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Author Topic: ACI gets a tough challenge... multiple lesions  (Read 15617 times)

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Offline mayme

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Re: ACI gets a tough challenge... multiple lesions
« Reply #15 on: September 14, 2007, 01:37:21 AM »
Hi David,

I'm like you--one knee fixed and the other one in bad shape. This isn't the ideal solution for biking but I have a Schwinn AirDyne stationery bike. I just prop my bad knee up on the enclosed wheel & bike to beat the band. The arms on this bike also move so I really get the heart rate up. I know, I know, it's not like biking outside but it'll tide you over until you're ready to hit the road again.

Also, the AirDyne has been around awhile & they last forever so you can usually find them for cheap in the classifieds of your local paper.

Much good luck to you!

Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #16 on: September 14, 2007, 11:37:49 PM »
Hey, thanks Mayme. I looked up the Schwinn AirDyne on the net - looks to be just what I need. I'll investigate further.     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: ACI gets a tough challenge... multiple lesions
« Reply #17 on: September 15, 2007, 03:51:55 AM »
Hey David,

Check out Craig's List.

Swim Chick (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 David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #18 on: September 30, 2007, 07:35:30 PM »
9-1/2 week update:  I'm somewhat uncertain now as to how things are going. Advice and opinions welcome....

The positives are that my pain level is steadily decreasing and I can do more with my knee. As per my protocol, I've been WB with 2/3 of bodyweight for about 10 days now (with crutches of course), and that's going well. I can 'walk' reasonably well without any particular soreness on the graft sites, even late in the day.  :) My quads are coming back with the help of loads of quad sets, SLRs and e-stim. Most of the time, my knee feels fairly comfortable, although far from normal due to swelling (see below). With little or no soreness at the graft sites, I feel as though I'm ready to move to full WB at 10 weeks, as per protocol and I think I'm on target to drop crutches at 12 weeks. So far, so good.

However, I'm a bit concerned that I still have a fair bit of swelling. The swelling is delaying progress with ROM - I've progressed slowly but steadily to around 120 degrees flexion, but haven't made any further progress in the last 10 days due to the remaining swelling. The swelling is diminishing veeerrryyy slowly, but there's still a long way to go. Medial side is OK with very little swelling, but especially after 'walking' there's a fair bit of fluid build-up on the lateral side level with the bottom of my patella, and also above the patella (supra-patella). My PT thinks this is from the lateral release (part of the TTT procedure). There is sometimes soreness on the lateral side which seems to be shallow, appearing to come from the soft tissue and maybe being caused by the pressure of swelling at the lateral release site?? However, I've become concerned in the last day or two - I've noticed that, when I place my fingers on the extreme lateral aspect of the joint (outside left of my left knee), I can feel what seems like crepitus when I bend my knee. I'm hoping this is fluid moving around as I move the joint, rather than problems with my LFC site.  ???  I'm icing alot, massaging fluid out, and cycling daily, slowly without resistance, to dampen swelling.

Has anybody experienced this swelling on the lateral side? Is it possible to get 'crepitus-like' sensations from fluid moving in the knee?

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.

jonhark

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Re: ACI gets a tough challenge... multiple lesions
« Reply #19 on: September 30, 2007, 08:56:34 PM »
David,

What you describe is very similar to what I experienced after my TTT LR Microfracture with Dr. Minas back in January. It wasn't until 3-4 months post op that the swelling really went down considerably. Considering you had three large defects your timetable might even be longer. I didn't have crepitus, but I did experience snapping of the IT band and scar tissue on the lateral aspect of the knee. Another thing to consider is that  you were at 45 degrees restriction on the CPM for the six weeks. The CPM is a big contributor in reducing swelling. Do you still have the machine? If so, stay in it for 2-3 hours a day. The big thing is you don't have discomfort from the graft sites....something I never experienced with my microfracture. Also, I'm sure you already know this....Tim Bryant (Minas's RN) is an excellent resource for these types of questions.

Jon


Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #20 on: October 14, 2007, 05:12:16 PM »
Thanks Jon. Encouraging for me to hear that swelling can last 3-4 months after LR / TTT. Hopefully that's what I'm experiencing.

I'm now about 11-1/2 weeks post-op. I've been FWB with crutches for over a week now, still as per protocol. It seems to be going OK. I had some soreness at the MFC site late in the day for the first few days of FWB, in fact it felt like the MFC graft site surface was slightly proud of the rest of the chondyle, so sometimes it was very sore. However, that all went over within a few days and all the graft sites are pretty much pain free now. No noticeable pain from the patella, trochlea or LFC graft sites. In fact, when I can get swelling down, walking FWB seems comfortable. Although I have crutches by my side outside the house and at work (I'm supposed to be FWB with crutches), I've actually been walking around at home with no crutches for the past few days. Great to be able to carry things again! ;D

However, my swelling is still at the same stage as it was when I wrote at 9-1/2 weeks. Fair bit of swelling on lateral side, which is causing stiffness and reduced ROM (still at about 125 degrees). The fluid in my knee is affecting my gait somewhat when I walk. It is also causing some discomfort, although the soreness seems to be in soft tissue on the lateral side and very shallow, not deep in the knee. I'm still wondering if this is from the lateral release. If this goes over, I'll be feeling good. The 'crepitus' that I thought I felt last time has gone - it probably was fluid moving around combined with a good dose of paranoia from my side!!

I see my OS late next week for my 12 week follow-up, so will be looking forward to his view on my swelling. Will hopefully get the green light to go crutch-free too.

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: ACI gets a tough challenge... multiple lesions
« Reply #21 on: October 21, 2007, 02:25:33 AM »
Hi David,

I was just wondering how your visit to Boston and Dr. Minas went?  Are you trundling around without crutches, now?  If so, how is the walking feeling?  I sure hope things are progressing with you! :)

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 David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #22 on: October 24, 2007, 09:57:54 PM »
3-MONTH UPDATE:  Wow, time passes quickly when you're having fun!  ;) 

Thanks for thinking of me Peg Leg. I saw my OS late last week and he seemed pretty happy with my progress. He said the patella and trochlea grafts felt really smooth when I flex my knee, so he was pleased. Progress also seems to be OK with my MFC and LFC grafts, which are giving me no pain at all when walking. He wasn't too concerned about my swelling, indicating that it could take quite a while longer to subside considering the amount of damage I had. I've been encouraged to continue cycling with light resistance daily and take several 30 min walks each week. Also cleared for light cycling outdoors, although I think I'll wait another 6-8 weeks before I try that. Don't want to tempt fate.....   

All in all, a good report. He suggested staying in touch with his RN by phone every 6 weeks or so but, providing everything continues to progress well, no more visits until April (9-month post-op) when he's scheduled me for an MRI with gadolinium. 

I've been without crutches for the past 5 days. Walking has been pain free, although my gait is still hindered by a fair bit of stiffness from the swelling I have. There has been improvement since last week though, so I'm holding out hope that I might be limp free within a few weeks. At the moment I'm just happy to be off crutches!

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 David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #23 on: December 03, 2007, 10:35:45 PM »
4-MONTH UPDATE:  Hi folks! A bit over 4 months now, so thought I'd keep you posted.

Progress is steady. I think my MFC, trochlea and patella grafts are doing well - they feel very comfortable, to the point where I'm noticing the medial and P-F part of my knee less and less. I've had a couple of episodes of intermittant pain on my extreme lateral side, although in both cases the pain has subsided after a few days and left me feeling better than before. I'm hoping this is scar tissue, perhaps from the Lateral Release area, although obviously I don't know. I'm still getting some aching from time to time on the lateral side, and sometimes a 'stinging' sensation, so I'm just hoping this is scar tissue or soft tissue irritation. I'm not having any pain on the lateral side or anywhere else when walking, so fingers crossed that things are OK.

Swelling is virtually gone, at least seen from the outside of my knee. However, I can still feel some fluid in the knee, which is causing some stiffness, but stiffness is much improved from a month ago. I'm walking with a normal gait now, which is a relief, although not walking really fast yet.

Although there's still a long way to go, I'm generally pretty happy with progress, considering I'm only at 4 months and had alot of damage. I'm due to travel abroad on business and then vacation for a few weeks and do not anticipate having any problems travelling or walking through airports, etc.

My OS said that there often tends to be a fair bit of improvement between 4 and 6 months, so I'm hoping the progress will continue. Hope all you ACIers have a great Christmas.

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: ACI gets a tough challenge... multiple lesions
« Reply #24 on: January 06, 2008, 01:45:59 AM »
Hey David,

I know you have been busy traveling the world, but we boring homebodies would like to hear from you!! How's the knee holding up after all of your adventures?!!

Sad Peg Leg (no swimming for her till stitches heal  :'()
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 David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #25 on: January 06, 2008, 03:01:40 AM »
Hi Peg,

Yeah, it's been a hectic period with lots of travelling, first work, then Christmas & New Year vacation back in Europe. All good fun, although I've been taking it as easy as possible on my knee. I'm just back. My knee was holding up really well until about a week ago - in fact it seemed to improve while I was travelling, with long periods without any pain. However, the last week has not been good - it seems like that damn LFC site again. The MFC, trochlea and patella seem really comfortable, but I've had renewed episodes of shooting pain on the lateral side, not good. There has also been some fairly pronounced clicking over the past 2 weeks, again on the lateral side. Have to say that I'm extremely concerned  ???. Not sure what the symptoms of overgrowth are??? Ironically, I'd be a bit relieved if this turned out to be overgrowth, although I was under the impression from my OS that overgrowth was less likely with the porcine 'bio-guide' membrane that my OS used instead of periosteum. I'm now at 5-1/2 months - any advice or experience welcome.

I last spoke to the RN who assists my OS in early Dec - he is very knowledgable and helpful. I'm going to call him again on Monday - he suggested that if I'm still having problems in early Jan (which I am), the OS might want to consider an MRI at pretty short notice.

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 kevinnjaime

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Re: ACI gets a tough challenge... multiple lesions
« Reply #26 on: January 06, 2008, 04:38:52 AM »
David,

Hey Im about the same amount of time out as you and I also have some pain when I have done to much and I have also noticed that I have clicking under my knee cap.  I mentioned it to me OS and he said that it was probably scar tissue and not to be worried about it.  Hopefully its not anything major in your case.  Good luck.

Kevin
05-07 Meniscus tear cut out
07-07 Carticel implantation femoral condyle on left knee
03-09 Reinjured same knee during a car accident

Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #27 on: January 06, 2008, 07:09:44 PM »
Thanks Kevin. Good to know what others are going through. It has dawned on me that this might be a reaction to an increase in activity - I tried stairs for the first time a week ago, just up, not down, and have done a few more flights since. I've waited a long time before trying - my OS said I could try stairs some time ago, but I want to be conservative. Going up stairs seems pain free, but maybe it's caused a reaction which I feel afterwards?
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 djs60

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Re: ACI gets a tough challenge... multiple lesions
« Reply #28 on: January 07, 2008, 02:49:04 AM »
David,

It may just be the change/increase in activity.

I had a similar setback in Sept when I was a little over 4 months out.  In my case, I had been doing a lot of walking/standing and some cycling.  I got quite worried (the knee was pretty swollen, and I was limping again), and my 6 month f/u MRI got moved up.  It looked OK, and my knee calmed down with more modest activity.  So, hopefully your experience will be the same.

Dan

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 jlmojica

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Re: ACI gets a tough challenge... multiple lesions
« Reply #29 on: January 07, 2008, 06:00:22 AM »
Hi,
I also had ACI procedure done 2 weeks ago. Your post really keeps my hopes up about the future effectiveness of this procedure. My lesion is not as complicated as yours, but I still have to be very careful and NWB for 6 weeks (carticel was very expensive). I also live in Houston, and had the surgery done by Dr. Harvey from Orthopedic Associates, but I have not really liked the attention he or his staff gives to patients. Well, good luck and speedy healing!

Jose
Injury: patella dislocation while playing basketball (June 07)
trauma: large OCD in femoral part of the knee
treatments: (1) scope surgery to remove fragments and microfracture, (2)recommended for Carticel treatment and received ACI procedure (Dec 07)















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