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Author Topic: Distal realignment with ACI....yes or no? Serious anxiety.  (Read 804 times)

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Offline kde77

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Distal realignment with ACI....yes or no? Serious anxiety.
« on: July 06, 2005, 02:54:31 AM »
Hello, .
I'm new to the board.  I am 28 years old and have been dealing with knee pain for 7 years.  I was once a division one basketball player then had a lateral release and it ended my career - and I have not run, jumped, kneeled, or squated since.  After the lateral release I had a scope, another scope with microfracture and recently yet another scope to get a cartilage biopsy for ACI.  I never expected to play basketball again, I don't expect to run, but I miss my former active life.  I also worry about someday getting pregnant (a question for the mothers out there) and how I'll physically be able to carry extra weight, not to mention walk around with a baby.  Right now I can't imagine holding a child and standing out of a chair at the same time.  Impossible! 

My new doctor is recommending that I get a distal realignment (osteotomy?) along with the ACI.  I have bipolar lesions (under kneecap and trochlear groove).  I can walk relatively pain free.  I have pain up and down stairs (acute - then goes away).  I have pain whenever I stand up out of a chair, a car, toilet.  I use my arms to help push myself up.  I can't squat to tie a shoe.  I can do an eliptical machine or a bike (most of the time). 

Because of my experience with the lateral release, I am terrified of getting a surgery that may make me worse.  I am having a difficult time with the following issues...maybe someone out there can help?

 - I have issues with certain daily functions but the bottom line is I CAN walk.  And if I have this surgery and even walking becomes difficult I couldn't forgive myself....fool me once shame on you etc.

- Has anyone had the osteotomy with the ACI together?  What were your results?  Did you have a trochlear lesion?

- I got a second opinion from a very conservative doc who told me not to get the surgery.  This doc does not do this surgery at all.  Do you think I should get more opinions?  How does one make this decision?  It's not black and white and no one can guarantee that I'll get better, or how much I'll be better or that I won't get worse. 

- Oh yeah, should I mention that my right (good) knee is now headed down the same path.  I can't blame it, it has been compensating for years now.  And it would have to hold up through this intense rehab. 


I would love to hear the good the bad and the ugly relating to these procedures if people will share.  I understand the rehab will be long and difficult.  It is a risk versus reward decision that I just don't know how to make.  Any advice?  I would be grateful.

Kristina

Here is my history:
Dec 1998 - lateral release
Nov 1999 - scope
May 2004 - mircrofracture
April 2005 - scope for cartilage biopsy
Aug 2005 - doc wants to schedule osteotomy with ACI


Offline blackbeltgirl

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Re: Distal realignment with ACI....yes or no? Serious anxiety.
« Reply #1 on: July 06, 2005, 02:26:41 PM »
Kristina -

#1 - I'd recommend you post this on the ACI board.  It's under the arthritis section.  But a lot of people have procedures to correct alignment in addition to ACI.

#2 - Go to carticel.com.  Look for their surgeon referral page (in the patients section).  If your dr is not on this list, make an appt with someone who is.  Genzyme offers different levels of training for doctors, but to be listed on their referral page you have to complete all of their advanced training.  A while back someone had posted a good list of questions to ask your OS too - how many have you done - especially on this part of the knee, success rate, etc.

#3 - You may want to ask your OS about the bike.  I have 3 lesions, and one is in the trochlear groove.  Because of the placement of my lesions, I am not to do any activity that includes repetitive bending of more than 70 degrees.  A bike requires 90 degrees.  This is to prevent the patella from constantly running over the trochlear lesion.  I do the elliptical and the arc trainer at the gym.

#4 - there are several threads discussing the same question you've raised.  If you can walk, etc. are you really interested in taking the risk, etc.  The answer is different for different people.  I actually ended up meeting one of my OS's ACI patients through this board.  She is several years older than me, and basically said that she was not interested in compromising so much of her life so young.  At 31, I dislike the fact that I think about my knee before planning a vacation, when deciding what to pack, that if I'm taking a walk with a friend even moderate hills can put me in agony, etc.  And yeah - what about carrying a child, or playing with one?  One of the unfortunate truths is that there seems to be little connection between size/placement/depth of a lesion and pain.  And for people who've had knee issues for years, we've learned to ignore a lot of the pain.  I'm a bit terrified that if I wait until I'm in agony, my knee will no longer be in good enough shape to make ACI an option.  Of course, I'm already a borderline "salvage case".

My point in all of this - do some more research.  It is a long recovery.  It is a risk.  But wondering if you can really go visit your friend, who lives in the 3rd floor walk-up, when you're 28 years old is not the way I would want to live.  (Of course, at 31 I am living that way at the moment, but....)  If you need to travel to see a cartilage restoration expert, do it.  Even if all you get is comfort and comfirmation in the surgeon you've chosen, it will be money well spent.

Good luck.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline kde77

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Re: Distal realignment with ACI....yes or no? Serious anxiety.
« Reply #2 on: July 07, 2005, 01:30:16 PM »
Jess,
Thanks so much for your input.  I think I will re post in the arthritis section.  As for your advice, I checked carticel.com and my doctor is listed and I have an appointment today so I'll ask about the bike.  He will want to schedule the surgery today but I just don't think I'm ready.  I have confidence in the OS but in order to feel comfortable, you're right, I need to do more research.  Thanks so much!

Offline Leentje

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Re: Distal realignment with ACI....yes or no? Serious anxiety.
« Reply #3 on: July 07, 2005, 08:40:38 PM »
I also had a failed lateral release and was in constant pain 14/7. OS wanted to do a realignment but I hesitated and put it off. I finally had the Fulkerson TTT 1.5 year after the TTT. It was a major surgery with a hard recovery but I can say it was a big succes!!! I do not have to grab things to get up from a squatted position, I can run, jump etc without pain! I do have some occasional pain and grinding but nothing compared to how it was before! I have more painfree days than I ever had!

I would recommend surgery!! I have the same problems in my R knee and one day I'll decide to go for the TTT again! No LR, but the whole TTT. After all those years of pain pain pain I have my life back! Not a new knee but a good knee!!

Helena
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline kde77

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Re: Distal realignment with ACI....yes or no? Serious anxiety.
« Reply #4 on: August 25, 2005, 09:41:00 PM »
Helena,
Thanks so much for sharing your story.  It's amazing how a little bit of good news can brighten your day!  When you say you were in constant pain, what does that mean?  While sitting?  Sleeping?  Or just on stairs, sit to stand, getting out of cars?  With my knee I have to do something to it (like get out of a small car) to get a sharp pain.  While sitting still I don't have pain.. not really any pain with walking either.  That's why I can't decide if I should get the TTT because I don't know if I'm in ENOUGH pain.  Does that make any sense?  I guess I'm used to living with the pain.  Thanks so much!!















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