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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!

Offline blue_ezzie

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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















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