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Author Topic: Looking forward to ACI?!  (Read 10463 times)

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Offline RichUK

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Looking forward to ACI?!
« on: June 19, 2006, 01:26:39 PM »
Hi,
I'm new to this but i've been recommended to have a look on here by my surgeon (Mr Briggs @ RNOH - anyone else had ACI with him?). I am having the first stage done on 19th July and I am in the process of letting work know about the ops and how much time they can expect me to be off wotk etc. I am a PE teacher but luckily I have already arranged with my head of dept to teach classroom lessons when i first get back to work. Mr Briggs has suggested that I wouldn't be able to go back to work at all for about 5 weeks. Anyone got any experience with getting back to a physical job and how you have got around this with your employer.

Also, since looking at this site I reckon I've read about 10 horror stories to every success so I would love to hear from people who have had good experiences with ACI and any advice you could give to me regarding the above and rehab etc.

Cheers

Rich

Offline Started1991

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Re: Looking forward to ACI?!
« Reply #1 on: July 03, 2006, 10:12:29 AM »
Hi Rich,

First of all good luck, and second of all this forum is a little bit of a board of horror  :D

I had harvesting (1st stage) in April and 2nd stage (MACI) end of May '06 with Mr. Briggs as well. First Stage was a piece of cake as knee did not swell dramatically and I claimed stairs without problems within 2 days.

Having read most stories on this message board and speaking to one person who had the procedure done, I went into surgery with rather mixed feelings for the second stage. But be assured, for no reasons.

The only obsticals I had to fight were the discomfort of the cast and my struggle with medication (upset stomac and dehydration). I was out of hospital within 2 days. The only problem I faced during the the 10 days of 'wearing' a cast were immobility (welcome to the bathroom!) and slight back problems arsing from lying in the same position for quite some time.

After the cast was removed, things got better dramatically. My strength/stamina was back within 2 weeks and I was back to work after 3 weeks (could have gone in earlier, but played it save).

Things I did NOT experience at all so far were: swelling of the knee, infection, pain (stopped taking painkillers after a week)

I'm still not weight bearing, so I can't give my final 'verdict', but things have been very good so far without any complications.

Please let me know if you would like to have some further info.

Cheers,
Oli

Offline shade

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Re: Looking forward to ACI?!
« Reply #2 on: July 03, 2006, 12:47:52 PM »
Rich,

Good luck with your procedure.  You'll find lots of info about this procedure but protocols seem to vary.

Here is an article on post-op ACI rehab that might give you a general idea of your surgeon's protocol.

http://orthopedics.about.com/od/hipknee/a/aci_2.htm

Trust your surgeon.  ~Shade
July '05 (RK) - LR/debridement
Mar '06 (RK) - Open LR + Allograft w/OBI TruFit Plug + Fulkerson TTT
 Feb '07 (LK) - LR + Fulkerson TTT

Offline RichUK

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Re: Looking forward to ACI?!
« Reply #3 on: July 03, 2006, 08:04:08 PM »
Thanks for that Oli and Shade. Only a couple of weeks to go now until the first stage. Hopefully Oli I will have a similar experience to you. Any idea how many lesions you had and how bad they were. I have two lesions that are apparently quite bad so I don't know how that might effect the outcome. Also do you (or anyone else) know the difference between ACI and MACI (if there is one) and if they are doing all MACI at RNOH or whether it depends on the circumstances?

Thanks again and I'll let you know in a few weeks how I have got on.

Oh, one last thing Oli, what are you doing at the moment rehab wise? Did Mr Briggs provide you with a programme?

Good luck with your rehab,

Rich

Offline blackbeltgirl

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Re: Looking forward to ACI?!
« Reply #4 on: July 03, 2006, 08:50:03 PM »
ACI is the original version of the surgery, and they use periosteum as the "patch cover".  MACI is membrane or matrix enhanced ACI.  It is often done arthroscopically instead of with an open incision.  Instead ot using the periosteum it uses a membrane/matrix as the patch, and in some cases the new cartilage cells are actually matrixed on the patch when it is placed.  This is 2nd generation ACI, and available in the UK, Europe, and I think Australia.  Not available yet in the US.  The recovery is a bit easier, but you still need to spend about 6 weeks NWB to let the cells mature.  And early studise have shown MACI to be better than ACI for larger lesions, with a reduced incidence of overgrowth of the caritlage cells.

Good luck with your surgery!
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 Started1991

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Re: Looking forward to ACI?!
« Reply #5 on: July 03, 2006, 10:42:00 PM »
Rich,

Shade and blackbeltgirl gave you a nice run-through on your MACI question.

Some facts on the procedure can be found on the Gencyme Website, http://www.carticel.com/patients/default.asp. These are the guys who will grow/cultivate your cartilages.

On rehab, I started simple exercise to strengthen my quads after 2.5 weeks and with added weight (2kg) after 4.5 weeks (simple leg extentions). I will start using the cycle after 6.5 weeks and further strengthening the quads by doing squats.

Rich, you have to quiz Mr. Briggs. He assumes that you and I have gained enough information otherwise. If you haven't met Fred, the physio, yet, ask for a joint meeting once, to get a feeling yourself of what to expect, at what time, etc.

I questioned the two of them rigorously, and had a clearish picture after that (as written, the cumbersome experience with the cast was not expected).

One more peace of advice (or two) this forum is awesome. You get some valuable information form it. Unfortunately, there are not so many cases form the UK on here yet (well, positive ones). Given from the information I gathered on here, the procedure in the US is different as MACI hasn't gained FDA approval. Expect your rehab a quarter to a third shorter then most of the cases on here  :D

So, within 12 months (post scan) you will be off and gone!

On my lesion, it's a single one but quite big (over 2X2 cm) and on a weight bearing section of the knee.

If you would like to chat, let me know. My memory is still fresh and my spirit high!

Oli

Offline DJF

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Re: Looking forward to ACI?!
« Reply #6 on: July 05, 2006, 01:36:01 AM »
Here is a link showing the entire Carticel operation.  Very interesting:
http://www.slp3d2.com/sfi_1012/broadcast.html

Don
50 y/o male
Houston TX 

4 surgeries
Manual manipulation Dec 2006
Carticel implant with TTT October 2006
Carticel Harvest August 2006
The following done October 2005:
Chondromalacia Grade III to IV
Scope with chondromalacia
plus lateral release
plus plica resection

Offline RichUK

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Re: Looking forward to ACI?!
« Reply #7 on: July 24, 2006, 07:24:05 PM »
Hi there, well I thought I would have had the first stage of my ACI done on Wednesday 19th. The theatre slot was booked, a team of the best surgeons around were ready to perform the op and at half past three on the day before I got a call saying it had been cancelled due to a lack of beds on a ward! Anyone else out there been through this at RNOH? I've now been told that the next available date is 30th August. Typical NHS I suppose?!

Rich

Offline kiwi girl

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Re: Looking forward to ACI?!
« Reply #8 on: November 02, 2006, 07:30:32 PM »
Hey Rich,
I am meeting Mr Briggs soon as I have been refered for the same surgery.
Have you had yours now?
How did it go?
Well I hope!
Nicole

Offline RichUK

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Re: Looking forward to ACI?!
« Reply #9 on: December 06, 2006, 07:59:22 PM »
hi nicole,

no i haven't had the surgery. I had what was meant to be the harvest about 6 weeks later than planned but during the arthroscopy they found that my knee was too damaged and therefore probably unsuitable. i had 2 loose bits of bone removed as well as a large flap of cartilage. I went back to see Mr briggs about 3 weeks ago and actually saw his registrar mr david. he was really helpful and we talked through the options. apparently they have not done aci on an area as large as the defect in my knee. it sounds now as if they are going to do an osteotomy to offload the pressure going through the outside of my knee and they might still attempt aci. I am going back to see mr briggs/david tomorrow to see what they have finally decided.

my one word of advice before you see him (if you haven't already) would be to use these message boards to get as much info as you can. briggs is a pretty busy bloke and from what i have seen he tends to assume you know all about it. the more informed you are the more you will be able to ask him about his exact procedures. RNOH are trialling the treatment still and they will randomly assign you to either ACI or MACI. I think their results so far are showing no real differnces between the 2 although MACI is a simpler op.

since i have had a good read on here and have seen them kind of knowing what i was talking about, they have seemed more keen to get something done for me. since my last op my knee has been by far the worst it ever has with pain on a daily basis so they could see i was desperate to get something sorted.

Hope that helps. let me know how you get on and i'll be back on here with what is decided tomorrow,

Rich

Offline JulianUK

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Re: Looking forward to ACI?!
« Reply #10 on: January 26, 2007, 08:35:17 PM »
Hi Rich,

Just to let you know , if you haven't read my posts, is that I had MACI under Mr.Briggs & Mr.Pollock at RNOH Stanmore.

I have had both knees done, the left 3.5yrs ago and the right 2.5 yrs ago.

Both have been a complete success, although very long rehab.

I can know run up to 4km and do weights, jumps, squats, stairs, etc. All with no problem, except for some mild pain if I really do too much at once.

If you need any advice then get in touch, although best message direct as I'm not on here that often anymore.

kind regards,

Jules  :)
Julian

Offline RichUK

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Re: Looking forward to ACI?!
« Reply #11 on: January 30, 2007, 11:34:44 AM »
Hi Julian

Glad to hear a success story on here at last! It has been decided that MACI is my only option now so Mr Briggs is willing to give it a go. My problem area is quite deep so they are going to graft some bone from a non-weight bearing part of my knee. Apparently this 'sandwich' technique does slightly reduce the chances of success but I'lll give anything a go at the moment. I had the harvest yesterday so should have the big one in 4-5 weeks.

I'm quite apprehensive about what to expect in terms of pain at the moment - many people have said on here that it is almost unbearable.

It would be great if you could give me some detailed info on your rehab programme and any advice you got from your physio. Did RNOH put you in contact with your physio or did you have to find one yourself who knew about ACI? My girlfriend is a sports therapist and is keen to get involved - getting some advice from a physio who has done it before would be a great help. My email is [email protected]

Thanks for taking the time to tell me about your positive experiences,

Rich

Offline tundi

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Re: Looking forward to ACI?!
« Reply #12 on: January 30, 2007, 09:32:23 PM »
Rich,

Just wanted to say good luck with your MACI. I had my harvesting arthroscopy last Thursday for plain old welfare ACI  ;).  I know everones recovery is different but it will be interesting to compare progress.

I can fully relate to what you're saying about being apprehensive, there are some real horror stories in some of the posts. I figure that if it's successful in the long term it will be well worth the short term pain / discomfort - does make you realise that recovery is definitely long term though.

My op is being performed by John Skinner who I believe works with Mr Briggs at RNOH, I'm actually having the op at BUPA Bushey and will be having my physio in Southampton, I'd be particularly grateful if you could share any info you receive about physio as it's unlikely i'll find any physios locally with ACI experience - just have to find someone whose particularly good with knees.

Good luck again,

Tony
Apr 10 RK - 2nd Stage MACI
Feb 10 RK scope - biopsy for MACI
Dec 09 RK scope - debridement
Feb 08 RK - plate removal
Feb 07 RK  - 2nd Stage MACI & Distal Femoral Osteotomy
Jan 07 RK - scope - biopsy for MACI
Jul 06 RK scope - debridement & Microfracture
Nov 02 RK scope - debridement

Offline LadeeStingray

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Re: Looking forward to ACI?!
« Reply #13 on: January 30, 2007, 09:42:52 PM »
Hi Tony

Looks like u and i shall be going thru the process close together also.   Im waiting for them to schedule my ACI now .... had the biopsy the end of November.
Look me up.  Im online almost non stop since i am unable to work until after my ACI surgery.   Where are your lesion/s ?

Hope to hear from you soon
 
Ladee
10/05 Rt medial meniscal tear repair 1/06 synvisc injections
3/06 cortisone injection   6/06 open OATs MFC
9/06 drained/cortisone  11/06 biopsy for ACI surgery
6/07 scoped again....failed OBI plugs
awaiting approval for HemiCAP

Offline RichUK

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Re: Looking forward to ACI?!
« Reply #14 on: February 01, 2007, 02:48:19 PM »
Hi Tony and Ladee. Its good to know there are a few people in the same boat. I guess you two will have your ops before me so best of luck. You will have to let me know how the first few days go regarding pain, how long you were in hospital and how long you will be in plaster etc.

Tony, I will definitely share info in terms of physio recommendations and rehab etc. I have heard some stories about physios with no ACI experience ignoring the surgeons advice and getting their patients weight bearing way too early. I guess you just need to be forceful when dealing with the physio and not doing anything you feel contradicts what the surgeon has recommended. I think RNOH have a physio who deals particularly with recovery from RNOH. Perhaps someone on the message board could provide us with some details - a previous message from Oli said something about a guy called Fred.

Well keep me updated on how you are getting on and I'll do the same.

Rich