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Author Topic: ACI gets a tough challenge... multiple lesions  (Read 15618 times)

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Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #30 on: January 08, 2008, 07:01:07 PM »
Thanks for the encouraging words DJS. I spoke with the RN at my OS's office yesterday on the phone. He was intrigued, and very understanding, but still not too concerned, which is encouraging. He gave me the option of travelling to Boston for an MRI + appointment, or getting an MRI done locally and having the results sent to my OS for review.

Ironically, the pain is beginning to subside now and things feel pretty good today. I'm going to hang on for a while longer and see how it goes. I've had a few periods in the last 2 months with pain, although in each case it has subsequently cleared up, so maybe this is something I just have to go through. I'm still only at 5 months, and with multiple lesions, some of them large, I probably have to expect a few ups and downs. Will keep you posted.

Jose - good to see that you got your ACI done in Houston. I saw a couple of OSs here, but they weren't too optimistic about my chances, so I elected to go to Boston to see Dr Minas. With your case (smaller lesion, early twenties) you should do well. The OS who referred me to Dr Minas told me that patients under 25 usually do really well with ACI. Hope that's true for you.

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 #31 on: February 04, 2008, 07:53:01 PM »
I'm a bit over 6-months post-op now. I'm still keeping my activity level very conservative. As usual for me now, the MFC, patella and trochlea are feeling very comfortable indeed, so I'm confident that the grafts there are doing well.  ;D

However, I'm experiencing yet another period of intermittant pain and clicking on my lateral side, which is frustrating. ??? I had a similar episode around New Year, although then the symptoms gradually disappeared and I ended up feeling pretty good and optimistic for a 3-week period in January. The return of clicking and pain is therefore a concern. For some reason, the clicking and pain is worst in the morning and seems to lessen during the day. I only feeling it walking - the light/moderate resistance cycling I'm doing feels fine - in fact, cycling improves how my knee feels. The very few stairs I do (at home only) are also very comfortable.

I've decided to bite the bullet and have the MRI that my OS's Registered Nurse suggested when I was having problems on the lateral side at New Year. I'm scheduled for the MRI locally tomorrow afternoon, armed with a whole sheet of MRI instructions from my OS. He's asked for the CD to be sent to him in Boston, so hopefully he should be able to evaluate it late this week, if not early next week. Wish me luck!

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 MegTX

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Re: ACI gets a tough challenge... multiple lesions
« Reply #32 on: February 04, 2008, 08:07:06 PM »
Thanks for your updates!!  My single patellar lesion is nothing compared to your repair, but I'm going in on Wed for ACI with a Fulkerson TTT and am really getting nervous about the pain and rehab.  Hearing how well yours is progressing is making me feel a lot better about it!!
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

Offline Peg Leg

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Re: ACI gets a tough challenge... multiple lesions
« Reply #33 on: February 04, 2008, 10:31:04 PM »
David,
 
You're in our thoughts and prayers and we are all wishing you GOOD LUCK!!!!!!  Hopefully your concerns will be put to rest and it will be yet another of our many 1 step forward and 2 steps backward phases.  Let us know when you get the results.

Hang in There,

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 #34 on: February 16, 2008, 12:27:08 AM »
MegTX, Peg,  Thanks for the good wishes.

Well, after a week's wait between getting my MRI done here in Houston and having it reviewed by my OS in Boston, I finally have some news. It's been a week with increased and constant pain, so fortunately the news is somewhat encouraging.

Dr Minas reckons that all four of my grafts are doing well. In fact, he believes that the LFC is doing really well, which was my big concern given the pain I'm having on my lateral side. However, he has identified pretty "well developed" adhesions on the lateral gutter, the area on the lateral side between the patella and the IT band.

It'll require a scope to remove the adhesions. 3 months ago I'd have been frustrated at the thought of more surgery, but I'm actually pretty happy with this outcome. I'm in a fair bit of pain at the moment, and was definitely prepared for very bad news on the LFC graft, so am encouraged by this development. I don't have a surgery date yet, but am obviously hoping for something asap. I've been told to expect a couple of days on crutches, although I'm sure that there will be a few weeks further recovery after that. Fingers crossed that Dr Minas can get me back on track.

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 casey2291

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Re: ACI gets a tough challenge... multiple lesions
« Reply #35 on: February 16, 2008, 11:36:50 PM »
Hi,
Sorry to hear that you have to go back in for more sugery!!  It is encouraging to hear that your OS thinks that all your grafts are doing well.  Did you have any ROM problems that would lead you to believe that you had adhesions or just the pain?  I hope this turns out to be just a very minor setback for you!
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #36 on: February 17, 2008, 03:23:46 PM »
I certainly haven't had major ROM problems Casey, although I have never regained full ROM. Full extension came relatively quickly, by about 2 to 3 weeks. As for flexion, I'd reached 90 deg by 3 weeks and 110 degrees by 6 weeks, just about on schedule. However, things did slow after that. I struggled for quite a while to get much past 120 degrees, although as activity increased through cycling etc, I increased to just over 130 deg by 5 months. However, my pre-op ROM was about 145, so I've defintiely lost a bit. I can live with 130 degrees, although if I get back further ROM from a scope, as well as eliminating the all-important pain, that would be a bonus.

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 djs60

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Re: ACI gets a tough challenge... multiple lesions
« Reply #37 on: February 19, 2008, 08:49:13 AM »
Hi David,

Sorry to hear you need more surgery, but as you point out, adhesions are a lot better than graft failure.

Maybe as a bonus you'll get better extension out of it.

Let us know when you get a surgical date.

Best,
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 David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #38 on: February 27, 2008, 06:58:10 PM »
Well, I'm now set up to take the next step. My scope is scheduled for March 14th. The objective will be to remove the adhesions (scar tissue) that have been identified on MRI, although it'll be interesting to see how the ACI grafts are doing (I'll be about 7-1/2 months post-ACI then).

Does anybody have experience they could share on Lysis of Adhesions, either after ACI, or in any other context?
Was LOA successful? What rehab was required? How long before you saw improvement? How long on crutches? What are the risks of regrowth of scar tissue?

Thanks.
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 joew

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Re: ACI gets a tough challenge... multiple lesions
« Reply #39 on: March 02, 2008, 02:19:30 AM »
David,

Check out the arthrofibrosis section of this web site.  There are also rehab tutorials on this site.
http://www.kneeguru.co.uk/KNEEnotes/node/632
In short, the important things are:
- Icing (I used the Theracool for constant icing during the night)
- CPM at night (probably for 1-2 weeks in your case since it does not sound too bad)
- Passive ROM (wall slides, extension heel props, etc)
- patella mobes
- elevation
- crutches (could be a few days or a couple weeks)
- don't inflame the joint by going right back to where you left off with the exercise you are currently doing.   Do no/low resistance on the bike after surgery.

Everyone is different, so this protocol may be a couple of weeks or several weeks.  In rare cases, it can be months.

Joe


   
7/02: ACL and medial meniscus tear playing basketball
9/02: ACLR; meniscus repair (local OS)
2003-2005: Patella grinding and pain after surgery.
12/05: Scope. Patella and trochlear groove debridement (kissing lesion).  Partial medial meniscectomy. (local OS)
5/07:  LOA/AIR, plica removal (Vail)

Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #40 on: March 06, 2008, 02:05:52 AM »
Thanks for a good summary Joe. Also, some really great info on adhesions and arthrofibrosis in the link. A bit scary too... given the strong emphasis on treating adhesions early, hope I'm not too late. A week to go before I find out....

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 #41 on: March 18, 2008, 12:36:26 AM »
I had my scope on Friday 14th March to remove adhesions. Sorry, but I've always wanted to do this:   ;D ;D ;D ;D

My OS said all 4 grafts looked great, with firmness as expected at 7-1/2 months, margins all integrating nicely with the native cartilage, and no flaps, edges or bits missing. He showed me lots of photos and described it as a "perfect 4 out of 4". I'm obviously more than a tiny bit pleased after all the anguish that we ACIers have to get through!!

There were adhesions on my lateral side, and a bit below my patella (around the fat pad) and a tiny bit above the patella, in the pouch. My OS says I should get a "turbo boost" now these are gone.

3 days post scope, I still have a fair bit of swelling from the scope, but can already feel the improvement - no lumpiness or tightness and my limp is gone. My OS told me FWB straight away and cycling from tomorrow. I'm walking fine without crutches, normal gait, but a little slowly due to the swelling. Me thinks this might be feeling pretty good in a couple of weeks....   OK, one more for the road:  ;D

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 #42 on: March 18, 2008, 01:42:20 AM »
David,

That is awesome news!!!  I am thrilled for you; no more worrying (WMD!!), just get down to business with the rehab!!  Here's to you  ;D ;D ;D ;D

Peg
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 MegTX

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Re: ACI gets a tough challenge... multiple lesions
« Reply #43 on: March 18, 2008, 02:08:07 AM »
Excellent news!!!  :-) :-) :-)

I'm still hoping to not have to have surgery for my scar tissue, but I know it's a real possibility if we don't get some mobilization going soon.  It's good to hear from people who've had to have it that say it's made all the difference in their rehab.
Lateral Release, Medial "Reef" - '91
{16 years of grinding, pain, swelling and lots of ice}
'scope 7/07 - .7cm2 tibial plateau microfracture, 2.5cm2 grade4 patellar CP debridement
ACI & Fulkerson TTT 2/08 (patella lesion then 4.5cmx3cm)

Offline casey2291

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Re: ACI gets a tough challenge... multiple lesions
« Reply #44 on: March 18, 2008, 07:00:51 AM »
Hi David,
Congrats on the great news about your graft.  This news definately deserves happy faces.   ;D ;D ;D ;D  I too just had surgery yesterday to clean up scar tissue and my OS also said that my graft looked fantastic.  I had scar tissue on the medial and lateral side of the knee.  I am still all bandaged up so I have not seen the knee yet, but I too was thrilled with the good news.  Again, glad to hear that you got a good report from your OS!
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05















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