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Author Topic: ACI/Carticel  (Read 13990 times)

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Offline noddy

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ACI/Carticel
« on: July 16, 2002, 12:01:45 PM »

I am having an ACI in 3 weeks time. I live in Australia where this surgery is fairly new. Can anyone tell me what to expect, how long I will be in hospital, off work and anything else I should know. I would particularly like to hear from anyone in Australia who has had this surgery. I have already had the harvest done.

Thank you in advance.

Offline kyle

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Re: ACI/Carticel
« Reply #1 on: July 16, 2002, 05:58:46 PM »
I don't want to get off topic but I am having the same surgery in September.  Did you have any problems with the harvest?  Did you require any stitches?  Thanks.

Offline noddy

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Re: ACI/Carticel
« Reply #2 on: July 17, 2002, 03:43:04 AM »
The only problem I had with the harvest was that one of the portals bled slightly for a day or two. This required one stitch. Other than that the harvest was a simple arthroscopy and no other stitches were required. My knee is recovering well from that.

Offline muffy

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Re: ACI/Carticel
« Reply #3 on: July 17, 2002, 07:15:25 AM »
I had my ACI main surgery 12 weeks ago in BOston Mass, USA. I must tell you it is the hardest thing I have done in my life. The first 6 weeks are non weight bearing, and after that you progress 1/3 of your weight every 2 weeks... It hurts at times alot and at other times it does not. My quads are gone, PT is impossible... All I can tell you is be ready for a hard ride... More importantly, make sure your other half is ready for this because, she will have to live with someone who cannot do anything. I mean, you put your foot down the wrong way and the surgery is history. Its that sensitive. The doctor says 4 to 6 months before results can be seen. A tough one. Any other questions, let me know...
Walter

Offline noddy

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Re: ACI/Carticel
« Reply #4 on: July 23, 2002, 09:49:51 AM »
Thank you for the information muffy.  It sounds like I am in for a long hard rehab.  Hopefully it will be worth it.  My OS says it is delaying a TKR for another 5 - 7 years.  

Offline The KNEEguru

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Re: ACI/Carticel
« Reply #5 on: July 24, 2002, 12:04:51 PM »
For those of you reading this section for interest, an ACI means 'autologous chondrocyte implantation' - also known as the Carticel or Genzyme technique.
It is a 'cutting edge' procedure for managing large areas of damaged joint surface in the knee, usually on the femur (thighbone).
The words mean 'taking cartilage cells from the joint surface, and implanting them somewhere else in the same person'.
The method relies on taking normal cartilage (joint surface) and sending it away to a laboratory to be cultured - to provide a much larger bulk of cartilage. This is the 'harvest' stage, and requires a small operation - usually keyhole (arthroscopy).
When sufficient new cells have been grown (a few weeks time) the patient comes back for a second operation, this time to transplant these cells (his/her own cells) back into the defect that the surgeon is trying to cover.  Of course, they would just float away if just smeared on.  So in a rather bigger procedure this time, a piece of the fibrous material covering the bones is removed and sewn over the defect, and the cells are pushed in behind this envelope, where they are contained until they unite into functioning cartilage.
The procedure is very expensive and only done is a few centres. As I said it requires two operations, sometimes three if the surgeon needs to go back and take a look at a later stage to see if it has worked.
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Offline drnscr

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Re: ACI/Carticel
« Reply #6 on: August 09, 2002, 12:25:15 AM »
I have had two carticel implants (one in both knees).  It is tough but doable as long as you keep a positive frame of mind.  Stay on top of your pain meds and do the exercises as told.  I started quad sets and straight leg raises the morning after surgery and am convinced it was the difference in my recovery....

good luck

chuck

Offline kyle

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Re: ACI/Carticel
« Reply #7 on: August 19, 2002, 09:21:36 PM »
How long was your hospital stay after surgery?  I have a history of scar tissue so my surgeon is going to keep me at least 3 days so I can be monitored.  Also, what pain medication did you take?

Offline noddy

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Re: ACI/Carticel
« Reply #8 on: August 21, 2002, 10:12:54 AM »
Kyle

I was in hospital for 4 days.  They started me on a CPM machine within 24 hours of surgery.  I was given morphine and panadiene forte while in hospital and am still on painkillers 2 weeks post op. I have just started physio and am going 3 times a week so it is important to control the pain.  

Offline troydonovan

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Re: ACI/Carticel
« Reply #9 on: August 21, 2002, 06:21:52 PM »
Noddy

What was the cause of the cartilage problem you have, broken patella or something else?

I'm wondering also where to find info on centres in Aussie or NZ that do this, any ideas? I'm presently in Ireland but coming home soon to NZ to try and fix my left knee.

Troy

Offline mark

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Re: ACI/Carticel
« Reply #10 on: August 22, 2002, 07:39:37 AM »
I am currently being considered for carticel, the doc is supposed to call by the end of the week to let me know one way or the other, I have been 8 months to get to this point I am hoping to have good news this week
2/95 Rt knee scope, 3/96 L knee scope, mencus repair, 1/02 L knee scope, realligned patella debrided cartlage damage, 10/02 carticel harvest attemped, failed, 12/02  L knee Fulkerson

Offline noddy

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Re: ACI/Carticel
« Reply #11 on: August 22, 2002, 10:26:04 AM »
Troy

My cartilage damage was caused by a fall.  I was diagnosed with chondromalacia of the patella.  I had a lateral release done 2 years ago and have continued to have problems.  An MRI and arthroscopy were performed and both showed no cartilage behind the majority of my patella and other areas within  my knee also had no cartilage.  I had 2 areas implanted during the most recent surgery.  

I live in Australia and there are several surgeons now performing this procedure, although they are scattered and it is a fairly new procedure in Aus.  I know it is performed in Melbourne, Sydney and Canberra.  If you go to the site www.mercytissue.com.au you will find info on the procedure in Australia.

I hope this has helped.  I can give you the name of my surgeon if you can't find one closer to home.  Cheers

Noddy

Offline troydonovan

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Re: ACI/Carticel
« Reply #12 on: August 22, 2002, 04:49:13 PM »
Noddy

From what I have found on procedures this ACI treatment appears the best first oiption.

I still cannot find any info on NZ/Aussie surgeons that perform this. Can you please give me the details of your surgeon and any others you know of and I will go from there.

Cheers
Troy

Offline noddy

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Re: ACI/Carticel
« Reply #13 on: August 24, 2002, 11:56:54 AM »
Troy

My surgeons name is Dr Paul Miniter and he is based in Canberra.  I am sure his staff would be able to give you names of other surgeons if Canberra is not easy for you to come to.  If you get in touch with Mercy Tissue Engineering in Melbourne I know they also have a list of surgoens who perform ACI's.  As it is fairly new in Australia not a lot of doctors perform this surgery yet.  

Cheers

Noddy

Offline mark

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Re: ACI/Carticel
« Reply #14 on: September 07, 2002, 09:29:47 PM »
hey noddy, are you still out there, last time I heard from you, was two weeks post op, how are things going? ???
2/95 Rt knee scope, 3/96 L knee scope, mencus repair, 1/02 L knee scope, realligned patella debrided cartlage damage, 10/02 carticel harvest attemped, failed, 12/02  L knee Fulkerson

Offline noddy

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Re: ACI/Carticel
« Reply #15 on: September 08, 2002, 05:26:02 AM »
Hello Mark

Thank you for asking.  I am now 4 weeks post op and things are going slowly.  I go to physio 3 times a week and currently my ROM is about 55 degrees, which is ok but not great. My quads are also a little slow at regaining strength.  I have to wear my brace for another 2 weeks.  The worry at the moment is that I am developing arthrofibrosis which will require another surgery to correct.

Some days are better than others. It is very frustrating not being independant. As I had the surgery on my right knee I am dependant on others to drive me everywhere.  You really need a good support network if you are going to have this surgery.  

It is still early days and I am hopeful that with more hard work it will all be worth it. I knew that the rehab was long when I agreed to have this procedure. I have an excellent and patient physio who gives me lots of encouragement and support.



Offline mark

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Re: ACI/Carticel
« Reply #16 on: September 08, 2002, 11:24:53 PM »
hey there, sound like things are moving along and I wish you the best of luck on your recovery, I have still not heard anything from my surgeon, hoping to get ahold of him tomorrow, I really want to get the ball rolling on this, I have to schedule the procedures with my college schedule, its a virtual nightmare. Good luck
2/95 Rt knee scope, 3/96 L knee scope, mencus repair, 1/02 L knee scope, realligned patella debrided cartlage damage, 10/02 carticel harvest attemped, failed, 12/02  L knee Fulkerson

Offline Ghostrider203

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Re: ACI/Carticel
« Reply #17 on: September 09, 2002, 01:16:43 AM »
I Had ACI 2 Years ago in the Forces at Haslar, Portsmouth.  I was told that recovery is usualy about 2 years but unfotunatley the Back third of my graft detached.
I was up and about after 2 days of the op on crutches and of the crutches after about 4 weeks.
Strangeley I had very little pain at all ,in fact iv'e felt very little pain during any of the 6 operations i have had on my right knee.
I took Glucosamine & chondroitin supplements as they are supposed to be good for Hyaline cartiladge tissue.
At the moment I have full range of motion but still cannot run as I get pain under extreme load bearing.

If there is anything I can help you with please don't hesitate to email me.

I'm not regreting having the surgery one bit as it was my last chance saloon to stay in the RAF  !

Offline Joanna

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Re: ACI/Carticel
« Reply #18 on: September 18, 2002, 12:01:00 AM »
Hi everyone,

I am six months post op from a right knee ACI.  I had it done in the UK and the procedure is a bit different than everywhere else.  I was able to walk on my leg the day after the operation, my whole leg was in plaster for two weeks which helped to support it and stop me twisting it.  After that I was on crutches for two months and then walked unaided.  My ROM didn't take long to recover either.

I have got on really well.  The pain can still be bad but the graft is still growing.  I think being able to walk on the leg helped me rehabilitate quicker.  I couldn't image being non-weight bearing for six weeks :(

I hear a lot of bad stories about this operation, it is very hard, but definately worth it.  

Best of luck to everyone out there who has this operation pending.

Joanna ;)
3 Arthroscopies; 2000 - Shaving and clean out; 2001 - Wash Out; 2002 - 1st Stage ACI. 2nd Stage ACI - 2002; Arthroscopy to check ACI graft - 2003; ACI failed - Jan 2005; High Tibial Osteotomy & MACI - March 2006; Hardwear removal - 2007; MACI failed - 2009.

Offline mark

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Re: ACI/Carticel
« Reply #19 on: September 18, 2002, 06:22:52 PM »
Hey there, I have been approved for the procedure, I go in next Friday for the first procedure and then scheduled for the 13 of December for the second procedure. Im happy and scared at the same time. I pray that this will work, shoot I pray that I can walk on campus next Monday :o
2/95 Rt knee scope, 3/96 L knee scope, mencus repair, 1/02 L knee scope, realligned patella debrided cartlage damage, 10/02 carticel harvest attemped, failed, 12/02  L knee Fulkerson

Offline wriggley

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Re: ACI/Carticel
« Reply #20 on: September 19, 2002, 03:07:52 AM »
Hi troy, you said you were in "ireland" but which country?  I live just outside Belfast where are you?
Paraplegic(inc. L5) due to a spinal cord bleed along with previous knee and hypermobility problems

Offline noddy

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Re: ACI/Carticel
« Reply #21 on: September 19, 2002, 04:39:46 AM »
Hi Mark

Good luck with your surgery.  The harvest is straight forward.  The best advice I can give you to prepare for the second surgery is to work really hard on your quads before you have the implantation.  I am 6 weeks post op and my quads are only now strong enough for me to lift my leg.

Hope all goes well

Noddy

Offline kyle

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Re: ACI/Carticel
« Reply #22 on: October 17, 2002, 07:53:12 PM »
I had my transplant last Wed.  The first two days were terrible for me but it is getting better fast.  I also had a distal realignment so my increased pain isn't surprising.  I start therapy on Friday (9 days after surgery).  Curious as to what to expect from therapy.  Also, any advice going into Therapy?  If you could have done something (while in therapy) differently what would it have been?  Thanks. Kyle.

Offline mark

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Re: ACI/Carticel
« Reply #23 on: October 18, 2002, 02:22:06 AM »
Hi Noddy,
Well Im 10 days post op with what was going to be the first procedure, once they got in there they decided not to do the carticel. the doc felt like it was not warrented with the little damage that he found. I go back in one month to discuss ?raising the patella? to take off the excess pressure against my joint. Hope you continue to do well, my thoughts and prayers are with you. Mark
2/95 Rt knee scope, 3/96 L knee scope, mencus repair, 1/02 L knee scope, realligned patella debrided cartlage damage, 10/02 carticel harvest attemped, failed, 12/02  L knee Fulkerson

Offline noddy

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Re: ACI/Carticel
« Reply #24 on: October 19, 2002, 10:01:11 AM »
Mark and kyle

Mark I am sorry to hear that you could not go ahead with the surgery.  Here's hoping that something else can be done for your problem. Thank you for your good wishes.  I  am progressing slowly but that is the nature of ACI's.

Kyle - I am very lucky as I have excellent physio's who know what to do and when to do it.  They give me nothing but encouragement and support.  The first months of physio is dedicated to regaining your ROM and quad strength.  Work hard on both as this is the key to a good recovery. My ROM is only about 70 degrees and it looks like I am heading for another surgery to clear away scar tissue.  My physio and I are working hard not to let this happen.  I go to physio 3 times a week and I also have a pool programme that I do up to 3 times a week.

I hope this helps.  Good luck.

Noddy


Offline chr12t1ne

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Re: ACI/Carticel
« Reply #25 on: October 19, 2002, 04:21:17 PM »
Noddy,
I've been following ACI posts with great interest as I had the procedure done Dec 01.  Finally decided to register and start to take part.  I had MUA for adhesions 8 weeks post surgery I had physio daily to try and improve my 45 degree flexion but got no-where, all I can say is for the sake of a 10 min procedure it was well worth it my ROM improved in leaps and bounds afterwards without too much of a struggle, I'm sure you would find your rehab would be much quicker if you opt for MUA before the scar tissue starts to harden!  I still havent quite got full ROM but I had quite a lot of damage plus 3 grafts and the trochlea drilled all at the same time, but things are certainly better than before and the pain relief from this surgery is worth all the rehab!  Good luck S

Offline kyle

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Re: ACI/Carticel
« Reply #26 on: October 19, 2002, 05:54:17 PM »
Noddy,

How far along are you now?  I have a history of arthrofibrosis (had 3 manips in past) so I wouldn't be surprised if this happened to me.  My doctors biggest concern is extension which I am at zero degrees right now.  If you have the time go to http://www.cartilagedoc.org/ and click on Rehab Protocols.  This page was designed by my doctor and this is the protocol I am following.  My protocol is the Autologous Chondrocyte Implantation (Trochlea/Patella) link.  I am curious if this looks anything like your protocol.  Thanks, I would like to keep in touch through this process.  Kyle

Offline noddy

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Re: ACI/Carticel
« Reply #27 on: October 21, 2002, 10:46:43 AM »
Hi Kyle

I am currently 10 1/2 weeks post op, 11 weeks on wednesday.  I went and had a look at your site.  It was very interesting.  

The protocol described there is similar to mine but not completely the same.  I could partial weightbear right from the beginning as long as I had my brace on.  I had an extension brace only.  I was not alllowed to do SLR until 8 weeks post op as this would have compromised my main implant site which was my patella. I had virtually no cartilage there at all. Thus my quad work was all static. I was required to wear my brace for 7 weeks also.

Everything else looks pretty much the same. Some days physio is good others not so good.  It requires great patience. My ROM is stuck at about 70 degrees.

I am happy to keep in touch. Please ask if you have any questions as I know what it is like trying to find anyone who has had this surgery to talk to.

S - thank you for your information.  I think I am heading for removal of scar tissue. Then I might be able to bend my knee again.
Here's hoping.

Noddy

Offline noddy

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Re: ACI/Carticel
« Reply #28 on: December 13, 2002, 06:12:11 AM »
Just thought I would give you an update on my ACI.  

I have just returned home from hospital yesterday after having fibrous tissue removed and having a manipulation. This went well. While the OS was in there he took the skin flap off my graft area, which was the back of my patella, and he says that my patella is covered with spongy cartilage material. It appears that the surgery has worked for me. Now we will have to wait and see how functional my knee is when it recovers.

Hope this helps those of you considering aci.

Noddy


Offline Linda

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Re: ACI/Carticel
« Reply #29 on: December 13, 2002, 09:57:11 PM »
Hey Noddy,

That is great news! I am sorry that you had to have more surgery, but glad that things seem to be progressing well.

Good for you!
Linda
LR and Chondrplasty 1/22/02, Clean-up, Chondroplasty and biopsy 6/4/02, AC Implant 11/6/02, Micro fracture and adhesion clean up 8/12/03

Offline kyle

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Re: ACI/Carticel
« Reply #30 on: December 22, 2002, 04:10:50 AM »
What was your flexion to require you to need a manipulation?  I am almost 10 weeks post-op Carticel transplant w/a distal realignment and there is a little bit of concern my flexion is lagging.  I have a history of needing manipulations with my surgeries so this isn't a big surprise to me, I am just curious where you were in your flexion/extension when the doctor decided to manip.  Thanks.

Offline noddy

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Re: ACI/Carticel
« Reply #31 on: December 24, 2002, 12:23:05 AM »
Kyle

My range was 70 - 75 when the os decided that I had developed arthrofibrosis and needed a manipulation and lysis. I had full extension.  I was 4 months post op from the transplant surgery when this was done.

I am now 2 weeks post op from this and my range has gone backwards to about 90.  However I think that this is because it is still very painful to bend beyond this.

Noddy

Offline kyle

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Re: ACI/Carticel
« Reply #32 on: December 27, 2002, 07:05:38 PM »
Thanks for the response.  I see my doctor Jan. 2 and I think we are going to talk about a manip at that time.  Right now I can get to 80-85 degrees and my therapist can push it to 90.

How has pain management been?  I am still having pain that requires medication and I am 11 weeks post-op.  Much of my pain is caused by my lack of flexion.  I still don't sleep thru the night w/o taking pain medication.  

Offline noddy

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Re: ACI/Carticel
« Reply #33 on: December 28, 2002, 08:27:24 AM »
Kyle

Pain has been mixed. I required pain meds to sleep and do physio for maybe the first 8 weeks.  I would still wake with pain at night several times a week until my latest surgery. I am now taking pain meds again after the manipulation. It is still painful to do certain things with my knee such as walk down stairs and my physio thinks that it is being caused by my patella still not being properly supported by my very weak quads. When the physio tapes my knee it feels very good, nearly normal in fact.  I see my os on 30 dec and will be interested in what he says about this.  I will post and let you know. The pain, I feel, is causing my range of motion problems at present.

Noddy

Offline mj/usa

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Re: ACI/Carticel
« Reply #34 on: December 28, 2002, 05:34:55 PM »
Noddy--
I am sorry to hear that you are still having problems....I can relate to the going down-stairs part.  I had/ still have probs with that, too and my os told me that it was because the patella shifts laterally since the vmo and the quads are still too weak to support it in its usual track.  This had gotten better (now 3+ mos post-op) but I can still feel the patella moving when I go downstairs.  The pain is a lot less, though.
AS for weak quads...I have been working and working and working on them, when will they be back to strength??? AT least now the quads on both legs are of equal circumfrence...
Good luck to you and happy new year!!!
Mary Jane
plica excision 05/01,  followed by OATS 09/02

Offline noddy

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Re: ACI/Carticel
« Reply #35 on: December 29, 2002, 04:02:48 AM »
Thank you Mary Jane

A very happy New Year to you also.  

It seems like a never ending obstacle course these knees of ours.  One thing improves and another thing springs up to test us. I am still optumistic that all will be well in the end.  

You describe the problem with the patella well.  That is what my physio said.

All the best

Noddy

Offline mj/usa

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Re: ACI/Carticel
« Reply #36 on: December 29, 2002, 05:26:00 PM »
Noddy--
I forgot to mention that my os told me to wear a sleeve if the kneecap was bothering me.  I have one that has a doughnut  around the patella and sort of keeps it in place.  But the problem here is that if I use the sleeve, the muscles don't get stronger....As you say a catch-22.
Anyway I thought this might be a help to you, too.
Mary Jane
plica excision 05/01,  followed by OATS 09/02

Offline noddy

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Re: ACI/Carticel
« Reply #37 on: January 04, 2003, 06:38:44 AM »
Thanks Mary Jane. I will look into what I can get that is like that.

I saw my os on monday. He is pleased with my progress since the manip. I still have significant patella pain, however he tells me that it will continue to improve for up to a year yet, so he is not prepared to make a prognosis on the outcome until then.  My range is about 90 but my quads need a lot of work.

Noddy


Offline noddy

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Re: ACI/Carticel
« Reply #38 on: June 07, 2003, 11:02:52 AM »
Hello

I haven't posted for a while as I have had other medical problems to deal with, including having a breast lump removed.  

I am now 10 month post op with my ACI and the pain in my knee is getting worse. I have to take pain killers every night to get a good nights sleep and celebrex to help with the inflammation. To add to it all my hip is so painful that it is becoming difficult to stand and sit without significant pain and my good knee is starting to give under the pressure.

I was wondering how other ACIers are going? I am starting to wonder about the wisdom of having this surgery. Maybe a knee replacement would have been a better option with faster recovery.

I look forward to reading other posts on the subject

Cheers

Noddy

Offline kyle

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Re: ACI/Carticel
« Reply #39 on: June 07, 2003, 11:03:35 PM »
I am exactly 8 months post op and I think I am doing better.  I walk about 2 miles per day w/o much pain.  The one thing I still cannot do is a leg extension with my bad leg.  I saw my doctor last week and he told me one of his partners had the transplant three years ago and she is better than ever.  Seems like a long time to wait.  Overall I would recommend having the transplant but I think you need to be mentally prepared as much as physically prepared.  It's the mental part that doesn't get enough attention (dealing w/many ups and downs).

Offline Golfer

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Re: ACI/Carticel
« Reply #40 on: June 15, 2003, 08:44:05 AM »
I was wondering if anyone has had the ACI procedure, has had time to heal from it and what were the results?

I was under the impression that this could only be performed for small lesions and therefore, how extensive this procedure is for arthritic knees.

My knee should be in the Smithsonian after 8 surgeries and want to avoid TKR for as long as possible, hoping new procedures are on the way.

Regards,

Golfer