Banner - Hide this banner





Author Topic: 4 weeks down the long ACI road  (Read 17309 times)

0 Members and 1 Guest are viewing this topic.

Offline bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #15 on: October 06, 2006, 01:13:35 AM »
Post-op week 6, but it feels like week 96!  The goal is 50% weight-bearing by the end of next week.  Looking forward to it, except for one thing.  I'm having a lot of pain over the condyle repair area, especially on the day following PT.  I'm convinced that most of this pain stems from a procedure done in PT - weighted leg extension (lying on stomach with leg hangin over table end).   This is very painful - primarily because the proximal end of the tibia compresses against the condyle repair.  I'm convinced that this aggravates the area, leading to pain and inflammation.

 My PT and OS tell me the condyle pain is normal.  But I'm not convinced.  Not this much.  Given 2 days rest,  the pain almost subsides.  I'm going to address this with my PT, and firmly suggest that we drop this from the routine.

Has anyone else who's had ACI for condyle lesions experienced this?   To what degree have you experienced pain 4-6 weeks out?

Thanks,

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 bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #16 on: October 08, 2006, 12:45:00 PM »
Just a quick update.... I discussed the pain issue with my PT and explained why I thought we should stop doing the prone leg extensions as described in my pevious post.  He was completely in agreement and used an alternative procedure which was much less painful.  I must admit that I was a bit anxious about bringing this up with him, but I've learned that we are own best (and perhaps only) advocates when it comes to decisions about surgery and rehab.

My PT also sent me home with an OrthoDx unit which provides high volt stimulation to improve circulation around the knee and also muscular stim to jump start my VMO (vastus medialis oblique), which at present looks and feels like a week rubber band.  Anyone else using this?

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 bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #17 on: October 21, 2006, 02:55:07 PM »
I haven't posted here for a while, so I wanted to give a quick update.  My PT is pleased with my progress.  We're working toward 75% WB by the end of next week and maybe 100% by 2 weeks  with 1 crutch.   I still have some mild pain at night, especially after PT or doing alot of "walking."  My quads (or what's left of 'em) are reawakening, albeit slowly.  I welcome the muscle soreness.  It's a reminder that the knee is getting stronger.  It's nice to be able to do a few more things at PT.  As the only ACI patient there, I feel like I'm on training wheels, while most others are speeding through reahab.  Probably more to do with my perception than reality though.

I see my OS in December for a 2 month follow up.  The overgrowth issue has me a bit concerned, though I haven't experience any signs of it yet.

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 victoria628

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #18 on: October 27, 2006, 02:37:22 PM »
Glad to hear you are doing well!

Offline bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #19 on: October 27, 2006, 02:45:58 PM »
Thanks Victoria!  How's your rehab going?  My PT wants me to use one crutch as of today.  He told me that if sees me coming in with two crutches, that he'll kick one out from under me ;D  He was kidding of course, I think!

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 bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #20 on: November 02, 2006, 01:11:56 AM »
Make that 9 weeks.  I must admit that I'm a bit jealous of the folks who have access to the MACI procedure.  I know that there are several reasons why it takes our medical establishment here in the US so long to get up to speed on new technologies, but it is frustrating to know that there are potentially better procedures out there for which we do not yet have access. >:(  OK, end of rant. 

My rehab's going well, but there's definitely an ebb and flow pace.  I have great optimism when I reach a milepost, such as one crutch and 75% WB.  But there's also impatience and frustration when my knee aches and stiffens following PT or other activities.   I'm hoping for less of this 2 or 3 mon down the road.  Not much in the way of useful information in this post - more reflection I guess.

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 bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #21 on: November 19, 2006, 02:22:19 PM »
Just a quick update:  Week 13 post implant and I've finally tossed my 2nd crutch aside to go full WB...with my PT's blessing.   I wouldn't describe my walking gate as smooth, but it's a start...baby steps!  There was somewhat of a threshold breakthrough for me when it came to regaining strength in my atrophied quads and vastus medialis (the muscle directly medial to the knee joint).  Through week 10 post op, I experienced very little change in muscle size and strength.   Between weeks 11-12, the muscle ridges began to "rise from the ruins", and I could place much more weight on the leg without it feeling like it was going to collapse.  This progress of course was due in large part to my PT who's very much in tune with my rehab regime.  I've said it before, but having confidence in my PT (even more than my OS) is the most important factor in my recovery.

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 victoria628

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #22 on: November 19, 2006, 02:35:43 PM »
Hi Mike!
     I am doing OK, thanks for asking.  I am on week 3 and I am only at about 68 deg.  My doctor had me limit the CPM machine to 40 degrees b/c I also had my ACL reconstructed during the surgery and he thought that too much of the CPM would damage it.  Do you know about what your range of motion was at 3/4 weeks?
     I am kind of frustrated with the progress but I am very impatient and usually very active and social.  I read the protocol for PT on the Carticel website and it is pretty different than the PT description the doctor sent me home with!  My PT is OK, but not too familiar with the ACI, but we have been following the doctor's PT description so hopefully it will be OK.
     I hate my crutches and I can't believe it has been only 3 weeks.  I am still no weight bearing and I get the pain you are describing - in the defect area.

Glad to hear you have tossed the crutches!  I can't freaking wait!!

Vicki
« Last Edit: November 20, 2006, 12:19:38 AM by victoria628 »

Offline Chondrosoldier

  • Regular Poster
  • ***
  • Posts: 64
  • Liked: 1
    • Myspace
Re: For a good PT, ask your surgeon
« Reply #23 on: December 01, 2006, 09:33:33 PM »
Thats the biggest no-brainer on this board.  The surgeon relies on a PTs for a successful outcome like his/her left hand.  Call their nurse and ask who they recommend as it is guaranteed it will be somebody with extensive ACI experience.  PLUS, that PT will most likely be in-network.

Good Luck. I'm 6 weeks post-op and have nothing but OUTSTANDING things to say about the ACI experience.  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 bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #24 on: December 02, 2006, 04:17:01 PM »
Glad to hear your ACI is going well Chondrosoldier (great name!).  If you scan some of the previous post of this thread and others, I think you'll find that the OS - PT relationship is not always as you described, or it isn't always made clear to the patient by the office staff.  After my first post -op exam, I did exactly as you said.  I asked the PA and nurse for recommendations on a PT.  They gave me a list sorted by location.  When I asked them about which one they would recommend who had the most ACI experience, I got that vague look and a shrug of the shoulders - I dunno.  The OS happened to be out that day, so I left without getting an answer.  I then cold-called a few PT's in my area, finally settling on a nice, but ACI-inexperienced one.   That lasted two weeks ( a critical 2 weeks!) until I demaned to speak with my OS (very personable, but nearly impossible to catch for a quick question).  Only then did I get the name of a ACI-experienced PT near me.  The rest is history - so far so good.

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 bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Pain, stiffness at 3.5 mons
« Reply #25 on: December 10, 2006, 08:08:46 PM »
I'd like to hear from others about their level of pain and stiffness at about 3-4 mons post op.  I've been FWB for about 3 weeks, but since then I've had fairly consistent, albeit not excrutiating, pain at the iimplant site (medial. fem. condyle).  I saw my OS last week.  He said he's not concerned "yet", suggesting that he would expect the pain to subside in about 2 mons.  If not...Well, I can't even go there.

I've been in PT for about 3 mons (3 days/wk).  The routine has been stepped up within the last week including some step exercises and Total Gym workouts (sort of a leg press using the body weight).  Anyway,  I'm anxious to hear from those that have been through this stage.

Thanks,

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 bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #26 on: January 20, 2007, 02:44:27 PM »
It's been a while between updates (last Dec '06), but I feel compelled to keep at it because I drew so much information and inspiration from the brave folks on this forum prior to my surgery.  I'm now about 5 months post-ACI (Carticel).  There is no easy or quick way to describe progress on a small scale.  As anyone who has gone through this knows, day-to-day recovery is a physical and emotional rollercoaster.  Overall though, I'm making good progress.  I'm walking mostly without any noticeable limp.  Stairs are still a challenge, especially descending.  I'm at 0 degree extension and about 145 flexion.  Ironically, my PT wants to see my flexion decrease a bit. He explained that my loss of muscle mass in my hamstrings has allowed greater than normal flexion.

Most days are relatively pain free.  I have soreness (not pain) mostly at the end of the day (particlularly a PT day) when muscles, tendons, etc have had enough.  PT has been ramped up to wake up my "comatose" quads.  Lots of bike, squats, "monster walks", etc.  Stairs are still a challenge, particularly on the descent.  My quads are still too weak to support my weight, so I end up coming down with a thud on my good knee - which has taken much abuse but has held up so far during this ordeal.

I had to have a face-to-face recently with my PT.  The facility has undergone an expansion, adding more patients and staff.  At one point, I saw 3 different PT's in one week.  There was a clear breakdown in communication, with each PT not aware what the other one was doing.  I was constantly being asked, "How much weight were you doing?"; How long were you going for?", etc.  Each was also adding new activities to the point that my visits were over 2.5 hours long.  I finally spoke up and described my concerns.  The supervising PT was very understanding, and promised to address my concerns.  He noted that I wasn't the only one complaining about service.  Things have gotten much better after the meeting.  The lesson here is that if you are concerned or dissatisfied with your rehab, then your need to speak up.  There is already enough inherent uncertainty and stress associated with this type of rehab.  The last thing we need is to worry about whether our OS or PT is doing their job properly.

Wishing all here a new year filled with speedy recovery!

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 BarryB

  • MINIgeek (20-50 posts)
  • **
  • Posts: 32
  • Liked: 0
  • User's Text
Re: 4 weeks down the long ACI road
« Reply #27 on: January 22, 2007, 09:00:21 AM »
Hi Mike,

I've just jumped on this site for the first time in a while (i am 2 years post MFC implant and 3 years post patella and trochlea implants).

Just wanted to wish you luck with your recovery and hope you don't stress about any pain etc too much! If i was to give anyone who was having this surgery any advice it would be not to rush things and not to judge your recovery on a month to month basis let alone week to week. You really need to look at how things have gone every six months and then when you look back you will be able to see that yes in fact the knee has improved. the first 6 months are a bastard, but at 12 months you'll be a lot better than at 6 months, and at 2 years you'll still be way better than what you were at 12 months!

Good luck!

Baz

Offline bioprof

  • Regular Poster
  • ***
  • Posts: 66
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #28 on: January 26, 2007, 11:38:32 AM »
Wow!  Thanks Baz.  Your comments are greatly appreciated, if not a bit sobering.  The literature on ACI doesn't exactly match your account, and I suspect each individual heals at a different pace, but I believe your experience is more realistic and closer to the "norm."

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 DJF

  • Regular Poster
  • ***
  • *
  • Posts: 116
  • Liked: 0
Re: 4 weeks down the long ACI road
« Reply #29 on: January 26, 2007, 10:01:38 PM »
Hi Mike,

Sounds like you are doing very well.  I am at 4 months ACI(carticel) and TTT.  I had a setback in December when I got stuck at 70 degrees of flex.  I have surgery to cut adhesions away and I am now at 130 degrees.  My walking is a problem as I have about 4 degrees of positeve flex.  I am working on that with an extentionator.

Like you said, it is hard to measure progress at this point.  There is no giant leap each week, but it does get better.

My pt can last anywhere from a hour to 2 .5 hours.  We generall do some palattes, ride a stationary bike (I do about 3 miles on low resistance), leg lifts, balancing, NMES while standing in different positions.

The leg lifts are giving me trouble and I want to talk with the OS about it.  If I start at a 45 degree angle, I get a lot of pain.  I think that is putting a lot of preasure on my Carticel patch.  This makes me a bit nervous.

Thats about it for now.

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