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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

Offline hathor65

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Re: MACI - six months later
« Reply #15 on: January 27, 2005, 01:57:49 AM »
ezzie

Glad to hear you are doing so well on the flexion front !!

With all your new gym workouts, I strongly recommend protein shakes to speed the muscle re-growth up. As I'm working my quads/hammies out every day, I have 1 shake per day (3/4 scoops of whey protein in a glass of skimmed milk). I've set myself a goal to get my left leg the same size as my right by my 12 month anniversary.....(there is a 5cm difference in diameter at the moment).

Did I read a post somewhere that someone was taking glucosamine. Is it safe to take for M/ACIer's ? Has anyone got feedback on it ?

Ezzie, am also still getting sharp pain btwn 20-45 degrees flexion in my bad leg when I do 1 legged squats. Still not sure what its about but am hoping it will fade or go altogether at some point. Has you OS got an explanation for yours ?


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 #16 on: January 28, 2005, 03:00:49 AM »
Hi Hathor,

Hmm, haven't been able to replicate the flexion, but at least I know I can get there, even if it takes a 1 hour massage to do so!

With the protein shakes, will they affect the rest of my body?? I am keen to get the muscle bulked around my knee but not anywhere else!!!  ;D I'm not sure what the difference in width between the two legs is, I'll get my physio to measure it next time.

I take Glucosamine-chondroiton (a brand of tablets called Nutra-Life Joint Food) and my surgeon has cleared me to do so. In terms of whether it actually works, the jury is still out. On the "Nutritional/Oral Supplement" board a few people in the US are talking about another oral supplement to assist with cartilage growth - it's called Hyalouric Acid and apparently has been used on horses for awhile. I haven't found it in Australia and I won't take it unless my surgeon clears me to take it, but it may be something interesting to keep an eye on.

In terms of pain while squatting, I don't experience pain until about 40 degrees and then it kicks in really sharply. I go back to see my OS in April so I'll tell you what he thinks it is then. My physio is baffled.

Take care
ezzie





Offline Jules

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Re: MACI - six months later
« Reply #17 on: January 28, 2005, 10:08:43 AM »
Hi All,
I was told at my first appointment prior to my ACI, that the supplements are a waste of time, and that there is no proven medical fact that they actually work? But then my last appointment 10 weeks post ACI, my OS told me to take cod liver oil capsules? Yes now I am confused? I did try them for 2 years prior to surgery and found no difference whats so ever. So I am thinking do they actually work? Or is it mind over matter when you are taking them?
Jules.
Apr 01 - bi-lat debride
Dec 01 - bi-lat mircrofracture & LR
Nov 02 - bi-lat debride & LR
Oct 04 - bi-lat A'scopy & harvest
Nov 04 - R ACI
June 05 - R A'scopy/shave
May 06 - R TKR
Aug 06 - L  PFJR
Jan 07 - L open LR
Oct 08 - L open LR
Feb 09 - L A'scopy/shave
July 09 - L TKR......
20 ops in 13 years

Offline blue_ezzie

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Re: MACI - six months later
« Reply #18 on: January 28, 2005, 12:44:16 PM »
Hi Jules

My surgeon also told me prior to the operation, when I already had missing cartilage, that the supplements were a waste of time. However, when I asked him after the MACI whether I could take supplements, he told me that I should hold off for 3 months. So I'm not entirely sure either! I don't think there are any proven studies that they work or not (or, there are studies that say they work and studies that say they definitely don't!). I personally know some people who swear by the supplements. I couldn't honestly say that they have worked for me, or whether I have just naturally improved, so I'm just not sure. I just guess it can't hurt (after the 3 months mark that is, according to my surgeon).

In terms of mind over matter - probably an element of that! It's reassuring to take something tangible like a tablet.

Offline hathor65

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Re: MACI - six months later
« Reply #19 on: January 29, 2005, 01:43:09 AM »
Jules/ezzie

Thanks for the feedback. I might just give the supplements a miss. If there was a miracle cure we probably would have all heard about it !!

Ezzie, I'm interested in your knee pain though. When you get to 40d does the sharp pain continue through the flexion to a given point or is it across the entire range. Mine is sharp from around 20 through to 45 then goes away as I bend further which leads me to think that it is occurring as the joint forces push down hard and over the new cartilage (which is @ 4cm sq.) !? I'm guessing its still tender under the new cartilage where the deep debridment was done during the ACI but I'm no OS !!!

Any clues welcome......

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 #20 on: January 30, 2005, 07:20:45 AM »
Hi Hathor

It's interesting we have something similar happening with our knees. When I am doing a one-legged unassisted squat, I am in no pain until about 20 degrees, then it's very slight pain at the bottom of the patella, until it really kicks in at 40 degrees and I just can't go down any further. However, when I do a two-legged assisted squat, I can push past the pain to get to as far as my flexion will allow - uncomfortable, but I can definitely do it. This makes me think that the fact that I can't go past 40 degrees on the one-legged squat is more to do with the lack of muscle strength and my fear of falling!

Your idea about the joint forces kicking in at the 40 degrees mark does seem to make sense, though. I've no idea how much cartilage I lost in square centrimetres, but my OS told me he had to take out about 75% of the cartilage from behind my patella after my accident, so I may have a graft size similar to yours? Anyway, I'm interested in your joint force theory and will run it past my phyio when I see her later this week!

ezzie

Offline hathor65

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Re: MACI - six months later
« Reply #21 on: January 30, 2005, 07:51:12 AM »
ezzie,

Looks like we are on the same path to recovery......let me know what your PT has to say. I would have thought that if you lost more than 75% through your accident then your new cartilage would be >4cmsq. more like 8cmsq.+.

Just to try something different, I have been doing one legged leg presses at the gym and the knee seems to hold up ok. I do 5 reps of 5 with no weight (other than my body weight) by which time my left glute is knackered. It's intruiging that I can do this with no pain and yet can't do a squat ?!

I've also started v. slow shuttle runs in my back yard. Jog one way and walk back. Haven't done more than 4 or 5 at a time so far..have you tried these ?

Re your question on protein, it will only help with your leg muscles if they are the ones you are working on. If you use skimmed milk with the shake, your fat intake is negligible. Anyway it works for me cos I also do weights for the upper body(gave me something to do for the last 9 months).

take care

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 #22 on: February 02, 2005, 02:36:11 AM »
Hi Hathor,

I tried your one-legged knee press at the gym yesterday (are you doing leg presses where you lie on your back and press towards the roof? My leg press at the physio is just one where you're in a sitting position and push to bend/straighten the knee, but this new gym I'm going to has the one where you lie on your back). Bizarrely, I don't have nearly as much pain at the 30-40 degree mark and I kept going to around 90 degrees, but struggled at that point...it's a strength issue but I also got a clunk in my knee. How many degrees can you get to on the leg press?

I'm also really going to start working on running and your shuttle run idea is getting me motivated. I've been doing some (rather uncoordinated) running steps for a month or so, but I've been worried about falling so haven't been practising like I should have been. However, the bus timetable seems to have changed over the last week and I've been needing to move faster to get to the bus on time - yesterday I looked down to notice that I was actually jogging!!!  But I really need some advice from my physio on style, it's quite embarrassing doing it in public right now!

Actually, something the personal trainer at the gym said when I was on the inclining treadmill - I seem to walk quite normally on a flat surface, but as soon as I inclined I started to straighten my bad leg. I wonder whether I'm doing something similar when I try to run. It can't be good for my joint if I am.

Hmm, I have been wondering for some time what my lesion size actually was, I will ask my OS when I see him in April.

Offline hathor65

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Re: MACI - six months later
« Reply #23 on: February 12, 2005, 06:43:27 AM »
blue ezzie

Got a  laugh with your running for the bus story. Maybe you should leave home 2/3 minutes late every day !!

I have been 'running' for trams and trains more recently too. A month ago I would just let them go off even if I was 5 meters from getting on as I knew i wouldn't get there on time. Now I can do a gentle jog and make it most of the time !!

I'm still working on the leg press thing as well and the one at my gym appears to be the same as your PT as I sit down and push up and away. If you put no weights on, you are effectively only pushing your own weight. I do one leg presses and can only muster my own weight for the reps that I do. It's obvious that this puts heaps of pressure on the knee as it feels awful inside. I don't seem to get any pain though.

Having said that, I'm still getting sharp pain on the squats. I find doing a lot of stairs aggrevates it too. I went to the MCG last week to watch the cricket and went up and down the stairs in the stands what seemed like a hundred times and was in agony by the end of the game !!

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 #24 on: July 10, 2005, 09:39:05 AM »
Hi All

Well itís been awhile since I posted. I really felt earlier this year - when I was about 8 or 9 months after the second stage of MACI - that I was making good progress, but since then unrelated illness on my part and deaths in my family have meant that I have completely neglected my knee. And Iíve really backslid and it's been hard to catch up.

Iíve again lost the quad muscle in my left knee so that it is again nearly half the size of my right (I never built it right back up anyway). My patella 'rocks' from side to side and I can hear the dreaded cracking and clunking more frquently. I get fatigued easily. I still can't run more than a few metres. However now I've finished this session's uni exams, I've started a new regime to get the strength and movement back in my knee. I've started a good yoga class and water aerobics class and this has helped me regain the bending - I'm at about 130 degrees. I plan to start going to the gym again. However I haven't been to physio or massage in months and my IT band is stretched as tight as a rubber band (am going back to physio for a torture massage tomorrow). I can feel the rest of my body is now really out of kilter - muscles are tight that were never tight before and I've put on a few kilos. The good news is that although I'm now often 'aware' of the knee (opposed to the start of this year, when I could almost forget about it), I'm not in PAIN unless I do a one-legged squat, or try to push past my flexion limits. And I'm confident that I'll get back to at least where I was at before, if not better.

I am now at the 13-month post MACI and I had an MRI scan and went back to see my surgeon last week. The MRI showed that I do have cartilage coverage behind my left patella, although it looks pretty 'irregular' according to my surgeon. My surgeon was also unable to tell me whether this was 'good cartilage', or whether it would still be there in 5 years time. He thought that the patella was rocking and the clicking was caused by overgrowth of the cartilage, and this was permanent barring further surgery to shave off the overgrowth. I am not going ahead with this surgery - has anyone here done so?

I was also told not to squat on one leg if it caused me pain (which it does). My surgeon was pretty impressed that I was able to squat unassisted with both legs to the limit of my left knee's flexion. He also was not as distressed as me (and my physio) about the lack of my quad muscle - in fact he expressed surprise that I had any VMO muscle at all, after what he did to it! He encouraged me to keep doing activities to work out what my own limits are, particularly with running - he didn't prohibit me from doing anything. He said that the operation had turned out as well as he could have hoped and he is going to show my Xrays, photos and scans to his university class. I am to see him again in a year.

I am interested to hear how everyone else post-MACI or ACI is motoring. For anyone thinking about going through with it, or recently done it, if you have any questions that I haven't covered in this post please ask. Another note - I read back over what I wrote last year and I am interested to see that my posts don't necessarily reflect how hard it really was to go through this operation and its rehabilitation. Nothing can prepare you for the pain and debilitation that open knee surgery can cause. However as I was in permanent pain before the operation and unable to walk, I have to say that MACI has been a resounding success for me because I virtually have my pre-injury life back (with some modifications, and much more body awareness!). But as I've said before, the most relevant thing for me has been my mental attitude - if I approach my knee positively, I am more likely to make progress. But more than a year down the track, and a less-than-perfect knee, it can sometimes be hard to keep that positive energy up.

Best of luck to all.
blue ezzie

Offline hathor65

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Re: MACI - six months later
« Reply #25 on: July 10, 2005, 10:44:49 AM »
blue ezzie

Good to hear from you. Sorry to hear about relatives though.

In answer to your question, I had overgrowth shaved at 9 months and it seemed pretty harmless.

I have been working hard at getting my knee/quad muscles back to normal. I still get sharp pain under the patella which I think is the new cartilage still sensitive to load. I am getting fed up with waiting for it to heal completely.

I tried skiing last week (at 14months post) and even though it hurt like hell under the knee cap I managed to do a full day and a half. I spent the rest of the week in the bar recovering.

Can you give me an indication as to how sharp the pain is when you squat. Mine seems to get better when I back off doing too much sport but as soon as I try to increase load it hurts again. Bearing in mind these are pains I never experienced prior to the ACI op !!! I am trying to stay convinced that it will go with time......

Take care

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 #26 on: July 11, 2005, 04:12:55 AM »
Hi Hathor

Whoa - a full day skiing!! Skiing is one of the few things that I wouldn't even consider doing with my knee the way it is, so I am extremely impressed! (And again, mathematical abilities escape me - I had the operation as the same time as you did I think and now 14 months, not 13, after the second stage of MACI).

How far can you run? eg can you play a game of tennis? Are you still icing your knee regularly? What is now the difference in diameter between your two legs?

Re the one legged squat - I was previously able to get down to about 40 degrees until the sharp pain kicked in, but I doubt I could get to about 30 degrees now. Again, it's something that must be muscle related, or perhaps even related to the tracking of my patella, because I can do the two-legged squat with no worries - I think I break through the position that causes me pain on the left leg. The pain at the one-legged squat stage is intense - enough to stop me moving down any furhter at all. My surgeon didn't seem to think it was going away, but I know it was better when the muscles in my leg were stronger. I will ask my physio again when I go back this afternoon (eeek!).

Re the overgrowth surgery - was this via arthroscopy or was it open knee surgery? I just can't put myself through another open knee surgery, although the 'rocking' (or maybe this means maltracking?) of the patella, eg when I sit on a chair and straighten and bend my leg - is certainly uncomfortable and a little disconcerting. Were you on crutches after the shaving surgery? Do you feel that it made much of a difference? My surgeon said that he wouldn't want to put me through it, although now I'm wondering...

Good to hear that you are progressing to the stage of playing sport. I am with you on the 'fed-up' feeling - it can be hard to stay motivated when we've already dedicated so much time and energy to these knees!!

Kind regards
blue ezzie




 


Offline BarryB

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Re: MACI - six months later
« Reply #27 on: July 11, 2005, 06:45:10 AM »
Hi Blue Ezzie.

I had an arthroscope at 9 months to shave the overgrowth from my grafts to the patella and trochleo.

It isn't open surgery, and i walked out of the hospital after the operation. It is only a small op. just like when they first take the cartilage to send to the lab to grow.

Did it help? Well, it did seem to get rid of most of the crunching, gravel like sounds. But i still have one bick click/catch at about 15 degrees, so every time i walk there is a big clunk as the patella slides over this. I am at 18 months, and surgeon reckons another scope will fix this, but then, he also said he could fix it the first time.

Anyway, i still think it is worth it. I can't help but think that if you just have one more small op to get rid of the overgrowth then i'll have a perfect knee....i hope.

Cheers, good luck!

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Re: MACI - six months later
« Reply #28 on: July 12, 2005, 01:55:21 AM »
Hi fp,

Thanks for your post. I am surprised to hear that the shaving surgery can be performed via arthroscopy as I certainly got the impression from my surgeon that it was a big deal - thanks for letting me know your experience. I don't have much to measure athroscopic surgery by because my first surgery, where the cartilage was removed, was a pretty major one for me to clean up a broken kneecap after an injury. But if 'walking out of the hospital' is anything to go by, it sounds like I may need to rethink my decision. I am a little down at the idea that the rocking kneecap and crunching may be permanent.

Thanks again
ezzie

Offline hathor65

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Re: MACI - six months later
« Reply #29 on: July 26, 2005, 11:34:15 AM »
ezzie

I also had the overgrowth shaved via arthroscope. I had a bit of swelling for a couple of days, then back to 'normal' after that.
I would not stress too much and go ahead. It got rid of my sandpaper grating feeling which was a relief.

Re the rest of my rehab, I have concluded (rightly or wrongly) that the reason I still experience pain (which is aggrevated by too much exercise) is that the undersurface of the patella and the site of the ACI is still tender from the op and will take time to recover. My injured left leg is almost back to the same size as the right one in the quadriceps and hamstrings. The only muscle which I am struggling to build up is the vastus medialis which lies on the inside of the leg just above the knee. I am guessing that this one won't build up until I am completely pain free as it's used when running and climbing stairs etc.which I try to minimise. The other quad muscles (lateralis&femoris) are the same now on both legs due to the amount of cycling I am now doing. I try and do leg flexion with a 20lb weight around my ankle most nights as well (3x10 reps) depending on how the knee feels.

I was thinking about going to see a PT to see if he can show me how to tape my knee cap over to one side and see if it helps with the squats and the other activities which hurt. Has your pt ever discussed this with you ?

Take care
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 #30 on: July 26, 2005, 04:21:15 PM »
Hi Hathor

Funny you should say that about the taping - I saw my physio yesterday and she has recommended that I should start taping my knee whenever I do my exercises (which I am back to doing, spending about half an hour every day after a long period of neglect!). She thinks that the one-legged squat may be causing me pain because my IT band, running down the outside of my left leg, is far too tight. She thinks the IT band is pulling my knee cap over to the left so it causes me pain at that 30-40 degree mark when I do a one-legged squat. Visiting a physio to see the best way to tape your knee is a really good idea - there are different taping techniques but my physio has showed me how to drag my left kneecap over to the right and secure it with some of that brown elastoplast tape.

I am also focusing on improving my glute and VMO muscles to reduce the tightness in the IT band. Also, I am doing glute stretches to try to stretch out the whole IT area, but it is a difficult part of the body to stretch!

I too have a major problem in building up my VMO muscle on the inside of my knee. My surgeon tells me this is because he had to cut through it twice and he doubts whether I will improve on what I have so far. I (and my physio) are a little more optimistic because I know that with hard work this muscle increases.

I am still a little reluctant to have the extra surgery and haven't properly investigated it further at this stage, but will definitely think about it. Thanks to you and fp for sharing your experiences. I think too that this has some problem with my pain while squatting, as I am worried that my patella will move around...it has a tendency to skid or rock from one side to the other - not a dislocation but it definitely seems unstable - at about the 30 degree mark when I'm trying to do the one-legged squat, or when I'm sitting in a chair and trying to raise my leg up and down. It is very uncomfortable, although not acutely painful, and I avoid moving my leg in this way by supporting it with the other leg. This can't be good in the long term.

How often are you doing your exercises with the weight and your cycling? How are you finding running?

Good to hear your progress and let me know how you find the knee taping!

ezzie

Offline hathor65

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Re: MACI - six months later
« Reply #31 on: July 30, 2005, 10:23:46 AM »
ezzie

In answer to your  question, I am trying to exercise 6 days a week. I ride 4 times a week for 1 1/2hrs on average. The other days I do some shuttle runs for 20 mins in the morning and weight training for 1 hr in the evenings. As mentioned before, I also do leg raises with weights most days.

I am trying to get back into the shape I was before the op where I was training 2x 1hr most days either bike or run. It feels like it's taking forever. Every time I start to ramp up cos the knee is feeling good I have to back right back off again because it starts to ache.

I still haven't got round to seeing a physio re the taping but will soon. I have noticed that in my daily routine, I tend to avoid all the situations which aggravate the knee, ie going up too many stairs, squatting on one leg etc. Having said that, I am going to go skiing again for a day in 2- 3weeks so will see if things have improved under pressure (it's still winter here in the southern hemisphere)

How are you going with your exercising. Are you back into a routine ?

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