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Author Topic: 4 weeks down the long ACI road  (Read 17276 times)

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Offline bioprof

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Re: 4 weeks down the long ACI road
« Reply #60 on: April 16, 2007, 03:34:01 PM »
I've not been doing leg extensons regularly since "the event" that led to where I am now.   But when I do try to do them there is popping - more like cracking - and soreness/pain.  The pain doesn' seems to be deep, but rather within the supporting tissue - i.e. muscle, tendons, etc.

Mike
8/05 - Cortisone injection, L. knee
10/05 - Meniscus repair, microfracture, L. knee
7/06 - Arthroscopy, Carticel biopsy, L. knee
8/06 - ACI, L. knee
5/07 - L. knee arthroscopy; post-ACI "clean up"

Offline TallPaul

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Re: 4 weeks down the long ACI road
« Reply #61 on: April 17, 2007, 01:39:52 PM »
Hi Mike

First of all I'd like to say thank you very much for sharing your experience. I may well be undergoing ACI myself (or rather MACI hopefully) so reading expereinces such as yours is fantastically useful. My fingers will be crossed for you early next month when you're scoped, I very much hope it's the best case scenario.

I'd like to quiz you a little on your setback if that's ok? Clearly you believe it was the elliptical and/or stairmaster that caused it. Can I ask how convinced you are? And whether your OS is equally convinced? Is there any possibility that it was step downs that caused it (i.e. the damage had already been done by the time you switched and it was just coincidence that you were doing elliptical exercise when your knee flared)? I'm trying the rehab as best I can from my 9/06 op and have now settled into a PT routine of cycling, stretching, cycling, controlled lunges forward/backwards, streching, elliptical, stretching, hamstring curls, clams (for glutes), cycling, stretching. I know there isn't a huge amount of variety in this, but I've settled down to these as they tend to be the most effective w/o causing inflammation. I do occassionally do other things e.g. step ups, singles leg squats, but not as regularly. How do you think the elliptical caused the damage given the lack of impact? Is it just a question of pushing down whilst knee is somewhat flexed?

Paul
3/96 ACL
9/03 notchplasty
9/06 notchplasty/partial meniscotomy
currently considering MACI

Offline bioprof

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Re: 4 weeks down the long ACI road
« Reply #62 on: April 18, 2007, 02:00:30 AM »
Thanks Paul.  I've certainly benefited from others who've posted here, so it's good to know I've paid a little back.  I wish you the best if MACI is in your future.

You ask a good question.  I've said it before, one of the most agonizing aspects of ACI is not knowing what the hell is going on "under the hood."   The fact is, this procedure "works" more times than not - though the published studies (i.e. Sweedish study, etc) do show an uncomfortably high frequency in the "no improvement category."  Anyway, to your question...I do not know for certain that the elliptical caused anything, and I think there is a very good chance that there was already an underlying issue (i.e. overgrowth, undergrowth, graft delamination, etc).  We'll find out on May 9.

Ironically, I've been walking without pain for the last 4 days and my knee has been feeling significantly better.  I called my PT and asked him about doing therapy, given that my OS said don't bother.  He was emphatic about continuing PT - stating that to lose the 8 months of progress I've made didn't make sense, especially with another surgery in less than a month.  I agreed, so we're firing up PT again this Thursday.

I'm curious.  Are you working with a PT now or have you developed your own routine.  What advice would you give others when it comes to following your gut and own comfort level when it comes to PT?

Mike
8/05 - Cortisone injection, L. knee
10/05 - Meniscus repair, microfracture, L. knee
7/06 - Arthroscopy, Carticel biopsy, L. knee
8/06 - ACI, L. knee
5/07 - L. knee arthroscopy; post-ACI "clean up"

Offline David3

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Re: 4 weeks down the long ACI road
« Reply #63 on: April 18, 2007, 03:14:39 PM »
Mike, 

Great to hear that your knee has improved over the past few days and that you're walking pain free! This is good news indeed!

I've been following your thread with interest - in some ways I think I'm following in your footsteps with a failed microfracture and then most likely moving on to ACI (to be confirmed this week). I can therefore definitely add my name to the list of people who have benefited from your posts.

I see from your signature that your ACI implant was performed about 10 months after microfracture. Did your OS say anything about how long it is advisable to wait after microfracture before having ACI? I had an e-mail exchange with Dr Minas' office about my case (although didn't end up going there due to the 6-9 month waiting list) and they mentioned in their response that they would not contemplate doing ACI within 6 months of microfracture. I'm therefore assuming that there is a minimum time, presumably to let the sub-chondral bone heal. Maybe the longer the better? Any insights?

David
2006: Left Knee (LK) microfracture (MFC, LFC, Trochlear), failed at 6 months
7/07: ACI/TTO of LK (MFC, LFC, trochlea, patella)
2014: Considering ACI treatment on RK.

Offline bioprof

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Re: 4 weeks down the long ACI road
« Reply #64 on: April 19, 2007, 02:45:43 AM »
Thanks David.  Good luck with your ACI eval.

I don't recall my OS discussing a minimum waiting period following microfracture.  There may be medical reason as you stated, but there also may be an insurance issue at play.  That is, insurers may not approve another procedure until the failure of the first procedure has been verified.  In the case of microfracture, I believe it takes at least 6 months to evaluate its success or failure.

Mike
8/05 - Cortisone injection, L. knee
10/05 - Meniscus repair, microfracture, L. knee
7/06 - Arthroscopy, Carticel biopsy, L. knee
8/06 - ACI, L. knee
5/07 - L. knee arthroscopy; post-ACI "clean up"

Offline kalyjoe

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Re: 4 weeks down the long ACI road
« Reply #65 on: April 19, 2007, 01:14:26 PM »
Good luck to you Mike.  Glad to hear that it may not be as bad as you originally thought.  I'll be anxious to hear what your OS found when he actually got in there.  I think going back to PT will help you immensely too...mentally at least.  And I'm sure your PT will be somewhat conservative knowing the situation.  This is definitely a "one step forward, two steps back" recovery and I know how emotionally taxing it can be.  You've got a great attitude though I know that plays in your favor. 

I go back for an MRI tomorrow because I've had pain the past few weeks.  Hopefully it's not something major. 

Keep us posted!   :)

Kristi
2 x 1.2 cm defect of right medial femoral condyle
Microfracture, right knee, October 18, 2004.
MACI using CaReS, same knee, November 30, 2006

Offline TallPaul

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Re: 4 weeks down the long ACI road
« Reply #66 on: April 23, 2007, 10:53:00 AM »
Hi Mike,

Glad to hear things are looking up again somewhat.

In answer to your question about my PT, I'm on my own at the moment, except for a occassional sport massage (the no pain no gain type! - it really helps). However, everything in my routine has at some point in the past been advised by a PT. The exercises I listed are my staple exercises that I fall back on. The happier my knee is when I'm exercising the more likely I am to add a few other exercises advised by PTs. It's a constant compromise between not overdoing it, and not just doing the exercises that I 'like'. When my knee gets angry I tend to fall back to cycling only, fairly high reps, low pressure. I couldn't recommend that more. It actually helps reduce the inflammation. My theory is it helps the refresh (if that's the right word?) the synovial fluid.

Paul
3/96 ACL
9/03 notchplasty
9/06 notchplasty/partial meniscotomy
currently considering MACI

Offline bioprof

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Re: 4 weeks down the long ACI road
« Reply #67 on: April 25, 2007, 11:35:15 AM »
Thanks Kristi.  You're right, starting PT again did give me an emotioinal boost - at least I felt like I was going forward rather that sliding backward. 

How did your MRI go?   I guess I should take a look at your thread first to find out.

Mike
8/05 - Cortisone injection, L. knee
10/05 - Meniscus repair, microfracture, L. knee
7/06 - Arthroscopy, Carticel biopsy, L. knee
8/06 - ACI, L. knee
5/07 - L. knee arthroscopy; post-ACI "clean up"

Offline Rod G

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Re: 4 weeks down the long ACI road
« Reply #68 on: May 05, 2007, 08:12:39 AM »
Hi Mike,

Good luck with your scope in May and i hope it goes well for you.

Regards

Rod

Offline kalyjoe

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Re: 4 weeks down the long ACI road
« Reply #69 on: May 10, 2007, 08:59:08 PM »
Just checking in to see how your scope went.  Hope you're recovering nicely. 

Update us when you're able.   :)

Kristi
2 x 1.2 cm defect of right medial femoral condyle
Microfracture, right knee, October 18, 2004.
MACI using CaReS, same knee, November 30, 2006

Offline bioprof

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Re: 4 weeks down the long ACI road
« Reply #70 on: May 15, 2007, 03:38:16 AM »
Thanks Rod and Kristi.

The actual scope procedure went fine...That is when it finally was done six hours later than when it was originally scheduled that morning.  It turns out that my OS was preparing to speak at a conference in Lansing MI when his first patient was being prepped for surgery at 8 am in the hospital 100 miles away.  The story is that my OS's staff forgot to clear his schedule and booked surgeries on the two days he was to be away.  By the time he arrived at the hospital, he only had enough time to do half of the schedule surgeries - mine was the last.  By the time they wheeled me in, I had been nearly 20 hours without food or drink!  Those of you that have followed this thread from the beginning will note that this latest fiasco is only the latest I've dealt with concerning this OS and his staff (read below).

I don't have many details about what my OS found - he was reluctant to talk to me as I was coming out of the general anesthetic.  He did talk to my wife (who is not well versed in anatomy or ACI).  I will know more details when I meet with him this Friday for a post op, but it sounds like a good news-bad news situation.  The good news is that my two grafts have filled in.  The potentially bad news is that it appears that each has only filled to about 80%, which of course mean that 20% of the area hasn't filled in.  Now, whether that means that it hasn't YET filled in or that it will NEVER fill in, I do not know yet.  I do know that a small edge of each graft did release and fray some.  This was "cleaned up" along with some scar tissue.  I also know that some small tears in my meniscus were also "cleaned up."  How these tears occurred and how extensive they were I do not know yet.

The incomplete graft fill does have me concerned and will be the focus of my meeting with the OS.  I suppose I will never know for sure, but I can't help but think that the experience I had with my immobilizer brace (no one - not any of the nurses, the PT staff or physicians new how to put the brace on) the day after my ACI surgery 9 months ago and my OS's decision not to use it may be a factor in the issue with the graft damage.  The good news is that while my knee is still stiff and swollen, I'm walking with much less pain than before the scope.  Will see if this lasts.

I'll post an update after my post op visit this Friday.

Mike
8/05 - Cortisone injection, L. knee
10/05 - Meniscus repair, microfracture, L. knee
7/06 - Arthroscopy, Carticel biopsy, L. knee
8/06 - ACI, L. knee
5/07 - L. knee arthroscopy; post-ACI "clean up"

Offline kalyjoe

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Re: 4 weeks down the long ACI road
« Reply #71 on: May 16, 2007, 09:21:17 PM »
20 hours with no food or drink??  Good God.  If that had been me....it would have been ugly.  I get grouchy if I'm hungry for a few minutes.  I'm sure my poor husband would have really suffered sitting next to me that whole time. <shudder>  I think I'm going to tell him about it tonight just to see the look of terror in his eyes.   ;D   I'm really sorry you had to endure that.  It's really unfortunate that you've had to deal with so much from your OS.  What a moronic office staff. 

Glad to hear that you are walking with less pain.  I hope that has continued.  It's also great news that your grafts have filled in, although I'm sorry that they are not completely filled in.  I'm anxious to hear what he has to say about this and if that is normal.  I hope it is just an ongoing process and they continue to grow.  I'll be glad to hear you report on your followup visit.   Good luck!  Are you still doing PT?

Kristi
2 x 1.2 cm defect of right medial femoral condyle
Microfracture, right knee, October 18, 2004.
MACI using CaReS, same knee, November 30, 2006

Offline bioprof

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Re: 4 weeks down the long ACI road - Update
« Reply #72 on: May 22, 2007, 03:27:30 AM »
Thanks Kristi.

Funny, I was looking at the emoticons (the smiley face icons above the message box) and thinking that ACI'ers are likely to experience every one of those emotions in a day!

I saw my OS last week Friday as planned (and only a 50 minute wait to be seen by him!).  I must say that I came away feeling much more encouraged about my progress.  It turns out that the grafts are 85% filled and have good thickness and texture for this stage of the recovery.  I was really struck (and I have to admit just a bit emotional  :'(when he showed me the before and after photos of the two repaired areas.  Where there was once a jagged rough-edged lesion, there was now shiny, smooth white cartilage - of course he contrasted this new "baby" tissue with my "old" aged cartilage that surrounded it!

The downside was that he had to trim some of the graft edge (on both areas) that had separated from the base and formed a flap.  These flaps were likely causing the catching and pain that really hindered my PT.  I have to say that there has been a significant improvement in pain and movement, even though the knee is still stiff and swollen from the scope.  Under the flaps were the areas that didn't fill.  Thankfullly, both areas were less than the diameter of a pencil eraser (the original lesions were about 3 cm in diameter) and were not in the main weight-bearing areas.  [Deep breath] I asked him if these were going to continually erode and enlarge so that I would eventually be back to where I started.  He didn't think so, stating that the repaired areas would eventually be strong, resiliant tissue with good "shoulders."  Will see, but I'm certainly more optomistic than I was 2 weeks ago.  I have a 1 month post-op in June.  I'll keep you posted.

8/05 - Cortisone injection, L. knee
10/05 - Meniscus repair, microfracture, L. knee
7/06 - Arthroscopy, Carticel biopsy, L. knee
8/06 - ACI, L. knee
5/07 - L. knee arthroscopy; post-ACI "clean up"

Offline kalyjoe

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Re: 4 weeks down the long ACI road
« Reply #73 on: May 24, 2007, 01:51:35 AM »
Sounds like you are doing really well Mike.  Glad to hear it.  It's certainly very promising to be able to "see" that new cartilage growing there.  Gives us all hope I think.  I'm not exactly anxious to get my one year scope in November, but I am anxious to see the resulting pictures and (hopefully) that new cartilage in my knee. 

I hope you continue to improve.  Good luck!   :)

Kristi
2 x 1.2 cm defect of right medial femoral condyle
Microfracture, right knee, October 18, 2004.
MACI using CaReS, same knee, November 30, 2006

Offline thkaa

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Re: 4 weeks down the long ACI road
« Reply #74 on: May 27, 2007, 04:45:56 AM »
Hi Mike,

Congradulation to your good progress. I think the best news you told us is that the newly formed cartilage is in healthy condition and normal thickness. I really hope that you can see your great improvement in the coming months and update us from time to time. I don't think it can improve in short time but eventually you will see it. I feel much better now since the micorfracture was done two years ago. I can't say that it improves steadily. Yet, there're many many ups and downs. I couldn't tell why there is often downs followed by ups which made me really frustrated and disappointed. I went through them and at least I can walk to swimming pool, go out to meet my friends now. I can't say that it's perfect. At least I couldn't do so before surgery but I can do so now.

Be positive and you'll achieve your goal.

Sammy
27 yrs old now
10/2000 hurt my knee
10/2003 found ACL broken in 2000
07/2004 ACL recon
01/2005 scope
04/2005 drilling















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