds for the first few days. My OS asked me which ones I wanted, so I told him whichever one he suggests. He suggested Vicodin or Percocet, so I just picked Percocet. He said he would also sew my knee up versus stapling it. He even said he would do the plastic surgery type of sewing, so I wouldn't have a huge ugly scar. I told him it didn't matter since my knees are still fat and ugly without any scars.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 13, 2010, 05:33:08 PM
We all have the legs modeling agencies drool over  :D

As for pain meds, whatever you can tolerate.  Just depends on the person and how they react.  I had a morphine drip initially, then a mix of oxycotin and codeine.   Although I've had success with morphine in the past, it didn't sit well with me this time.

I've also had oxycotin in the past that killed my stomache after a few days...but have never had issues with codeine.  So I used a mix of both oxycotin and codeine at home.  1 oxycotin to get me through the day and my cpm machine and then 2 codeine before bed and usually another two sometime in the middle of the night.

In general though...I found overall the pain was much less than expected and tolerable.  So don't lose any sleep over it :)  Plus if you are overnighting it they can always adjust as necessary. 

Good luck!  Best wishes and let us know how you are doing after surgery. 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Recovering Runner on March 13, 2010, 07:09:25 PM
If you were having an aci alone, two weeks off would be difficult, but doable. The osteotomy is much more painful a d requires more recovery time than the aci,though. I had an osteotomy AMZ and denovo nt (similar to aci). I took 2.5 weeks off after surgery, but really should have taken more. It was doable with a desk job, but it really takes the energy out of you just sitting up after that surgery.

The driving will be very tough with your right leg. Be careful. Good luck. 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: kralldaddy on March 15, 2010, 02:34:40 PM
It like my mind has been read with this string. 

I just found out that I won't be having a HTO, but I was expecting one all along.  For my biopsy and menicus repair back in Nov, I just had vicoden, (I didn't feel it did much and was off in couple days)  Mostly just used to help sleep.  This Time the Dr. is recomending Oxy and potentially a Nerve Block.  The Nerve Block's got me little worried, but would be interested in your thoughts since you've had that before.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 15, 2010, 04:43:27 PM
I've heard there can be some side effects of nerve blocks..but never really did any research on it.

For me, I couldn't have been happier with the nerve block and would never have another major surgery without it! 

One of my biggest anxieties about surgery has always been the immediate aftermath...the nerve block certainly changed this for me.  I felt great after surgery.  My friends visiting afterwards couldn't believe how awake and comfortable I looked. 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 16, 2010, 12:12:00 AM
kralldaddy,
    The nerve block was excellent for pain relief. I HATED the fact that when I tried to stand up and balance myself (like toe down), my leg completely collapsed, since I couldn't feel when my toe was touching the floor. It became complete Jello. It literally looked like I had no bones in that leg when I went down. This happened to me for both of my knee surgeries. This is why I have EXTREME anxiety about going through that again. I'm terrified of the crutches again. My mind cannot seem to understand that I cannot try to put that foot down at all, especially when I can't feel my entire leg! With my last nerve block, the upper part of my thigh was numb for at least a month. I could literally pinch myself and not feel it; weird, but that wasn't a big deal. Anyway, my surgery is tomorrow and it's crazy that the only thing I'm really worried about are getting on those damn crutches again  :'(
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: kralldaddy on March 16, 2010, 03:03:10 PM
Thanks for the feedback on the Nerve block.  Best of luck tomorrow. 

I'm one week out and starting to get nervous myself.

Kralldaddy
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 21, 2010, 01:41:47 AM
Had my surgery (see other post) and there is no way I can see myself going back to work after only 2 weeks. I can barely get out of bed 4 days post op. We'll see....maybe miracles will happen in the next week and a half.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 25, 2010, 03:56:45 PM
Hey LILS ..

Glad to hear you are through the surgery.  Week 1 was pretty tough...hard to move without pain and generally uncomfortable. 

The good news...is by the time you are into your second week you should start feeling a lot better.  As I said, I was able to come off meds fully by the end of the second week. 

I am now at 7 wks post op..and things are starting to look up.  I had some startling pain in my knee for whenever I moved but within just days of me being able to work on SLRs and get some muscle back it disappeared almost entirely.  And the stronger I get my quads the better it feels. 

I would begin working those quads as soon as your OS allows.  Also key is doing your ROM exercises.  Unfortunately after wk 5 I couldn't get any additional ROM (stuck at 90) and will now be going in to remove scar tissue.  Kind of a bummer as I am just beginning to get muscle back and come off the crutches.  But I guess it is only a small set back. 

Hope you are keeping sane! 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 25, 2010, 08:25:00 PM
Hi cfranc,
    You're right, I'm 9 days post op and feel better already. I guess miracles are happening. I still have bruising and swelling, but it is not that bad. I had my first PT appt yesterday and my PT doc was very happy with my progress. I expected to be tortured, but she said I was progressing so well on my own, that there wasn't much for her to do. Of course when I become weight-bearing in 4 1/2 wks, all that will change  :( Glad you're progessing well too. I'm sorry that they have to go back in to remove scar tissue. Hopefully that will be a quick recovery. I noticed you said before you were in the US; what state? I'm currently stationed in Mississippi. I did end up getting the Game Ready System and it has worked wonders. I thought I would just be using the ice system I had before, but I guess they thought this would be better, which it is....too bad I can't keep it. I'm off the narcotics and only take Tylenol. I hated the way the narcotics made me feel. My dogs hate my crutches. They take off running anytime I start crutching their way. It is ruining our relationship. LOL.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 27, 2010, 12:00:49 AM
Hey LILS

I am in Massachusetts.  Glad to hear you are starting to feel better already.  Thankfully my dog is not afraid of the crutches...though he is picking up some bad habits of lounging around (with me) :)

I'm also glad you say your PT is taking it easy with you.  Have they worked with an ACI patient before?  Most PTs aren't familiar with the surgery and try to start you on exercises too early that can damage your graft.

Just had a quick thought...maybe if you had some bones hanging from your crutches the dogs wouldn't be afaid of them anymore :)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 29, 2010, 04:01:08 AM
No, my PT has never worked with an ACI patient before. She had her cheat sheet with her. And you're right, she did try to start me on exercises too early. Luckily I knew not to do some of them. Her technicians kept asking me what type of surgery I had and I would say "ACI". They all would ask, "You mean an ACL"? So, they definitely didn't know what to do with me, but my OS has been good at telling them what they can and can't have me do. Since I'm not weight-bearing I'm not doing much. I reached 110 degrees on my CPM today, which was a shock. The CPM does give you kind of a false progress sometimes. Even though I was 110 on the machine with no pain, when I sit at 90 degrees, there is more pain. I have my 1st post-op visit with my doc tomorrow. We'll see if I'm going back to work Wednesday or not.

My poor dog jumped on my injured leg today and I accidentally flung her out of the bed (reflex). She only weighs 3.5 pounds, but I felt so bad doing that; luckily she wasn't hurt at all. My husband was more concerned about her, than me  :-\. I think if I had bones hanging from my crutches, my dogs might break my other leg trying to get at those bones. And then my husband would blame me for teasing them  ::)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 29, 2010, 04:31:06 PM
LILS...

Thats great!!! 90 degrees already...you should be really happy! As you move up your ROM the max is never comfortable...I would just make sure you only push it to a point where it is uncomfortable but tolerable. 

Good luck with your appt...but it sounds like things are going really well for you.  Let me know what your OS says.

LOL re: your 3.5lb dog.  I think just one of my dog's paws weighs that much!!  He's a 110lb Nefoundland/Golden retriever mix and impossible to move if he doesn't want to :)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 29, 2010, 10:41:18 PM
1ST POST OP APPOINTMENT (13 days post op): I drove myself 25 minutes to my 1st post op appt with my OS. My husband was the only one in his clinic today, so he couldn't drive me. I couldn't wear the brace while driving, but I took it with me to put on when I got out of the car. Since I was driving, I also couldn't take any narcotics, so I just took Extra StrengthTylenol, which is what I was pretty much on anyway at this point. I knew parking at the hospital (where I also work) was going to be an issue, so I got there early to make sure I could even find a spot. I found a relatively good one. Unfortunately, as I tried to put on the brace, I had extreme pain in my leg, so I said screw the heavy brace, since there was no way I was going to be able to crutch across the parking lot all the way to orthopedics. I work in a Regional Medical Center, so ortho was not right at the front door. I was so glad the temperature outside was in the upper 40s, since I knew I would be sweating doing all that crutching. By the time I made it halfway across the street, some guy was yelling, asking me if I needed a wheelchair. I guess my crutching skills weren't impressing him. Even without the brace, I think I had pretty good control of the leg, so I declined. When I got inside the hospital, the heat hit me. I felt so sweaty and sick to my stomach. I finally made it to the front desk of ortho after a couple of catch my breath breaks. I know I had to be as pale as a ghost. The technician took me back to the room, took off my ace wrap, and cut the 2 ends of the internal dissolvable sutures off. The OS came in and said everything looked fine. I told him I left my brace in the car, since it was just too much without the pain meds. He offered me more meds, which I didn't need. There is a baseball size lump below my knee, on the left side where the metal plate is. I told him that is where all my pain is coming from. Of course he said it will get better with time. He also showed me the x-rays of the plate/screws; pretty cool. He wants me to work on my range of motion more. I asked him if it was ok to drive, since I already drove there.  :-\. He said it's fine if I don't take the narcotics. I asked him when I could start taking Motrin, which is my drug of choice for most things, i.e., headaches, backaches, etc. He said I can be expected to be off of it for about 6-9 months! What?! Noooo......I love Motrin! I love Motrin more than my kids and husband!

My con leave was extended through Sunday, so I go back to work Monday. I think I will be ready by then. I even had to go up a couple of floors to my job to drop off the extension. I actually hung around work a little more, since I was too tired to crutch all the way back to my car and my foot/leg was starting to swell. My husband pops up out of the blue and rescued me. He called ortho looking for me and then figured I must be at my job. He had a sec and he said he would go get his car and drive me to mine. A co-worker wheeled me to the front door, while my other co-workers joked, asking me if I was their next patient. I work in Gastroenterology and our main patients are colonoscopy patients. I guess they were just tickled pink thinking of me getting scoped.....sick people. My husband drove me to the car. The drive home was a little harder, since my leg/foot was more swollen, but I made it just fine. I didn't even want to go back into the house, since I feel like I'm on house arrest.

Anyway, the moral to this story is: 2 weeks off after ACI/HTO surgery was not enough for ME. I think 3 weeks off will be more sufficient (hopefully). If not, I will just suck it up.

HAPPY ACI SURGERIES, ACI POST OPS, AND ACI RECOVERIES TO ALL!!!!!!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 30, 2010, 07:46:14 PM
All I can say is "Crutches suck!" 

As for the pain around the plate/screws...I think I was closer to 5/6 weeks before I could let someone touch that area without whincing a bit.  Now it is fine...just takes awhile for the area around the break to settle down. 

Warning though....careful not to bang that area on a table/chair, etc....if you ever thought hitting your funny bone was uncomfortable...just wait.  I have been told by my OS that the area will forever be sensitive.  I am now very careful about keeping it clear of tables/chairs, etc.

Glad to hear you appt. went well ...
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 30, 2010, 10:04:43 PM
Thanks cfranc for the warning and YES, crutches suck! I have been trying my hardest for the last week to lay on my left side (facing the TV), but I just can't get comfortable, since the plate in my inner right knee touches whatever I am laying on or touches my other leg. I'm fine now laying on my right side, since the plate doesn't touch anything when I do that. Since I spend my days watching TV, this situtation sucks too. Hopefully, it will work itself out in a few weeks. Your post gives me hope!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on March 31, 2010, 04:01:02 PM
It will definitely get better.  At 8 weeks that area is now only sensitive when I put real pressure on it. 

Hmm...my favorite TV since being couch bound:  Animal Planet Big Cat Diaries...I go on Safari every day :)  I'm also a LOST addict and found that I can watch old episodes on ABC.com

The dog has also gotten spoiled.  I think I am beginning to rub the fur off his ears!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: AndrewH on March 31, 2010, 07:57:19 PM
The lengths some folk will go to to get a few extra days off work...........  :lol:

I've been following this with interest LILS. I had microfracture on a 1.5cm2 defect on my MFC last June and its failed. My OS gave me the options of ACI & mosaicplasy in Feb and was hinting at ACI (I know he's conducting an ACI trial here in the UK and so knows quite a bit about it).

My problem has been that I was in the middle of being redundant and looking for a new job and didn't want an ACI operation to get in the way. I've now got myself a new job and start mid April. My plan now is to get the ACI op done in July and take a couple of weeks of my annual leave after it to recover. I don't want to go in and start taking sick leave! It seems I may have to take more than 2 weeks after reading this!

On the flip side however I do have the experience of crutching from last year and do a lot of upper body works outs to keep fit (seeing as I can't run anymore!) so crutching isn't a problem for me. Indeed, I look at crutching as a great work out in itself! The other advantage is that its not anywhere near as hot here in the UK, even in July!

All the best LILS. Seeing as you will probably be about 4 months ahead of me with this op I'll follow your progress with interest.

BTW - what size was your defect and where?
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: AndrewH on March 31, 2010, 07:59:15 PM
cfranc - what is the background to your injury? Size? Location? Did you have prior microfracture?

Sorry to be a pain if this info is to be found elsewhere!!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on March 31, 2010, 10:27:02 PM
Hi AndrewH,
    We have the defect in the same place, but mine is 4cm. Honestly, if it wasn't for the High Tibial Osteotomy (HTO) I had along with the ACI, I would have been ready to go back to work at probably the 10 day post op point. My OS didn't even tell me about the HTO part of the surgery, until a few days before the surgery; I had no idea I needed that too. When I initially posted this question, that was even before I found out about the HTO. If you are just having an ACI, you might be okay going back to work before 2 weeks, IF you have a job where you can sit most of the time. There are people on this forum that went back to work just a few days after their ACI. My incision doesn't hurt at all so that part of the ACI doesn't bother me, it's just the area with the plate and screws for my bone realignment (the HTO). Do you know if you will just be having an ACI, or will they be performing an osteotomy or anything else along with the ACI? I think an osteotomy or an additional procedure with your ACI would be the main issue. I've gotten pretty good with the crutches too; they're my friends now. They have to be, since I will be living with them for 4 more weeks. You sound more fit than I am, so you should be fine. BUT, as they say, everyone is different. I reached a personal milestone today. I took my first real bath in my deep tub. I was determined to get in and out of there on my own, and it was a piece of cake. I was so excited. Yeah, it's 15 days post op, but 2 weeks ago, I was stuck in the hospital for 3 nights. On another note, I am looking forward to going back to work on Monday. I AM SO BORED. I will post on Monday how going back to work went.

Christine, glad you and your dog are still friends. After flinging mine out of the bed, she doesn't really want me petting her  :(. Oops.....
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: AndrewH on March 31, 2010, 11:24:03 PM
Thanks LILS, although obviously bad for you, its good to know that its not the actual ACI that causes you the most main.

I've had no mention of HTO from the OS. My injury came as a result of excessive running - I was averaging 60 - 70 miles per week and then even after I felt there was a problem I clocked up over 140 miles in the 2 weeks after the initial injury. I then spent the next couple of months mamking attempted comebacks after my physio had assured me that there was no serious injury.

I think my problem actually started with a tendon problem on my ankle on my other leg. I ran through it for a few months before consulting a podiatrist. She gave me heel wegges to take the strain off the tendon behind my ankle. These wedges were on the medial side of my heel. I'm pretty sure that the hard mileage I was doing with these wedges is what caused it - it seems more than a coincidence that the injury happened not long after I started using them and on that exact side of my knee. Ironically the wedges cured the tendon problem!

The initial injury happened when I ran to work one morning. I live 9 miles from work and on that particular morning decided to make it a 12 mile run including a big hill in the last mile and to do it all at marathon pace (around 6.50 / mile) and finish the last mile at 6.00 pace. I used to do this type of run every 2 weeks and I would essentially jump out of bed, get my gear on and get out the door and start running with no warm up. I don't think that running at marathon pace for 12 miles within 15 mins of waking up with no warm up, no food, etc was essentially a good idea. However I thought nothing of it at the time and many of the guys I trained with had equally crazy training schedules. I felt some pain behind the back of my knee later that morning and it all began from there.

I think also the fact that I didn't start running until my mid 30s and within 2 years of starting from a point of being overweight, a smoker and completely unfit I had jumped into a crazy training schedule was too much too soon. But it becomes very addictive, particualrly when you are running races with and against guys you are training with and continually trying to get your times down. It just became an obsession.

Anyway, what is done is done and there is no going back. But in summary, I don't think I have any alignment issues with my knee and my OS has never mentioned anything like that. I think the heel wedges may be what caused the alignment issues and contributed to my injury along with my high mileage.

I'm disappointed that the microfracture didn't work but am much more hopeful about ACI.

All the best and I will be fe following your progress with great interest.

Before I clock off, can you give me some background as to how your injury occured? What sort of pain levels did you have before and after microfracture when walking? 4cm sounds huge compared to my 1.5cm yet I am limping about with a fair amount of pain.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on April 01, 2010, 12:42:40 AM
Holy crap Andrew, that's a lot of damn running :o! Thanks for making me feel like a lazy bum. My injury history is not that exciting. Back in 2003, I actually tore my meniscus while moving a dresser by myself. Don't laugh. I had the meniscus repaired and over the years, my cartilage just wore out. My knee got worse around 2006, as I was running more often. At the height of my running, I ran about 3 miles a week. Don't laugh. I only ran because the military made me. Before the microfracture, my pain level was about a 4-5 on a 0-10 scale (0=no pain-10=extreme pain). After the microfracture, it was a 5-6, so the microfracture failed miserably. I was mad with myself for even getting the procedure, since the pain was worse after. I also limped for a couple of months after that, so I thought I was permanently damaged, but that went away as my muscles improved. Yes, 4cm is big, but I don't do high impact activities, so it's probably a little more manageable for me. Are you going to go stir crazy not being able to run for many months? And yes, I have become a lazy bum, when I'm not at work, because of my knee pain. Hopefully, your OS won't spring a surprise extra procedure on you, like mine did. The way my post op is going, I think if I would have just had the ACI alone, it would have been a piece of cake for me. At this point, my only pain is from the osteotomy. Even with that, I am off all of my major pain meds and I just take Tylenol twice a day.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: AndrewH on April 01, 2010, 11:49:39 AM
Hi LILS

My running days are over and I have no intention of ever running again. There is no way I would ever take the risk. As it is, I've not ran since January last year. Its took me a while to get my head around that fact but I've got used to it now.

I only started running as part of a general keep fit thing and was playing football and doing weights as well when I started. The running just overtook everything else and became an obsession when I realised I was capable of good times and I kept getting better. Every race I ran was a personal best time and I was getting nearer to the top runners. In my last 10k I ran a time of 35.15 and finished 16th out of a field of almost 1,000 in a race in which I'd ran in 46 mins 2 years previously finishing mid pack. My last half marathon I ran 1.22 and finished in the top 100 out of 7,000 odd in a race I ran 2 years earlier in 1.46, again finishing mid pack.

By the time of my injury, I knew from my training that I was capable of much more and was throwing everything into it. It was also very convenient as my house was 9 miles from my work. I was therefore able to get most of my training done just by running to and / or from work in more or less the same time as it took me to get to and fromn work by any other means of transport. That therefore meant that I wasn't using up any family time and my wife had no problems with my obsession. All I did was throw in a couple of lunchtime sessions a week (again, no family time, just giving up my lunch hour) and a long run early on a Sunday morning before the family was up. It was perfect..... an obsession that I was good at, required huge amounts of training and yet for which I didn't actually need to find any time to do!!

The downside is that I became very skinny, despite eating huge amounts of food and of course I knackered my knee!

There is no way I could go back to running now with this knee. What fuelled me was racing and my knee just wouldn't be able to stand up to that amount of training. I didn't particularly enjoy running for the sake of it, what I enjoyed was the racing and competiting with my mates. If I can't have that then there is no point - there are other forms of cardio that I can do.

My hope is to take up cycling for fitness. Again, there is scope to cycle to and from work which would also mean not needing to find any time to do it. I doubt I will get to the same level of obsession again.....  but you never know!

For now though, my only concern is for my knee to get better!

Thanks for your insight. Its good to know from my perspective that the actual ACI itself isn't the main source of your pain. My concern with the op is that I don't want to take time off work from a new job on sick leave if at possible. It sounds like I will probably be able to get away with taking a couple of weeks holiday after the op and then get back to work and that would be ideal. I have a desk job so it shouldn't be a problem.

I'll keep following your progress - keep your updates coming!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on April 01, 2010, 05:27:07 PM
Hey Andrew ...

I must admit I am a wuss at least in terms of having technical medical discussions.  So, I am not exactly sure how big my lesions were...I know I had four seperate moderate sized grafts done during my ACI.  As I go in tomorrow for scar tissue removal, I am going to ask my OS to write down the specifics. 

As for my injury (ies), I have had 13 + knee dislocations between 1990 and 2001, combined with 2 major surgeries and 2 scopes (prior to any of the ACI work). 

Essentially I too learn the hardway, after having to quit track in college, I eventually picked up soccer, replaced running with hiking, and waterskiied as much as humanly possible in the summer.  And now here I am...with the cartilage of an 80 yr old.

During my ACI, I also had an osteotomy like LILS...unfortunately the second for me though...

I am now at 8 weeks and have been fortunate enough to take the entire time off of work...not great for the sanity...but better for the healing process. 

After my surgery, I had a ton of swelling and had a really hard time getting it down to be able to extend my ROM....because of that I am now going in for a scope to remove scar tissue build up.  I am told it is a fairly common occurence ...about 35% of ACI patients go through this. 

At 8 weeks, I am full weight bearing and can walk without crutches though at a turtles pace and not for long...not sure how the scope will set me back, but I will let you know as I progress. 

As LILS says there are many people that go back to work very quickly after an ACI and do so successfully...from experience though I've found the longer you can rest after a surgery the quicker you will heal.


Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on April 01, 2010, 05:40:09 PM
Christine,
    Good luck on your procedure tomorrow! I wish you well. That will just be more time you and your dog can bond  ;D. I'll be waiting for your update.....
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Rennschnecke on April 01, 2010, 06:08:33 PM
Hi Andrew

I know that you're planning on taking just 2 weeks to get back to work post-ACI as you're worried about time off.  However, it's probably unwise to bank on it.  Whilst some people managed to get back to work in that time, some have said it was a strain and it's better to give yourself recovery time.  What has the surgeon said about time off?

I know that early on I had lots of rehab to do.  Although I had only 4h on the CPM I had loads of other stuff which meant I was rehabbing all day.

It would probably be wise to let people at work know you're having this op.  It is, after all, a two stage procedure although the first stage is usually fairly straightforward.  Once you go back to work you may well need to get some adjustments made so that you can elevate your leg, keep it iced etc., maybe work on the ground floor if you're not already.  I know some people couldn't cope with more than half days as well.  Also check out how to get to work as you'll be non-weightbearing (but you said you were well practiced with that bit) and may well have a brace on.  You'll also have quite a few days taken with reviews etc.  Also consider whether you want to go back when you're not able to perform to your usual standards either through pain or meds or appointments etc.

If you're reluctant to take time off at the start of your new job have you considered whether you be able to delay the op for after the probationary period?  I think it would be near impossible to hide the fact you'll have had a major op on your knee if that's what you were hoping for.

Sorry if I sound really negative, but I've been struggling to get back for the past 9 months and may only just have worked something out with a special pain management package.  Clearly, this is unusual but how would things be if you had problems too?  (Sorry, I'm letting my risk-averse side come out.)

I hope that things will go smoothly for you, but you also need to have some back-up plan just in case ...

 ;)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on April 01, 2010, 09:04:40 PM
Hey Andrew...

Just read R's post...and noted again that you were thinking of a July Op date.  Just a thought:  I had mine done in early Feb and would have ideally preferred late November.  The weather is now starting to get nice and I am still probably another 2 + months off from being able to comfortably take a stroll outdoors.

Seeing as how you were pretty active you might want to think about having it so that you are not laid up during the nicer weather/seasons....though if you are in the NW then I guess it doesn't matter :)    3 months up there and I only saw the sun once...
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: AndrewH on April 02, 2010, 05:47:57 PM
cfranc & Rennschnecke - thanks for the advice, much appreciated.  :)

Rennsschnecke - I am going to tell my new employers about the operation, its just that I don't want to take time off work sick in a brand new job.

With regards to not being 100% at work, I think (hope!) I'll be in a better frame of mind after having the op, regardless of pain, than I am just now. I think I should be able to cope with the pain if I know I've had the op done and I'm on the road to recovery.

After microfracture last year I had 2 weeks off work but in reality I didn't need it. I had the op done on a Friday and I could have gone back on the Monday.

I realise however that this op will be open knee surgery so am unsure as to how much this will increase pain levels???? It could be that I ask for a 3 week holiday and that would give me the extra week.

I don't see crutching as a problem and can't see working on higher levels being an issue either as I can use the lift. When I was on crutches last summer I had to negotiate stairs to get to and from the car park and found it easy enough. I also managed to do quite a bit of walking on the crutches. I went to the dentist 4 days after surgery last summer and got a taxi there but on the way home I walked a mile to the train station on crutches and got the train back. It was okay.

The only problem I encountered was having to ask people to carry my notebook and files to meetings for me!!

I also managed to go on holiday to Portugal while NWB on crutches. The crutches came in handy because I managed to avoid all the queues at security and go through the disabled section.  ;D


cfranc - I'm not sure what the temperatures are like where you live but over in Scotland we don't get big extremes. Our winters are relatively mild and summers are never very warm. I think I'd rather go through the NWB period in better weather however - and I'd like to get it over and done with be on the road to recovery as soon as possible.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: momhanaway on April 02, 2010, 09:20:21 PM
My daughter was 19 when she had her ACI, just a few months out from playing collegiate volleyball, in great shape.  She bounced back faster than most on the board, but I will tell you that nothing prepared her for the pain and exhaustion she experienced afterward.  She almost moved back home because the 6 weeks on crutches about did her in around campus. 
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: AndrewH on April 02, 2010, 11:00:24 PM
My daughter was 19 when she had her ACI, just a few months out from playing collegiate volleyball, in great shape.  She bounced back faster than most on the board, but I will tell you that nothing prepared her for the pain and exhaustion she experienced afterward.  She almost moved back home because the 6 weeks on crutches about did her in around campus. 

Was it the pain from the surgery or the crutching experience that did her in?

I'm prepared for the crutches and I don't see that as a problem. I did it last summer and I spend a lot of time in gym doing upper body work, particularly dips in order that the crutching will be okay.

Its the actual pain from the surgery that I'm looking for some insight into. I didn't really experience any pain after the microfracture surgery last summer and didn't need to use any pain meds. It was only when I ditched the crutches that the pain from the injury returned.... and hasn't improved.

Going back to work after microfracture last summer after 2 weeks was no bother, I reckon I could have done it after a weekends rest. How much different is ACI? Does the fact that its open knee surgery make a huge difference???

Any insight is welcome.  :)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on April 02, 2010, 11:33:50 PM
Hey Andrew...

I think more than anything it will be the swelling that will challange you.  They will be poking around a lot and most likely filling it with quite an amount of liquid.  Again, for me pain was only an issue for the first week and 1/2.  Though I know my pain threshold is fairly high after 13 dislocations and 5 other surgeries. 

Crutches can be tiring but as you say...but you can still walk a fair amount if your'e determined...though don't think my OS would have been happy seeing me hike around Tucson AZ a few years back after another surgery :) 

They (OS) will tell you they are weary of you falling, which could potentially damage the implant...I've always thought these warnings were overkill...and then I read some of the posts on this site...there are quite a few people who have had some pretty good falls.  Not sure that I understand it...but I guess some people have issues.  I think when crutches have grown to become like another appendage for you...I think the warnings are overkill.

The only warning I would give here...is something that is now happening to me.  The more you are up crutching around, the more pressure and abuse you will be throwing at your other knee.  For so many of us, it has eventually led to damage in our so called 'good leg'.  Mine was definitely over a fair amount of time and abuse but it sounds like you are not the type to sit still either. 

I've been to Scotland more than 1/2 dozen times so I hear you on the weather.  There's the time it was so foggy and rainy, we walked around for a 1/2 hr trying to figure out if we had really hit the top of the hill.  My favorite though is getting drenched on the second day of the West Highland Way, blistering my feet pretty and crawling the rest of the grueling 60 miles to Nevis.  Haven't worn those boots since :)

Anyway, I think the morale of the story from all of us giving advice is to be prepared for the worst case scenario and then you can adjust as you figure out where you will fit in the curve.  Everyone of these surgeries is different with recovery varying by patient so you never know whether you will be the worst, best or average case scenario.  We hope for the best for you though :)

When you get closer we can give you a list of things to do/prep for that will make things easier.

 

Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on April 02, 2010, 11:38:00 PM
On another note, I had my scope this morning to take out scar tissue.  Apparently, there was quite a lot but my OS thinks I will now have a much easier time working my ROM now.

I am also happy to say that it appears the new swelling is not as much as I feared.  I start the cpm again tomorrow, ROM exercises and begin PT early next week.  So things are looking up again :)

Will keep you posted as I progress....oh yeah and no need for pain meds today even!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Rennschnecke on April 03, 2010, 01:24:06 AM
Christine, when you had the scar tissue taken out did they give you a pain block?  I had one and had absolutely no pain whatsoever – couldn't walk, but was aware I shouldn't anyway.

Andrew, I didn't have any problems with crutching post-MACI and after the biopsy I felt so good I got to wondering whether I really needed to follow through with the second stage.  The pain post-MACI wasn't good, but also wasn't horrendous until 8 weeks post when progress was blocked and then it began to decline at aeound 10 weeks post.  I was cheerfully mobile in my brace and FWB as it was a PFJ implantation not a femoral condyle.  However, I was full on with the rehab programme and this is essential for optimising your recovery.

I know that some of the guys here had 6 to 12 h of CPM to do.  I know some slept in their CPM – I'm not sure how they managed.  I couldn't (and didn't need to) at home and at hospital (following LOA/MUA) I was on a nerve block and fully drugged up.

Even if the pain isn't bad you need to check what demands your PT protocol will demand of you.  If you want a good bet for the amount of time out to ensure you can get back easily, 6 weeks is the optimum time.  Assuming no complications, most people have got back to work by then and managed to do full days.

As cfranc says, everyone will respond individually to this op.  Whilst 2 weeks is doable under duress, most people need a bit longer.  It will also help to minimise the risk of complications.

Like cfranc I had scar tissue which necessitated another op.  I think this was due to not icing enough and getting the swelling down early on.  I'm now battling AF and after a lot of research I think this is due to an overly aggressive rehab schedule which kept my knee swollen for too long.  I've now got to settle back and relax (slow down my OS has been saying) and tackle everything more gently.  Runs counter to my instincts, but I'm now 9 months post-op, in pain management and struggling to get back to work so I need to do something different.

I really would want things to be different for you, and would probably advise to plan for 6 weeks off and return earlier if you are ready.  You can always get your GP to sign a return to work certificate for you if you are ready to go back earlier.  It would get better brownie points to go back earlier than find you need to stay off longer ...

Sorry if this seems like a negative rant, but I guess I'm coming from the other end of the spectrum of successes.  With success rates of 75–80% the odds are against you following my steps, but stats don't matter much for each individual.

In the end you'll need to work out what's best for you and your work situation.  You may also like to check out the posts of some others on the board to see how they got on.  Erin is a physio who was very successful; JulianUK, djs60 (?) and some others.  I was following mainly PFJ patients so there is a bias.  You may find a different track record for other ops.

Happy hunting!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: momhanaway on April 03, 2010, 07:46:50 AM
My daughter was 19 when she had her ACI, just a few months out from playing collegiate volleyball, in great shape.  She bounced back faster than most on the board, but I will tell you that nothing prepared her for the pain and exhaustion she experienced afterward.  She almost moved back home because the 6 weeks on crutches about did her in around campus. 

Was it the pain from the surgery or the crutching experience that did her in?

I'm prepared for the crutches and I don't see that as a problem. I did it last summer and I spend a lot of time in gym doing upper body work, particularly dips in order that the crutching will be okay.

Its the actual pain from the surgery that I'm looking for some insight into. I didn't really experience any pain after the microfracture surgery last summer and didn't need to use any pain meds. It was only when I ditched the crutches that the pain from the injury returned.... and hasn't improved.

Going back to work after microfracture last summer after 2 weeks was no bother, I reckon I could have done it after a weekends rest. How much different is ACI? Does the fact that its open knee surgery make a huge difference???

Any insight is welcome.  :)

My daughter's comment to the nurses right after surgery when asked what her pain level was between 1-10 was "it's about 50." She said it felt like someone shot her in the knee with a gun. The first 2 days she couldn't go to the bathroom without someone holding her leg up.  The leg hanging down while using the crutches shot pain through her knee.  The Game Ready ice machine saved her life.  I had to set an alarm to make sure there was ice still in the ice holding compartment.  She has a pretty high pain tolerance.  She had a difficult time with the crutches trying to get to classes, carry her books, eat in the lunch room etc.  Everything was a chore and exhausting.  Once she was back at school, the athletic trainers pushed her fairly fast and her knee was pretty angry.  I was concerned.  BUT I just posted that she is back on the vb court as of this past Tuesday with no knee pain. It's been a year since her surgery.  She had no other problems other than the femoral defect. The doctor told her than this was a salvage project and that there were no promises returning to collegiate sports.  I haven't been great at posting because she is at school and I don't see her everyday, but you can read about it on the board.

Hope this helps. I'm not trying to scare you at all.  I just want you to know that it's a big surgery.  My daughter went in for microfracture the December prior to her ACI surgery in March.  They were not able to do the microfracture due to the surrounding cartilage and they went ahead and harvested the cells at that time.  She was up and around the next day.  Not with the ACI...
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: AndrewH on April 04, 2010, 10:37:02 AM

I've been to Scotland more than 1/2 dozen times so I hear you on the weather.  There's the time it was so foggy and rainy, we walked around for a 1/2 hr trying to figure out if we had really hit the top of the hill.  My favorite though is getting drenched on the second day of the West Highland Way, blistering my feet pretty and crawling the rest of the grueling 60 miles to Nevis.  Haven't worn those boots since :)


 :D

Always laugh when I read stuff like this or people who aren't from Scotland tell me stuff like this.....  You've probably seen more of Scotland than me and I've lived here all my life (40 years)!

I once went up to the Isle of Skye via Oban with my wife for a weekend and it poured with rain and looked like the most miserable place in the world - so we've never explored Scotland again!! Sute the scenery looked good but once you've seen one hill you've seen them all as far as I can see!  :D

My travelling around Scotland has more or less been limited to following my football team and that's mainly been to the cities and main towns in Scotland. Been up to Inverness a few times and its nice up there but again, all I've really done is go to watch the football and then have a curry in our favourite Indian restaurant up there!  ;D

People say Scotland is a beautiful place, but as I live in the biggest town, Paisley, which is right next to the biggest city, Glasgow and live in a conurbation where half Scotland's population lives. I just seems like any other big horrible city in the world!! I could run the 9 miles to work quicker than I could get there using any other form of transport due to the traffic congestion. For me, I've always considered that I live in the worst town, next to the worst city in the worst country in the whole world!!  :-\

Thanks for the advice by the way. It seems from those who have replied that there are differing experiences. I suppose a lot depends on the size and location of the defect and a whole host of other factors.

I don't believe the crutching will be a problem for me, I've done it before and I've got a lot of upper body strength. I actually looked upon last summer's crutching experience as a great daily workout that mean I didn't need to go to the gym!!

Not so sure about the pain though but I reckon even if its bad I'll be able to tolerate it more knowing that I'm healing. I hate they was I am just now knowing that its not getting better.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on April 07, 2010, 02:32:19 AM
Hey All...

Good news!! I had my scope on Friday to take out the scar tissue.  My OS said there was a ton!  Anyway...didn't even bother taking any pain meds after the scope and haven't needed any yet.  But the best news...my ROM has increased significantly!!  I don't want to jinx myself by throwing out any #s until I restart PT tomorrow....but suffice it to say...I will most likely be using a stationary bike this week :)

Swelling is still a problem and I am still using a machine similar to a Game Ready to try to keep it down.  My only concern now is keeping it down as much as possible so I can avoid developing any addiitonal scar tissue in the future.

Will post again tomorrow after PT!

Andrew...It wouldn't be fair to say my only memories of Scotland include rain....I've been lucky to see some unbelievable warm sunny days...Of all the places I've been it seems I've found myself in Scotland more than any other...you only need one day of sun to want to buy a return ticket.  And yes, I've even been to Glasgow and a Celtic game!

Hope to post more good news tomorrow.

Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on April 07, 2010, 07:50:46 AM
Christine,
   That's great to hear. Do you have to use crutches? My ROM has decreased and I'm worried I'm at my limit. At what point to they tell you your ROM needs fixing, i.e., another surgery? Just trying to keep up with your progress, since we had similiar surgeries.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on April 07, 2010, 02:40:14 PM
115....115...115!!!   :D  That's what they measured for my ROM before I even started my PT session today.  I can now begin using a stationary bike  ;D

I still have a ton of swelling but am now walking fully without crutches.  I have to work on loosening up my ankles and focusing on my steps ..but I am well on my way to burying those things!

LILS...as for knowing when I needed to have scar tissue out...I think it may depend on the OS.  Mine believed once it became obvious I could not gain any additional ROM without real force then it is time.  I have read on this site however, that other OS' have waited a few months before going in.  I was at 8 wks (although the decision was made at week 6). 

For me, I knew when after consistently gaining ROM each PT session it suddenly came to a halt and hadn't been able to make any gains for a full week and 1/2 (even losing slightly). 

I can't recall how far out you are....but if you are going to PT regulary (I went 3xs wk) and are not making ANY progress for 4/5 visits it's time to talk to your OS. 

My PT says its normal to gain and lose ROM as you are going thru early stages of rehab.  I was lucky enough to continue gaining and maintaining the ROM until I hit that wall at around week 5/6.  However, I was putting in 11 hr days of therapy....8 hrs cpm interspersed with other stretching exercises....heel slides down wall, leg daggling etc.  I would push to an uncomfortable but bearable level and hold these positions for 10 minutes at a time.

If your concerned though I would see if you can either get your OS on the phone or see if he will work with you via email.  I have been able to communicate progress/concerns with my OS via email which has been really helpful.

Good luck and don't get too distressed....this is definitely a game of patience.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: Rennschnecke on April 07, 2010, 04:19:55 PM
Sounds like a great result.  I hope it continues.

You're right about keeping the swelling down.  The trick is ice and elevate for incredible periods of time – something I didn't realise until late! :(
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on April 09, 2010, 02:12:28 AM
Cfranc: Congrats on the 115! I'm only a little over 3 wks post op., so I'm not too, too concerned about my ROM status at this point. I was just a little worried after reading some people's posts about having to get more surgeries due to ROM issues. My leg was really swollen today, even while sitting most of the day. I have a PT appt, so I know that will suck. Hopefully my swelling will better tomorrow or there is no way they will be bending it to reach any ROM goals. My OS told me the other day, "Wow, you're a machine!", since I told him I weaned myself off narcotics right after my 1st post op week. He said most people can't do that even with just the ACI surgery, so that's encouraging. I didn't tell him I only got off them because they make me too nauseated. I just let him think I was special ;D. If the narcs didn't make me feel so sick, I would still be on them. I definitely stay on the Extra Strength Tylenol though; that works well. I'd rather have Motrin though!
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on April 09, 2010, 05:28:54 PM
Hey LILS..

My PT recommended a nature anti inflamatory today...IbuActin.  I am going to try it.  I'll let you know if I think it helps.  It has Turmeric and Bromelain which are supposed to help with swelling.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: kralldaddy on April 09, 2010, 08:10:14 PM
I've had good luck with Naproxen  "Alieve".  It has really reduced swelling and if I take with a meal doesn't seem to bother my stomach.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on April 10, 2010, 01:05:57 AM
I had my PT appt today and I reached 113 degrees on my own and the PT forced it to 115. I was really surprised. I thought I could only get to around 100 degrees on my own. I did hold my breath each time we both tried to to go past 100 degrees; it did not feel good! I am on track though! The PT session actually wasn't as bad as I thought it would be. I skipped the CPM last night, since my leg was so swollen. Today, even after the PT session, my leg isn't even as swollen as its been the last couple of days. My toes are tingling now though. I have only taken 500mg of Tylenol this morning (it's 7pm US time now), but I will probably take another 500mg before bed, since I tend to wake up in pain in the middle of the night if I don't.

Hi kralldaddy: Unfortunately, since I had the osteotomy along with the ACI, I can't take any type of drug like Naproxen, Motrin, NSAIDs, etc. They interfere with bone repair according to my OS. I wish I could take something like that. I was told Tylenol is pretty much it for the next few months. Thanks for the suggestion though.

C, hopefully the IbuActin works.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on May 08, 2010, 04:19:22 AM
I am 7 1/2 weeks post op after my ACI/HTO surgery. I am doing well. I reached 128 degrees on the ROM on my own, without pulling my leg or having someone push it. My normal leg is 135 degrees. I still have a little swelling in the ankle and especially where the plate/screws are, but my mobility is pretty well. It's just painful going up and down stairs and off of curbs. I don't use a brace or crutches anymore. YEAAA! I'm hardly limping at all, which is weird, since I limped for months after my micro fx surgery. My x-rays look good; bone is regenerating within the wedge that was taken out. My scar is ugly now though. It started as a beautiful incision for 2-3 weeks, but has now developed into a keloid, which is painful and will need to eventually be injected with Kenalog to smooth it out. It's too early for that now though, since it's still healing and will probably get worse. Most of my scars keloid, so I wasn't too surprised. It limits my bending of my knee a little bit though. I was actually bending my knee one day and my insicion split open a little due to the pulling of the skin from the keloid. I'm not any any pain meds. My leg does get stiff, but I can stretch it out pretty quickly. My quad muscles are stronger than they were during my micro fx last year also, which I'm thrilled about. Hopefully the going up and down stairs pain will go away. I have to hold on the rail and go very slowly. Other than that, my pace is normal. I still struggle standing on one leg (injured leg) when I'm putting on my pants or get into my high bed or tub. It's getting stronger and less shaky though.  :)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: kralldaddy on May 10, 2010, 01:35:08 PM
LILS,

Great news on your progress.  The keloid thing sounds rough.  I'll be 7 wks post op on Tues with my follow up with the OS on Wed.  Hopefully I can ditch the crutches too.  I've been testing it around the house.

Are you completely brace free?  Or did your OS or PT have you wear it when you started walking.  Also wonderign how often your going to PT?  While I was NWB I only went a couple times and I wanted to get a feel for how often others are going.  I plan to step up to once a week or so.

Also have you done anything or taken anything to help generate muscle?  I 've tossed around the idea of Juven from Abbott or Muscle Armor from EAS.  Both are quite expensive but I've read good things about them helping build muscle.

Anyway great progress! :)
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on May 11, 2010, 03:36:40 AM
Hi Kralldaddy,
   Thanks! I actually was allowed to get rid of the brace while I was still on crutches (around my 4th or 5th week). I was more stable without the brace and my OS agreed. My leg bounced around a lot less without it. I was too clumsy with the cumbersome brace, and accidentally slammed my leg down a couple of times with it. When I was allowed to ditch the brace, I didn't have any issues. I went to one crutch at 6 weeks (after my OS cleared me). By the 7th week, I was doing very well and able to walk without any assistance.

I go to PT 2-3 times a week. I try to go 3 times a week, but it's hard to get away from work. To be honest with you, everything I do at PT, I can do at home. Many times I have felt I was wasting my time going there, but I know it's for the best. Like I told my Physical Therapist, I just like to go there to see how far I have progressed in my ROM and strength. I'm definitely progressing a lot faster than I thought I would, considering how much pain I was in the first few days after the surgery. The PT did tell me I need to ice my leg more, since he said my incision area was "warmer" than the rest of that area. I won't be going to PT this week, since my job is too short-staffed. I'll go back for the next 2 1/2 weeks, 2-3 times a week. I have another OS and Physical Therapist follow-up appt in June.

I have not considered any muscle building products since I am doing very well in that department. My quads never got too weak and I rebounded quick, as far as strength. My calf was very sore the first few days after my NWB though. My issue right now is getting used to the plate/screws in my bone; that is where the majority of the pain is. It does seem to get better each day. This weekend was the first time I got out of bed and actually did not even think about my knee until I was all the way across the house. To me, that means it's progressing. I look forward to the days I can go without thinking of my knee.....period....hopefully one day! Let us know how it goes once you start walking on it.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on May 14, 2010, 06:49:41 PM
Hey All..

Sounds like you are progressing awesome LILS!  I am now at 14wks post op and have 130 ROM (though my last measure I was a bit swollen so it might actually be a tad bit more).  I was only 135 before surgery so I am happy about where I am and ok if I can't push it any farther. 

My first big surgery my scar turned into a keloid as well.  That same scar has since been cut over twice (no other keliods and it's flatened out for the most part.  I wish I knew you were having these issues beforehand.  They say silicone strips work to help prevent keliod scaring...I guess it's what they use on burn patients as well.  I think something about keeping the air away from the scar helps prevent it from keloiding.  Think you can buy the strips now at a pharmacy. 

I went back to work at 10 1/2 weeks and was very sore after day one....muscles hadn't been used in so long.  Amazing how just walking from the parking lot to my office and back and forth to the restroom made me muscles burn as if I had spent 6 hrs at the gym. 

I was getting a lot of swelling still especially when I went back to work and was up and about more.  I bought the ACE soft touch ice wraps and they are awesome...they don't sweat so you can use them throughout the day without your clothes getting wet.  I still use them regularly and I think it has helped tremendously with the swelling.  I wrap one around my knee (with an ace bandage) on my way to and from work and use it a few times a day while I'm there then at least once at night.

I got permission to walk up to a mile a day from my OS so I can now at least walk the dog...which he is very happy about...but I try to limit my walking as much as possible other than that to keep the swelling to a minimal.  I am going to PT once a week now and may consider every other week or so.  As I can now do all my exercises at home and just need to go in to check progress and get new ones. 

I am still not going up/down stairs yet.  OS recommended waiting until I hit 4 months...so no harm in waiting.  I am doing ok with regaining muscle...but inner quad is still a bit weak and don't think I will be able to really start seeing some good progress there until I can walk up/down stairs as that makes a huge difference.  Overall though I feel pretty strong...much better than day 1 back to work.

Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: LILS on June 02, 2010, 08:02:12 PM
Hello,
    I am 2 1/2 months post-op and am doing well. I flew to D.C. for Memorial Day with no swelling in my leg. I was surprised, since my legs tend to swell anyway, even before the surgery. I am now on the way back to MS. I even went to Six Flags amusement park all day on Memorial Day and had no pain or any issues at all with all the walking and riding roller coasters. It was too freakin hot outside, but my knee was fine. I still can only reach 125-128 degrees ROM. I cannot crouch down without a little pain, but that is ok for now. I am currently seeing a plastic surgeon who has gone ahead and injected the Kenalog into my scar to flatten it out. He also gave me a cream to use on the scar to help speed the flattening out. The cream is called Aldara and it is usually used for patient's with skin cancer or venereal warts! He swears it will help my hypertrophic scar. We'll see. He also mentioned the silicone patch that I will be getting measured for. 3 different treatments for the scar. He also suggested cutting the scar out, but I know it will do the same thing and the last thing I want at this point is more pain in my knee. I walk up and down stairs and hills much better now than a I was a couple of weeks ago, but there still a little pain. I don't ice my leg at all anymore. I go to PT usually 2 times a week, but I'm taking a couple of weeks off until I see my OS again. Going to my PT is such a waste of time. I can do all that stuff at home.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: cfranc on September 02, 2010, 09:59:02 PM
Hey LLILS..

You still out there.  Haven't logged on in months but just read your last post from back in June.  It sounds like you recovered and are recovering quickly.  I still have some swelling in my knee, not much but some.  I can use the eliptical and stationary bike for 10-15 minute intervals without any pain/swelling and walk a couple of miles on fairly level ground....but I still seem to be so far away from normal.  I am now 7 months out.  I am geting closer to normal but don't want to push it as my doctor says and end up with more swelling, pain and lengthened recovery.  If you log on...let me know how you are doing now.
Title: Re: 2 WEEKS OFF AFTER ACI SURGERY?
Post by: mandl20 on April 24, 2012, 05:22:34 PM
Thanks for all of the information.  I'm 5 weeks post op from the scope and biopsy.