Banner - Hide this banner





Author Topic: Looking forward to ACI?!  (Read 10496 times)

0 Members and 1 Guest are viewing this topic.

Offline LadeeStingray

  • Regular Poster
  • ***
  • Posts: 81
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #30 on: March 18, 2007, 09:52:43 PM »
Rich,

Just wanted to wish u the best on your big day tomorrow. 

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 Chondrosoldier

  • Regular Poster
  • ***
  • Posts: 64
  • Liked: 1
    • Myspace
Re: ACI is best thing since sliced bread; heres how to prepare for it
« Reply #31 on: March 19, 2007, 08:11:56 PM »
I am a 27 y.o. post-op carticel patient recovering from a 4CM patellar lesion.  Have nothing but OUTSTANDING things to say about the procedure and was pain-free three months

PHYSICAL THERAPY: Started PT two weeks post-op and its been a great experience as they really help coach you through the rehab.  ASK AND GO WITH YOUR SURGEON'S RECOMMENDATION FOR A PT WITH CARTICEL EXPERIENCE.  This is critical and will be well worth going out of your way for.  Also, straight leg raises are very painful the first few weeks.  The purpose to maintain quad tone and for that, 150-200 daily quad sets are just as effective.

CPM: Like the stocking, annoying to all, this is a critical piece of equipment that can make or break you. The 4 2 hr sessions inconvenient but well worth the alternative: being really sore in the morning after 8 straight hours on it.

ICE/COLD THERAPY: The automatic ice machine; EB ICe, Polar Pak ect. (automatic cryo-cuff) has been a blessing.  I would encourage everyone having or considering the procedure to get one. One eBay they can be had for $40-50.  I also picked up a mini-freezer for a $150 and just refreeze ice blocks without ever having to leave the futon.

The other item which is a MUST HAVE is what looks like a dog leash that use to lift your foot while in the straight leg brace.



This video is graphic but highly informative for those who are  trochlea implantion on a 38 y.o male.  The surgeon, Dr. Jack Farr is a highly experienced carticel surgeon based out of Indianapolis.   The video is OUTSTANDING because Dr. Farr does a great play-by-play as he does the procedure.   Video is an hour long but a MUST-SEE for all

http://www.slp3d2.com/sfi_1012/broadcast.html

Have a couple of great studies (PDF files) on ACI vs Mosaicplasty and a 2-9 year study on carticel treatment.  Will send them to you upon request.

Carticel's patient education reps are great at answering questions and concerns. You're paying them so use them.  I'm just a happily satisfied patient/athletic trainer but can be contacted anytime at [email protected]  Best Wishes, Brant
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant
Happiness!

Offline LadeeStingray

  • Regular Poster
  • ***
  • Posts: 81
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #32 on: March 19, 2007, 09:11:37 PM »
Hi ya Chandrosoldier,

Thanks for all the info,  i have seen that video of the surgery very informative.  I went thru the therapy, ice machine and CPM with my OATS i had last summer.  I can say the CPM really didnt bother me much but i never could figure out how someone could sleep with that on.  As for the "dog leash"  great idea i had lots of trouble getting my leg out of bed,  i shall try this when i have the next surgery. The first week after my OATs someone had to pick up my leg and hold it until i got to the edge of the bed, which didnt seem to bother them anyway since they would take my crutches from me so i wouldnt try to get up alone lol.

The doc i went to see today said he didnt have the experience to do such a complicated case, but he did mention Dr Farr. Indianapolis and Boston are almost the same distance for me to drive.  The doc in Columbus today said he would write a letter for my insurance company to go along with one from another doc, and hopefully that would be enough to get me to a doctor with the experience to help.

Who did your aci surgery?

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 Chondrosoldier

  • Regular Poster
  • ***
  • Posts: 64
  • Liked: 1
    • Myspace
Re: Looking forward to ACI?!
« Reply #33 on: March 21, 2007, 06:31:20 PM »
My surgeon was Jack Seaquist in Austin, TX.  I actually moved down here, took a job with his healthcare system for a month and intentionally got fired (refusing to speak Spanish) just so could get their health benefits and have all the surgery done.  Best move every made.  As a recent vet, the V.A. didn't even have the procedure on their books so I feel you wholeheartedly

A former Indianapolis resident, I have worked in Dr.Farr's group and seen his surgeries in person.  He is a pioneer of the industry, outstanding interpersonal skills and no case is too big for him.  Don't know about the guy in Boston though have saw his name mentioned with OATs a gazillion times.  Keep in mind its not a fly in, have surgery, and get out.  A good 6 months of rehab ends up costing more then the surgery itself. 

Got a lot ahead of you, wish you the best. Keep us updated.
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant
Happiness!

Offline tundi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 21
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #34 on: March 21, 2007, 08:36:53 PM »
Ladee,

  Sorry to hear that the outcome of your appointment wasn't more positive, hopefully you'll find someone capable of taking on your case soon !!! 

  Rich, you're probably still in hospital now but hopefully you're doing well and by the time you actually read this you'll be well on your way to making a speedy recovery.

  My recovery is going well, I have my 6 week check up on the 29th, it's a week early as my consultant is on holiday the following week, I moved the appointment back as it was originally scheduled for 7 weeks and I figured i'd rather get started with weight bearing and physio as early as is safe, worse case scenario is that I'm told I have to wait.  My physio at the moment is pretty much non-existent, just doing some simple exercises to prevent muscle wasting and build flexion / extension.

  I went back to work last Thurs / Fri, this caused my knee to swell up a little I’ve cut down to Mon/Wed/Fri this week and probably next – luckily I’m an office bod so I can sit on my butt all day, unfortunately, it’s impossible to keep your leg elevated and us a PC.

  I’ll let you know what the consultant says when I see him next week, hopefully I’ll be able to start some real physio and get back to weight bearing – I never though one of my goals would be to be able to carry a cup of tea from the kitchen to the lounge !!!  ;D

Take care

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

  • Regular Poster
  • ***
  • Posts: 81
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #35 on: March 22, 2007, 01:44:09 AM »
Tony,

Hey great to hear from you glad you are doing well. Come next week ill know where the insurance will let me go, I have again put in a request to go to Boston, and also this time to see a doc in Indiana.  Sometime soon they have to give in dont they?  Until then here i sit, but im starting to get the hang of this cooking thing now, hubby is happier lol.   Keep us posted on your visit and weight bearing status next week.

Rich i hope all is going well for you, cant wait to hear from you!

Take care all
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 24
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #36 on: March 22, 2007, 10:52:33 AM »
Hi Guys,

Got home about 7ish last night and had a pretty good sleep. I am in plaster for 10 days and then I see the physio to go through the rehab protocol.

Pain was quite bad in hospita, even thought I had a femoral nerve block and a PCA - thing where you can administer your own morphine when you want it. Last night and this morning have been fine. No real pain and I haven't taken any pain relief since last night. I had a look at the knee when they changed me from a half-plaster to a ful one. I didn't look too swollen but I do have about 15-20 stalpes. They didi think I might need a bone graft due to the depth of the defect but in the end it wasn't necessary although the defect was still big - 2X4cm.

Fingers crossed I suppose that all continues going well, I'll keep you updated and let me know how you are getting on.

All the best

Rich

Offline LadeeStingray

  • Regular Poster
  • ***
  • Posts: 81
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #37 on: March 23, 2007, 01:48:36 AM »
Rich,

So glad to hear you are home and all went well.  Sorry to hear that u had so much pain even with the femoral nerve block... I was really hoping to hear that helped with the pain.  Now the fun begins and you are your way to getting some of the things back in your life that you enjoy doing.   Fingers crossed here for you as well

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 tundi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 21
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #38 on: March 25, 2007, 08:20:29 PM »
Rich,

  Just wanted to say that I'm really glad everything went well and you've made it through the painful phase. I'll post again after my consultation on Thursday but I have a little bit of advice - buy your girlfriend some flowers tomorrow, she's going to earn them a million times over throughout the next few weeks  ;). Without my family ( who luckily live very close ) and my ex I really don't know how I would have coped.

Hope your recovery progresses well in both the short and long term.

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 RichUK

  • MINIgeek (20-50 posts)
  • **
  • Posts: 24
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #39 on: March 31, 2007, 05:24:50 PM »
Just thought I'd add an update on how I've been getting on:

I had the cast off yesterday which was a real relief - it was a full length cylinder and was really beginning to annoy me. Although now all the hard work has started! My first session with the physio went well and I was surprised at what I could do and what she pushed me to do. I just about got to 90 degrees of flexion and since then I have been able to carry the weight of my own leg rather than use my other leg to support it. I am still non weight bearing for at least another 2 weeks but I am going to get stuck into the exercises as much as the swelling and pain allows. On that note, I have not really experienced any pain and I don't take any pain killers - just anti-inflammatories and loads of icing to get the swelling down as much as possible.

One thing I am concerned about is that when I push into the last few degrees of extension using a gym ball as a resistance, my knee seems to pop - I can see it happen and feel it on the outside of my knee. Don't know whether anyone else has experienced this? Perhaps it is due to the swelling?

Anyway, mostly positive news to date with the only problem being the above and that the knee still feels very tight when I try to flex it but I guess that is to be expected.

Hope everyone else is good and progressing with their rehab/insurance companies,

Rich.

Offline LadeeStingray

  • Regular Poster
  • ***
  • Posts: 81
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #40 on: April 01, 2007, 03:41:26 AM »
Rich,

Great to hear the plaster is off and that therapy went so well.  90 degrees already thats wonderful !!  Im sure that knee tightness will be around for a while.  So no pain at all at this stage, thats also wonderful to hear.   Wanna swap me knees?? 

I wish you the best and keep the updates coming.

Ill have lots to say next week about my situation... ugh

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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 24
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #41 on: April 02, 2007, 11:24:34 AM »
Hi Tony,

Just wondered how your 6 week consultation went? Our experiences sound pretty similar at the moment. I haven't had any pain that is worth mentioning and I am also getting stuck into the flexion/extension and muscle maintenance exercises. Many people on here (ladee included) are particularly concerned about using a CPM. Just wondered whether you use one as it has never been mentioned to me and the other guy who went to RNOH also never used one?

I guess that after you have that initial all clear from the consultant you will be able to start putting weight through the leg and perhaps do some swimming and light cycling etc? I have got a rough outline of the rehab protocol from RNOH and they suggest that these sort of things can start to be done at week 6 although I assume yours will be a bit delayed because of the osteotomy? I have about 90 degrees of flexion already so I am quite pleased about that but i have read on here that the last few degrees of extension can be the hardest to regain.

Well let me know how you get on and we will have to compare rehabs!

Rich

Offline tundi

  • MINIgeek (20-50 posts)
  • **
  • Posts: 21
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #42 on: April 02, 2007, 11:09:29 PM »
Hi Rich,

  Had my 6 week consultation last Thursday, everything went really well and the consultant was pleased with my progress, especially as I was only at the 5 week point.  I did a little bit of weight bearing during the consultation with two crutches and then he switched me onto a single crutch – I ended up doing this strange hopping thing as my brain was so used to not putting any weight on my foot it just didn’t seem right. Once I managed to convince myself it was OK to do it I was amazed that it wasn’t painful at all. The consultant told me I was fine to start physio, I could ditch the brace (hooray !!!) and should only use a single crutch whenever possible, I have another appointment in 6 weeks and he told me he wanted to see me without my crutches.

  Everything was going great - until I left work on Friday that is ……… Apparently, wet, moss covered paving slabs and the rubber ends on these crutches I’ve got don’t mix at all well.  My left crutch slipped away from me and because my right foot was out in front of me I ended up slamming it into the ground with all my weight on it  >:(.  It was incredibly painful for 30 seconds or so but luckily the pain was on the inside of the knee ( I’d been having problems with pain there since the op and figured it was probably due to the re-alignment ), not the outside where the graft was done. I was right royally f*$#ed off, couldn’t believe it happened on the very first day I’d left the house without my brace on, after an hour or so I’d calmed down and figured what ever was done was done and I couldn’t change it, touch wood, I’ve not had any pain at all so I’m staying positive.

  Until today the only physio I’d done has been muscle maintenance + flexion / extension exercises. I get the impression that CPM machines are all the rage in the states but are only provided here whilst you’re in hospital – I used one for a couple of days as my consultant likes to get you to 90 degrees if possible before he discharges you. I did get a little slidy disk that you put on the floor and rest your heel in to assist with flexion exercises but I didn’t get on particularly well with it, I found sitting on the arm of my sofa with my leg dangling over the end was the most comfortable way for me to do the exercises.  When you say you’re concerned about the CPM, is that concerned about using one or concerned about not having access to one ?

  As I’ve already implied I had my first physio session today, my PT has done ACI rehab before with one guy who has had both knees done on separate occasions, so technically this is her third – This was quite reassuring for me as I was expecting to end up being somebody’s guinea pig.  The osteotomy won’t make any difference to my rehab as apparently the femur will have healed sufficiently to bear the weight without any problems.  Couldn’t believe that within 10 minutes of arriving she had me on the rowing machine, afterwards she took me through a series of exercises (lunges / squats etc) that I can do at home. I’ll be having weekly physio until my next consultation and we’ll re-assess things from there.  I know that rebuilding this scrawny lame arse excuse for a right leg is going to be hard work but it’s going to happen.  The knee is a little swollen and sore now but it’s too be expected – thank god for ice. I started off the session with approx 95 degrees flexion and was at around 100 by the end of it – I’m having extension problems but that’s nothing new, I found out when I had my microfracture last year that I have some bone growth that prevents full extension, I’m hoping that the re-alignment hasn’t exasperated the problem but I have my suspicions. I think that the most important thing with the rehab programme is that you make good progress and nothing happens to do any damage. I do hope our programmes don’t differ too much though as we’ll both be wondering whose is right  !!!

  Apologies for babbling, and I hope at least some of this makes sense and is helpful in some way.  If you have any questions on what you can expect a month down the road a any point then feel free to fire away. Look forward to hearing about your rehab news, I think it'll help keep things in perspective.

Cheers,

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 RichUK

  • MINIgeek (20-50 posts)
  • **
  • Posts: 24
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #43 on: April 13, 2007, 04:55:32 PM »
Hi Tony

Glad to hear your rehab is underway, even with the mishap you mentioned. I think everyone who has had this surgery would have been paranoid about damaging the graft. I can only assume that it is a little more robust than we sometimes think otherwise we would all be in plaster from hip to foot for weeks on end. I did have a little incident on the stairs when I was still in plaster but there was no pain so I just made sure I was a little more careful up the stairs in future.

I am a bit lucky in a way as my girlfriend is a sports therapy lecturer/practitioner so she is taking care of my rehab. She has never treated anything like this before but she is researching ACI/MACI rehab loads and we have a physio at RNOH who we can call if we have any questions. I have just been doing the exercises prescribed by that physio since I came out of plaster. The leg, although not really getting any bigger definitely feels stronger and I have a lot of the movement back - up to about 115 degrees flexion and a similar story to you with the extension - those last few degrees that seem to be almost impossible for everyone. I have read on here that a few physio's have got their patients doing an exercise lying on their front on the couch with their leg over the end and a weight on their heel to force those last few degrees. Most have said that this caused problems after the session so possibly one to avoid if it is suggested.

I am also glad to here that your surgeon wanted you to start partial weight-bearing at week 5. I went for a check up yesterday (I am not yet at 4 weeks so not quite sure why I went in so early) and I was told that I should start 'shadow weight-bearing' from next week - basically just touching my foot on the floor and slowly building it up. My only gripe with RNOH is that nearly every time I have had an appointment or spoken to someone when I have been in hospital I have seen a different person and they seem to say different things - the most alarming of these being that one said I couldn't drive for 4 months and another saying 8 weeks as long as I was comfortably weight bearing. Have you been given any quidelines regarding this? The guy I saw yesterday said that I should be building up to full weight bearing by week 8. I thought that seemed a bit early but what you said has made me feel a little better about it. On the rehab side of things, I am gonna do a fair amount in the water and carry on with the previous exercises for now.

So tit seems we are not a million miles away from each other in terms of what we are doing and what we have been told. Hope your rehab continues to go well and keep me updated on how you are getting on,

Rich

Offline LadeeStingray

  • Regular Poster
  • ***
  • Posts: 81
  • Liked: 0
Re: Looking forward to ACI?!
« Reply #44 on: May 17, 2007, 06:04:37 AM »
Rich, Tony,

Hey just checking in with you guys, havent heard anything from u in a while.  And while im here thought i would give u a little update.  My insurance company is still refusing the ACI surgery and have sent me to yet another doctor, for those of you keeping track .. this is doctor number FOUR now.   This new doctor doesnt feel i am a good candidate for ACI surgery. ( Let me back up a minute ... i gathered all my surgical notes and such from all doctors before going to see the new surgeon, while reading them before my appointment i find out that my OBI plugs "failed" ... i didnt know this ... no one mentioned it to me.  But the one autoplug is doing fine.   The problem is now that i have 2 holes measuring 12x7x7 in the subchondral bone now)  The new doc said that since i have already failed one "biological" surgery that the odds were good i would fail a second.  And now with the holes in the bone... i dont have a good base for the aci surgery.   We have decided to go for another scope so he can take a good look at my knee for himself and he feels at this time i am a good candidate for a HemiCAP procedure for the MFC and the trochlea.   So my surgery is set up for June 14th and we will just go from there to see what my insurance says about the HemiCAP.

I hope you both are doing well.

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