The OSTEOARTHRITIS DEPARTMENT => KNEE ARTHRITIS - Articular cartilage repair => CARTILAGE REPAIR - ACI & MACI (autologous/matrix-induced autologous chondrocyte implantation) => Topic started by: LisaWilliams38 on February 15, 2016, 11:27:01 PM

Title: 10 Weeks out & ACI Post-Op Problems: Did your Dr. allow NSAIDS before 12 wks
Post by: LisaWilliams38 on February 15, 2016, 11:27:01 PM
For anyone who had Carticel/ACI Surgery....I'm 10 weeks out from my Dec. 8, surgery. Were any of you allowed to take an anti-inflammatory/NSAID to help with swelling? My Dr has said no anti inflammatories/NSAIDS before the 12-week mark, as it impedes the growth of  new cells. However, I can't find ANYTHING about this online or in the Carticel paperwork. I plan on asking in 3 days at my 10 week post-op appointment.

Why I'm asking: Temendous problems with continued swelling & flexion limitations (stuck at 112 degrees since week 6, highest I ever achieved was 115). An NSAID would help tremendously, as we've proven 3-4X in the past,  where 2 of the surgeries were ones he performed & prescribed the NSAID.

Lastly, this was surgery #6 on this knee. I had a 2.5 cm by 1 cm lesion on my medial femoral condyle that was NOT there in any form/fashion in 2013--last surgery where surgeon used Biocartilage to fix 2 tiny Grade 3 holes. Flexion is always slow to come back (all other surgeries were arthroscopic--this was my first open incision). My PT said it would be a marathon, but my PT is brutal at each visit, spending 30 minutes "stretching," cranking on it to improve the bending. Nothing has worked. I wonder if he is keeping it inflamed. His overall expectation is 120 degrees of flexion by Month 4 or 5. I have trusted him so far, as few other PTs in this area have expertise in rehab ACI protocol. I really like him & his partners, except for the thought of 2-3 more months of sheer "bending hell" 3X a week.

For the record, I have a high pain tolerance. After 7 other knee surgeries, plus a bad back from a car accident in college (no one knows really because I manage it quietly, don't complain), I get kudos constantly from my surgeon, my massage therapist, plus numerous other PTs over the years complimenting my high pain tolerance and how it's a detriment, as I wait too long to get help.

 My Dr. & his PA keep telling me to take the narcotics or I won't get the ROM back. I'm down to 4 Percocet a day, and that's even after going to using only 1 crutch the last 5 days. Yet, the PT is brutal & the worst pain I've ever felt in my life. I don't see other ACI blogs/ diaries describing this, so what's so different about me?
Title: Re: 10 Weeks out & ACI Post-Op Problems: Did your Dr. allow NSAIDS before 12 wks
Post by: poohray32 on February 21, 2016, 03:36:51 AM
Hi Lisa, I didn't have ACI (Carticel) surgery but had Cartiform (osteochondral allograft transplant) and was told the same thing you were told.  No NSAIDs because it slows down the integration of new cells/cartilage growth.  At my last follow up I asked my doctor if I had a migraine could I take an aleve (naproxen) and he said that would be okay.  I too, have been in a lot of pain and mentioned to my PT about not being able to take any anti inflammatories and she gave me a portable tens unit w/IVF for pain and inflammation.  It was covered by my insurance so definitely ask your therapist about that.

I know our surgeries are different but I'm pretty familiar with ACI and have had my healthy cartilage plugs frozen at Carticel waiting for in the lab if this past surgery didn't do the trick..  good luck and let me know what your o/s says. 
Title: Re: 10 Weeks out & ACI Post-Op Problems: Did your Dr. allow NSAIDS before 12 wks
Post by: jaclyn.jenkins on May 16, 2016, 12:58:12 AM
I was told no anti-inflammatories (advil, etc) for 9 months post op. I am going to confirm this when I go for my ACI on Thursday. It does impede the chondrocytes from implanting and growing.

Title: Re: 10 Weeks out & ACI Post-Op Problems: Did your Dr. allow NSAIDS before 12 wks
Post by: Torao on May 25, 2016, 01:44:39 AM
I was told 9 months. I kept my knee wrapped with an ace bandage overnight for several months and ate an alarming amount of broccoli as it's a natural anti-inflammatory. I also iced almost obsessively and kept my leg elevated at my desk at work with an ottoman.
Title: Re: 10 Weeks out & ACI Post-Op Problems: Did your Dr. allow NSAIDS before 12 wks
Post by: LisaWilliams38 on June 02, 2016, 07:09:53 AM
Thanks to everyone for the advice/information. I haven't updated the last few months because of more complications. I had another scope on March 2 to clean out loads of scar tissue (apparently I make enough for 20 people  :o) .It only gained me full flexion for 3 days, so 6  days later I had a Manipulation under Anesthesia to break 4 adhesions in my quadriceps. That was the final solution and I finally gained my full 135 degrees of flexion in late April/early May (knee only goes to 136 when I'm out cold under anesthesia).

 It's been a nightmare though. I was allowed anti-inflammatories at the 14 week mark, then 3 weeks of steroids after the manipulation. My quad had a massive freakout and swelled to 30-40% normal size. That took a month to calm down with steroids. I've been strength training steadily since May 1, but every 2 weeks when we increase the weights, I get massive irritation/inflammation and need 2 weeks of backing off to recover. It's a massive roller coaster. My knee is still very stiff, and I have to do loads of bending daily to maintain the 135 degrees flexion.

My PT is an expert on ACI and said I'm easily the most challenging knee patient he's seen in 15 years, and that's even with him getting all of the tough referrals. I'm starting to hate being "special." He was willing to cut me loose and do PT on my own at the gym, but my surgeon is afraid of another hiccup in the whole ordeal. I may be in PT 3 months longer than we ever thought. At least I'm getting my legs of steel back though.  Thanks again to all of the people who posted and offered info. There simply needs to be more personal experiences about ACI recovery. It seems everyone is SOOOOO different.