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Author Topic: Bilateral patellar and trochlear ACI  (Read 29600 times)

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Offline LadeeStingray

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Re: Bilateral patellar and trochlear ACI
« Reply #30 on: June 11, 2007, 02:26:43 PM »
erinee,

Wow cant believe its been 7 weeks already.  As i read your post i was very excited for you .... GO FREEDOM GO!!  I go in Thursday for my next scope, and hopefully the new doc will find everything he needs to get me into a trial so i can get moving along and get my life back too!

Once more im excited that things are going so well for you .... on your way to a great recovery. 

Take Care

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 David3

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Re: Bilateral patellar and trochlear ACI
« Reply #31 on: June 19, 2007, 11:23:34 PM »
Hi Erinee,   Hope things are still progressing well for you and that your mobility is slowly but gradually improving. Your last post looked really encouraging!  And I hope your pain level is tolerable now... 

A quick question for you. In your very first post, you mentioned that your OS was trying to get a synthetic patch for you instead of using periosteum. Did you end up having a synthetic patch?  (I see you refer to a periosteal graft in a later post). Do you have any information about the pros and cons of a synthetic patch as compared to periosteum? I'm interested because I'll be having ACI implant (and TTT) in just over a month for multiple lesions which, I guess, needs alot of periosteum.

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 erinee

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Re: Bilateral patellar and trochlear ACI
« Reply #32 on: June 23, 2007, 01:39:31 AM »
David-
I ended up using the periosteum.  It was my OS's preference, and he was able to do so.  I'm afraid I don't have any info for you.
I did feel like I had shinsplints for quite a while from the periosteal harvest sites though!

UPDATE-8 WEEK FOLLOW UP MD APPT-
Happier than a clam!
Xrays look good-osteotomy has healed bilat!  I am now WBAT.  He allowed me to D/C the brace on the right and unlock the left to 90.  I can finally get rid of the left CPM and do active motion!  I am to continue w/ the pool and now can begin stationary bike, and gentle closed chain ex.  I have about 130 deg of active flexion bilat.  I am wearing compression stockings as I sit all day at work and noticed some mild edema, but it's totally under control.  I am icing2x/day, getting in the pool about 3x/week, and will start on the bike tomorrow.  I'm doing my SLR, hip abd, ext, bridging, quad sets, knee flexion at least 1x/day, more on weekends.

37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline erinee

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Re: Bilateral patellar and trochlear ACI
« Reply #33 on: June 23, 2007, 01:41:57 AM »
I wasn't done yet!
At 3 mo post op he'll do the MRI w/ Gadolinium contrast to hopefully get an idea of how the grafts are doing, but he said symptoms are a decent indicator and I am feeling pretty good, all things considered.
I'm walking short distances now with only 1 crutch too-ah, the ability to carry something again!
Best wishes to all-I think I'm actually going to go out to dinner this weekend-
Erin
37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline David3

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Re: Bilateral patellar and trochlear ACI
« Reply #34 on: June 23, 2007, 05:31:21 PM »
Thanks for the info Erinee. Great news - you are making fabulous progress! I'm sure you are "happy as a clam" about how it's going - be aware that you're also an inspiration and encouragement to the rest of us.  We'll keep following with interest!

Also really good to hear that you are back at work - I really like my work, so hope I'll be able to get back in some capacity within a few weeks after my July 24th ACI / TTO.

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 Peg Leg

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Re: Bilateral patellar and trochlear ACI
« Reply #35 on: June 24, 2007, 02:47:26 AM »
Erinee,
I am also encouraged and very impressed with your courage.  I am thrilled to hear how well you are doing and how high your spirits seem to be!  You are an inspiration to me!  I will be having my ACI surgery this Thursday.  It is a bit less scary, having read the posts of those that have gone before us.  It gives us a better idea of what we are facing.  Thanks and keep up the good work!

Peg Leg
10/06  Miicrofracture Rt knee on mfc
defect was 1.3x2, small defect under patella
04/07 Arthroscopy/Cell harvest for Carticel
06/28/07 Carticel surgery ,Rt. Knee
12/27/07  Scope to debride Patella lesion,Rt. Knee
4/17/08  Fulkerson AMZ, Rt. Knee
6/25/09 ConforMis BiCompartmental Knee Replacement

Offline erinee

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Re: Bilateral patellar and trochlear ACI
« Reply #36 on: July 07, 2007, 01:41:41 AM »
Almost 11 weeks post op update:
Things are going well.  I've ditched the crutches and braces completely.  It was a gradual process, but today was the first day I did not use even 1 crutch all day.  My gait has gotten significantly better also-around about Tuesday I noticed I could walk without any noticeable limp.  Swelling is still evident, although less.  I am no longer wearing the compression stockings, but I am keeping my feet elevated while I'm sitting at my desk.  ROM is about 130 ish, strength is coming slowly but surely.  I'm doing deep water running for about 20m 3x a week, I've started back at the gym for upper body weight training and about 20m on the stationary bike.  On Wednesday I started very low front and lateral step ups-about 4" so that my knee is not flexed more than 40 deg.  I'm doing mini-squats 0-40 only, bridging, some straight leg deadlifts to start to fire my hamstrings and butt, and of course the SLR's abound.  I notice a very "tight" feeling-my OS said that is very common post-ACI-when I actively flex my knee against gravity, I can't get more than 80 degrees or so because the tightness is really uncomfortable.  Pain in general is minimal-totally tolerable.  Tylenol once or twice a day, if that.
Next MD appt is 7/17 at which point he'll be ordering the MRI to get an idea of how the grafts look-I hope they look as good as I feel!
37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline djs60

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Re: Bilateral patellar and trochlear ACI
« Reply #37 on: July 08, 2007, 10:21:23 PM »
Erinee,

sounds like you are doing great.

We are on parallel tracks; I have about 130 degrees of flexion in my operated knee (i'm now 10 weeks post-op).  I'm doing a bit less than you are, as my OS and PT seem not to want me to push too hard.  For example, they don't want me to do more than 10 minutes at a time on the bike and I'm not doing any squats/step ups.  I see my surgeon this week, and hopefully he'll let me do more.

I also have the tightness you mention, which I particularly note with extension.

It's interesting that you are having an MRI - my OS told me he was planning to do one at a year!

Do you still have a lot of swelling?

djs60
3/06 left knee arthroscopy - grade IV lateral trochlea defect
chondroplasy & removal of loose bodies
1/07 left knee arthroscopy/cartilage biopsy
4/27/07 left knee trochlea & patella ACI with TTO

Offline erinee

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Re: Bilateral patellar and trochlear ACI
« Reply #38 on: July 10, 2007, 11:20:10 PM »
DJ-
Swelling-well, it's there, but I don't think excessive.  Mostly just around the knee joint ans into my calf from time to time.  I'm still icing 3x/day, and I was in the Cryocuff a ton post op-from surgery until PO week 7 all 6 hours in the CPM, plus overnight, plus most of the time I was home.  I think that really helped.
37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline erinee

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Re: Bilateral patellar and trochlear ACI
« Reply #39 on: July 18, 2007, 10:39:22 PM »
12 week post op MD visit update:
X-rays look good, osteotomies are healed and bone density improving.  The past 5 days or so I've started getting a pretty significant "pop" on the L side at about 15-20 flexion-my OS feels the periosteum patch may have overgrown and be contacting the lateral aspect of the femur...we will watch it for now, it's intermittently painful, but he told me to continue and that everything looks good.  I'm to progress my rehab, allowed to squat to 90 (I can get to about 60 at this point) and progress cardio, etc.  No steps.  I am having the MRI w/ gad in 2 weeks, seeing him again in 4.  If the clicking gets worse or becomes more painful, then a scope may be indicated to smooth out the edge.  Hopefully it won't, but I'd rather have overgrowth than the patch not take.
Keep you posted!
37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline David3

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Re: Bilateral patellar and trochlear ACI
« Reply #40 on: August 06, 2007, 06:33:35 PM »
Hi Erinee,  How have things been going for you the last couple of weeks? Hope the popping is under control.

I'm now 13 days post ACI / TTO, including both trochlea and patella lesions. I feel some sensitivity and tenderness at the graft sites when I do flexion, particularly under the patella. Did you feel alot of tenderness at the graft sites in the early few weeks? I'm hoping this is normal.....

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 erinee

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Re: Bilateral patellar and trochlear ACI
« Reply #41 on: August 06, 2007, 11:09:53 PM »
Hey David-
For the first 4 weeks after my surgery I was on some pretty strong meds-I was taking Dilaudid every 6 hours if I remember correctly, and I did not miss a dose.  I didn't really have much pain, but that is likely why.  I did have one episode of severe pain at about maybe 5 weeks post?  At 13 days post I think you're fine-maybe ice more?  I was in the Cryocuff the entire 6 hours in the CPM, overnight, and pretty much all the restof the time excepting the 5-6 hours at work once I went back.

Had the MRI last week, my MD is out of town until I see him again next Tues the 14th.  The "pop" is very pronounced on the left and has gotten worse, so I'm very curious to see what's going on there.  I feel a scope is a foregone conclusion, and while I'm not crazy about the idea of a 5th surgery on the left knee, if the graft is taking I'll still be happy.  I'm rehabbing well all things considered.
37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline erinee

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Re: Bilateral patellar and trochlear ACI
« Reply #42 on: August 16, 2007, 01:02:26 AM »
MRI results:
MRI w/ Gadolinium contrast taken at 3 1/2 months post-op:
R knee (the better one symptomatically)-central zone of the patella 2.3x 1.6 cm wide injection area.  Medial end of defect shows 50% "fill-in" ratio from the repair procedure.  Lateral end of the defect reveals approx. 20% "fill in"
L knee: central zone of the patella: reparative area measures approx. 2.1x2.0 cm.  "fill in" on the lateral side approx 90%, 60-70% "fill-in" on the medial side.  Hypertrophic reparative response at the junction of the central zone and lateral facet extending to approx. 1.2x .5 cm in dimension.  (this is the "click" I've been feeling)

SO-ALL'S WELL!!!! ;D

My OS is very pleased with the graft growth, as am I.  The clicking has has definitely evolved, it has gotten less and we decided to let nature run it's course as it seems to be resolving.  He is allowing me to attempt stairs, which I am happy about as we are taking a trip to Carolina and I really want to cross the swinging bridge on Grandfather Mountain!  I can add weight to the leg press, leg curl, can do deadlifts- no lunges or squats with weight until 1 year post op.
The appt with the doc really lifted my spirits and made me feel so much better.  I feel like I don't have to panic every time I feel a pain or a click or something.  I was starting to feel like a washed up athlete, but now I have hope that I can return to my previous level of activity eventually. 
So-I feel very positive.  4 months post op now.  The journey continues.
37 year old physical therapist, Left lateral release '92, bilateral debridement and scope '04, bilateral patellar cartliage defects, denied ACI repeatedly by insurance.  Scope and debridement 12/06 L knee.Bilat patellar ACI with Fulkerson 4/23/07.

Offline and4400

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Re: Bilateral patellar and trochlear ACI
« Reply #43 on: August 16, 2007, 02:17:34 AM »
Erin, I am very excitied for you. I couldn't even ponder the idea of doing both legs at once, although I guess it really does cut the healing time in half. I'm gonna be working my ars off for the next to weeks and I'll be walking. I had a hole you could've put a golf ball in MFC so after four surgeries this will be a huge sucess for me if everything works out.  I'm be thirty in a month a don't want anything to do with the PKR. Anyway take care of them knees congrats on the good news.  Andy
osteochondritis dissecans  RT. knee
Debridement Oct 06
Bone grafts 3x3cm defect MFC(harvest ACI)Dec 06
Scope Apr 07
ACI done July 07
Scope May 08,Scope Dec09
surgery #8 Oats(MFC) Open wedge HTO July 10'

Offline David3

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Re: Bilateral patellar and trochlear ACI
« Reply #44 on: August 16, 2007, 02:55:02 AM »
Fabulous news Erin, both the fill and the fact that the clicking may be resolving itself!

Can you elaborate on what the 'fill percentages' mean? Presumably 50% and 20% fill means exactly that - the new cartilage has reached 50% and 20% of full thickness? Or is it 50% and 20% of good coverage by area? What happens from here? Do the chondrocytes continue to proliferate over the next few months such that the cartilage continues to grow towards full thickness / area? Your OS being very pleased with graft growth is a great sign, so I presume this is normal progression. Just interested in the process....

Apart from the click, how's your walking? How far can you manage, and how is the pain level?  Keep up the great work - your progress is fantastic!!! Hope I'm progressing as well when I get to 4 months.
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.















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