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Offline blue_ezzie

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MACI - six months later
« on: October 23, 2004, 12:05:17 PM »
Hi all,

I really benefit from reading about everyone else's experiences with this operation so I thought I'd update you with my latest news.

I went to see the surgeon last week for my (almost) six month check-up after MACI on my left patella. I do not experience joint pain (I was in a constant high level of pain before the op) but am uncomfortable after sitting in a chair for 1-2 hours, and do experience muscle tightness around my knee and general fatigue. I can walk around university quite comfortably all day with a backpack of books but am not up to jogging yet. I have a very slight limp. I have been concerned that I have been SLOW in regaining ROM (my current ROM in my left leg is -5-115, my right leg is -15-140) and am also a little concerned that my left leg's quad muscles are still a little wasted.

My doctor told me he was quite pleased with my condition six months down the track. He was not in favour of doing a further procedure to improve my flexion and he would be happy with/only expected about another 5 degrees. I was a little upset and surprised by this - my ROM is certainly very liveable but I didn't realise that I wouldn't get it all back. Has anyone else had this experience? Also, I need to work extra hard at getting the quad muscles back to support the knee. Also, the doctor was quite concerned that I have a loud "clicking" noise when I bend and straighten my knee - he said that was probably scar tissue but possibly bone rubbing on bone, which I wasn't too pleased about.

My doctor is not going to do a scope to see if the graft worked. He is going to see me again in about 6 months, at which point he said that I may be in a lot of pain, or may not be in pain. He will not declare that the operation has "worked" and keeps telling me that he won't know for up to 10 years. He also told me that he expected I would get arthritis in the knee in the medium-long term, again something that upset me a little. He recommended that I start taking glucosamine. He also said I could start reducing the physiotherapy, which I was really pleased about!!

Overall, the MACI operation has been a positive experience for me. I am living a relatively normal life in which I am always conscious of my knee, but it does not dictate my life as it did before the operation. I am certainly more in tune with my general health than I was before my knee troubles started, so I look at that as a positive! I will continue to work at it and hope that I will get back to a totally normal life at some stage, but I think that managing expectations is really vital in recovering (mentally and physically) from this operation.

Best of luck to anyone undergoing surgery, or thinking of doing it. Feel free to ask any questions. I will also try to get some pics scanned in to the computer if anyone is interested.

ezzie



Offline hathor65

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Re: MACI - six months later
« Reply #1 on: December 18, 2004, 10:57:36 AM »
ezzie

I am 7 months post op and read you news with interest. I had an aci to the left patella as well (4cm). Like you, I also have ROM limited to @ 120 degrees. I was also experiencing very sharp pain in back of knee cap when doing squats or going up stairs so my OS had a look via arthroscope last week.

He took photo's of a fantastic  new load of cartilage where my hole previously was so I was over the moon. The ACI was a success !! He also found a load of thick scar tissue in various spots between the patella and femur etc. which he lasered out.  

My aim is to rebuild my quads asap and I'm finding the best way is to ride a bike and take protein supplement.
Athough I'm still experiencing some minor sharp pain (which the OS can't explain as there are no nerves between the patella and trochlear) he said to go "as hard as I like". Until I have full muscle strength back, I won't be 'going hard' anywhere !!

I hope my news gives you some positive hope.

Hathor65
Nov 03 - L Knee debridement
May 04 - ACI L knee - Patella
Dec 08 - MACI L Knee - Patella
Oct 09 - L Knee scope

Offline BarryB

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Re: MACI - six months later
« Reply #2 on: December 20, 2004, 09:25:50 AM »
Hi guys.
I had a 12 month check up/MRI for a patella/trochlea implant recently and it shows it has filled nicely, which we already knew from a scope to shave up some graft hypertrophy. So i can say that my implant was a success.

Although, bad news from the MRI was that now i might need ACI to the medial femoral condyle since this showed signs of thinning and displayed a crack on the MRI. So back for another scope to determine the damage.

Good to hear that more people are having successfull implants though, because there hadn/t been many on here untill recently from what i've read.

Good luck to all.

Offline hathor65

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Re: MACI - six months later
« Reply #3 on: December 20, 2004, 08:57:09 PM »
fp

Great post. Reading some of the other posts around it could easily put some people off having ACI. During the early stages of my recovery (<3months) I used to read posts here and get pretty worried that my op was not going to be a success. In fact I fell down the stairs at week 9 and thought it was all over. I heard a loud ripping noise which turned out to be scar tissue tearing and the graft was intact.

Just out of interest, did you experience any sharp pains during the latter stages of you recovery when doing leg press/one leg squats etc. ? It seems to be coming from the back of the patella although there is no medical explanation for it as scope showed everything to be fine.

Thanks Hathor
Nov 03 - L Knee debridement
May 04 - ACI L knee - Patella
Dec 08 - MACI L Knee - Patella
Oct 09 - L Knee scope

Offline blue_ezzie

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Re: MACI - six months later
« Reply #4 on: December 21, 2004, 05:35:24 AM »
Thanks for your posts!

I am now 7 1/2 months post-op and reached another milestone at physio yesterday....125 degrees of flexion! My surgeon only expected me to reach 120 so I am really feeling great about this, all that agonising bending paying off.

Last week I started jogging on the mini-trampoline at physio and this week can *almost* do a semi-jog on carpet. I am terrified of falling though and I think it's lack of confidence which is holding me back from doing a proper jog. I also still have a lot of muscle wastage in my left leg and I get worried that it may give way.

Hathor - When I squat on my bad leg (left) I get quite a bad pain on the lower left side of the patella (I think at abou the 40 degree mark? I'm not sure exactly how low I can go!). My physio straps my knee up and this seems to help, although I still can't do a one-legged bad leg squat anywhere near as well as my good leg. I only experience this pain while squatting. Not sure what it is all about though.

fp - I'm sorry to hear that you have to go through the op again, but at least you have the confidence of making it through the first one! Why did you have the operation in the first place? Did you have an injury or osteo?

It's great to hear good news on this op, keep us updated everyone!

All the best
ezzie

Offline hathor65

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Re: MACI - six months later
« Reply #5 on: December 21, 2004, 11:41:31 AM »
ezzie

Good to hear your progress update. You've now set me the challenge to top 125degrees !! I haven't had any physio so far as my OS said it was up to me. I've been doing my own leg bending using my good leg (and my wife) and I stretch regularly anyway. I also never used a cpm machine which is probably why I got some scar tissue problems. My OS has an interesting approach when I read how some of the others out there have been going through rehab.

It's comforting in a way to hear you have the same pains when squatting the bad leg. Hopefully it will fade with time. Keep posting on how that goes.

I'm aiming to ride my bike to work and back in the New Year (1 hour each way) as I haven't done so since my op in May.

rgds

hathor
Nov 03 - L Knee debridement
May 04 - ACI L knee - Patella
Dec 08 - MACI L Knee - Patella
Oct 09 - L Knee scope

Offline Nick_Knack

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Re: MACI - six months later
« Reply #6 on: December 21, 2004, 05:22:24 PM »
Can you guys list the names and locations of your doctors?


Thanks,

Nick
Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline BarryB

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Re: MACI - six months later
« Reply #7 on: December 22, 2004, 05:14:58 AM »
Hi guys.

Ezzie, my original ACI was a combination of everything they think. It was caused by an accident, but because i presumably allready had some wear on the cartilage due to bad genetics and an alignment problem the accident caused more damage than on someone who had perfectly healthy cartilage.

Hathor, i too haven't had any formal physio. My doc reckons they push you too hard, and that all the stuff you need to do can be done at home.

Nick, i had my operation in Australia so if your nearby i'll give you the surgeons name if you want.

All the best.

Offline hathor65

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Re: MACI - six months later
« Reply #8 on: December 23, 2004, 09:08:59 PM »
Nick

I'm down under too so can give you details if you're in the neighbourhood.

hathor
Nov 03 - L Knee debridement
May 04 - ACI L knee - Patella
Dec 08 - MACI L Knee - Patella
Oct 09 - L Knee scope

Offline blue_ezzie

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Re: MACI - six months later
« Reply #9 on: December 24, 2004, 06:53:33 AM »
Hi everyone,

Hathor - I was never given a CPM machine either. I asked for one but was told that they weren't really used in Australia anymore. At the time it didn't seem all that important to chase up, considering I was in a world of pain and painkillers, but after reading everyone's experiences on this board, I have wondered in the subsequent months whether it would have helped with the scar tissue and reduced movement that I now have.

My boyfriend is just so fabulous with bending my leg - I've got to a point where I can't go any lower on the stationary exercise bike and I'm too easy on myself when I try to bend with an elastic physio band, so I get him to bend my leg back. I find the best place to do it is in the shallow end of a pool - I still go along for lunges and bending practice every week! How do you do your own bending? I can't believe that you are managing without physio - after the op I went 3 times a week and I'm still going to physio once every 1-2 weeks. I don't know where I would be without it, because the massage my physio gives me frees up the scar tissue and my tight IT band so that I can walk completely freely and normally. They do push you though...my first physio after the MACI had me strapped face down to a physio bed while he cranked my leg back, strapped that there too, and walked out of the room while I fought back tears and nausea. Horrendous! (Luckily I ditched that guy pretty fast).

My doctor has cleared me for bike riding but I just haven't yet...I think that might be a bit of a confidence issue too. I do ride the stationary exercise bike at the gym and physio and find the movement so useful in loosening it all up.

fp - I had a similar experience...really bad fall down some stairs but (from my own impression) there must have been something a bit dodgy with the cartilage or mechanics of my knee to have such horrendous damage from 4 measly stairs. When is your scope for your next one?

NickKnack - I had my operation done in Sydney, Australia and was am very pleased with the results. If you are interested, I can email you personally with my doctor's details in case he doesn't want his name on this board.

All the best for upcoming festivities!
ezzie

Offline hathor65

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Re: MACI - six months later
« Reply #10 on: December 28, 2004, 11:26:53 AM »
ezzie

Season's greetings to you too.

That physio sounds like a maniac. My OS warned me that very few PTs understand the shock that your knee/leg goes through post ACI/MACI and can do more damage than good so not a big fan. For the last 7 months I have done bending exercises by sitting on the edge of the bed and using my other leg to push down on the bad leg at least twice a day. Now that I have 100+degrees I am doing supported squats morning and night. I also go out on my bicycle every morning for 1hr which is always a good pre-stretch warm-up !! In the early stages (about 1.5 months ago) I was putting a hot pack on my knee before going out to warm it up and when I got back from the ride put an ice pack on to help with the pain. My knee didn't know whether it was coming or going !!

My quads are starting to get some mass so am pleased. I would really recommend it to you as well if you can get out there on a bike. Its great therapy all round especially as it's summer.

How do you go going up and down stairs. Do you still feel any pain ?

Hathor
Nov 03 - L Knee debridement
May 04 - ACI L knee - Patella
Dec 08 - MACI L Knee - Patella
Oct 09 - L Knee scope

Offline blue_ezzie

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Re: MACI - six months later
« Reply #11 on: December 30, 2004, 04:29:22 AM »
Hi Hathor,

Good tip about the bike riding and ice etc. I am really at the stage where I need to step it up a notch to fully get that muscle back - leg raises are only good to a point! Do you ride on flat ground or are you up to doing hills etc? I have (luckily!) just moved near a beach and am finding sand walking the most brilliant thing for strength training, although utterly exhausting!

I also do the bending back leg thing - lying on my back on the couch with my bad leg over the side armrest is a good one too because you get more of an angle! It's funny how it just becomes part of your life...I am always unconsciously bending in different places. I find bus seats particularly handy  :)

Also wanted to ask you about the supported squats; what is your technique for these?

In terms of stairs and pain....going down is alright, although occasionally I get some clicking, and if my knee is not warmed up it doesn't bend all that far, and I feel as if I may pitch forward. But no pain as such. I only seem to get that funny patella pain when I do the one leg squat.

Going upstairs....not *pain* but discomfort, or awareness of the knee. It almost feels like I can feel the mechanics of the joint as it goes through the motions...or that the knee itself is hitting the ground. Sounds really bizarre I know, but I'm not sure if I can explain it better than that!

Hope you had a good Christmas and that you have a good NYE coming up.

ezzie

Offline hathor65

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Re: MACI - six months later
« Reply #12 on: January 03, 2005, 08:00:48 AM »
ezzie

Happy new year !

Thanks for the post. I also live by the beach so will try that for exercise as well. It may also be a good place to start light jogging as well as its soft underfoot.

For the supported squats, I sit on the edge of the bed and lower myself to the ground as if doing tricep squats. I go down as far as the pain will let me and hold the position for 30 secs. Then I lift myself up and go back down again. I do 4/5 repeats b4 I go to bed. In effect, you are supporting yourself with your arms and using your weight to bend the knee. Give it a try and see how you go.

As far as the bike goes, I have been riding up and down hills and focussing on using my bad leg to ride uphill so as to work the quads and hamstrings hard. I caught up with some mates yesterday who were riding hard. I managed to keep up for 1/2hr but paid the price today !!!

I think we need a new year's resolution around our knee's. Any suggestions. !!??? My 12months are up on May 3rd how about you ?

Hathor
Nov 03 - L Knee debridement
May 04 - ACI L knee - Patella
Dec 08 - MACI L Knee - Patella
Oct 09 - L Knee scope

Offline blue_ezzie

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Re: MACI - six months later
« Reply #13 on: January 19, 2005, 05:24:16 AM »
Hi Hathor,

Well another barrier for me this morning - had an hour workout at the gym (torture!!). My bending is not really going anywhere - in fact I don't know whether it's even stayed at 125 degrees -  I've really been focussing on building up my quad muscles as they simply does not seem to be improving. I'm now approaching 10 months post-op (mine was on May 2nd 2004, just a day before you! weird!!!) but I just can't fathom the thought of being a year post-op with a teeny tiny left leg.

Had a great personal trainer who helped me out this morning and drew me up a program - which may also be useful for others to see what I'm up to at this point: 10 mins on "alpine" level on the exercise bike, 15 sets X 3 on leg press, 15 sets X 3 hamstring curls, 10 sets X 3 swiss ball squats, 10 sets X 2 hip extension, 10 sets X 2 hip abductions, 10 sets X 2 hip adductions then 10 mins walking 5ks p/h on treadmill inclined at 15 degrees. With the leg press etc, only using no weights/lowest weight at this point, and was puffed at the end (this took me an hour), but seem to be coping okay today.

Also been trying your squats using a kitchen bench - not sure if I've quite got the right technique, but seems to be doing something! Thanks for the tip. I'm looking into getting a bike too, the gym is good but there is nothing like riding around in the sunshine to be inspired to get out there and exercise! Weather has been great so I've been doing a fair bit of swimming too - I get pretty tired after 1/2 hour of freestyle.

How is that pain when you squat? I still hit it at the 40 degree point. No idea what it is!

I hope everything is going well for you.

All the best,
ezzie






Offline blue_ezzie

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Re: MACI - six months later
« Reply #14 on: January 20, 2005, 12:38:54 PM »
Well, some good news, back to the physio today after my epic gym session yesterday (soooo sore today!!!) and she gave me a fabulous hour-long massage...and then I asked her to measure my flexion and I got to 135 degrees!!! Two weeks ago when I last saw her I was at 120 degrees! I got to 125 degrees a couple of weeks earlier but hadn't been able to get back there, so I was thinking this might be the end of the road.

And just think, my surgeon told me when I was at 115 degrees (at the 6 month mark) that I wouldn't get much further. And I've only been inching along a degree or two a week for the last 8 or 9 months so my huge workout must have really, really helped to push me along! I'm kicking myself for not stepping it up a notch sooner.

PS I appear to be terrible at maths and I'm now approaching the 9 month, not 10 month mark. My 12 months is in May.

All the best everyone















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