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Author Topic: ACI gets a tough challenge... multiple lesions  (Read 15627 times)

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Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #60 on: July 26, 2008, 01:33:18 AM »
12-MONTH UPDATE:  I had my 1 year follow up yesterday with Dr Minas. Things are looking good. The MRI showed that all 4 grafts have now grown to full thickness and are well integrated with the native cartilage and underlying bone. Cell proliferation has clearly continued up to the 1 year mark - when I had an MRI at 7 months, the LFC and MFC grafts were fairly thick, but the patella and trochlea grafts were both around half of normal thickness. Great news that they've now reached full thickness - I can certainly feel the difference on stairs and cycling.

Furthermore, there were no signs of any bone edema anywhere under any of the grafts - this is apparently a really good sign that the cartilage is developing well and doing its job protecting the bone. My OS was really pleased since I had alot of bone edema pre-surgery, and he said that it normally takes longer than 12 months for significant edema to disappear. All in all, he described it as a home run. He said I can resume normal activities, although we agreed that I would steer clear of running. He did say that I was OK to ski this winter if I wanted to - however, after all the pain I've been through, I'm not going to take him up on the offer this season, but it's nevertheless a good indication that this is progessing well. I asked about longevity - he said that barring any accidents, he fully expected me to be doing well at 2 years, and that 96% of patients who are doing well at 2 years are also doing well at 10 years.

Although I have full ROM and good patella mobility, I am still experiencing slight tightness on the lateral side. He confirmed that there was slight regrowth of scar tissue visible on the MRI, but he said that it was minor and would probably stretch out or even disintegrate with regular exercise. He didn't seem at all concerned.

All in all, I'm starting to get pretty happy with my knee. I cycled really hard today on my road bike for about an hour. Despite favouring my ACI knee over my non-op knee (which is only just holding up), my knee was great - fitness and quad strength were the clear limitations. They are coming back slowly. I also hiked a bit during a recent vacation - only a couple of hours, but went reasonably well (I noticed a lack of muscle strength on uneven, rocky terrain). I'm sure that there's yet more improvement to come over the next 12 months.

With that, I think my regular posts are drawing to a close. I'll check in again around 15 months, or whenever I get my right knee done, which is probably only a matter of time. Good luck to all you other ACI'ers out there.

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 #61 on: July 26, 2008, 06:24:13 PM »
Thanks for such a positive report!  My progress is going well, but I'm a long way from knowing if I can go back to regular activities.  It's good to hear about people who've had worse lesions than me and are now doing great.

Keep it up!
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)

jonhark

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Re: ACI gets a tough challenge... multiple lesions
« Reply #62 on: July 28, 2008, 03:53:03 PM »
Thats outstanding news David.

I'm following a similar path. Knee just keeps feeling better and better.

It really is unbelievable the difference a year can make.

Enjoy that new knee.

Offline djs60

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Re: ACI gets a tough challenge... multiple lesions
« Reply #63 on: July 28, 2008, 06:13:41 PM »
David,

That is really terrific news.  At my one year MRI with Dr. Minas, I still had some bone edema under the patella graft, although it was a lot better than the 6 month scan.  At that time, he told me he'd let me try running at 18 months if that resolves.

The info he provided about long term outcomes is very encouraging.

One question for you: do you have equal muscle mass in your operated leg compared with the non-operated leg?  I am still lagging in that department, although I think I am seeing slow progress.

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 Julie P

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Re: ACI gets a tough challenge... multiple lesions
« Reply #64 on: July 29, 2008, 07:08:54 PM »
David,

My name is Julie.  Just read through your post. Your story is surprisingly very similar to mine.  I have a lateral trochlear lesion, patellar lesion and possible MFC lesion.   Failed microfracture.  Now I am having TTT and ACI out of state in January. Not til Jan because I  can not bear the idea of being stuck in the house and in pain during the beautiful weather.  I live in Chicago.  Would much rather be stuck in the house when it is 10 degrees with 1 foot of snow outside.  Now its just getting through the pain for the next 5 months.

I fortunately only live a 6 hour drive away from my surgeon.  Trying to decide if I should fly or drive.  And all of the other details that go with it.   Any advice?
L hardware removal and scar revision 6/4/9
Left AMZ and medial release 1/8/09
ACI biopsy 11/4/08 and bilateral scopes
12-22-06  L -Microfracture lateral trochlea, LR, and removal of loose bodies
1999-Right knee Loose body removal chondromalacia

Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #65 on: July 30, 2008, 06:17:18 PM »
Hi DJS - No, I don't yet have equal muscle mass in my operated leg compared with non-operated. I'm guessing that my non-op leg has reduced in muscle mass by about 3/4" in circumference relative to two years ago when I had to stop all sporting activities. That's just through having a low activity level. As for my operated leg, I've just measured it - it is currently about 1/2" smaller in circumference than my non-op leg, so probably about 1-1/4" smaller than two years ago. The 1/2" difference doesn't sound large, but it is visible, at least to me. Even though I'm now cycling fairly hard, I also notice a strength difference. The muscle mass does seem to be returning slowly, but it wouldn't surprise me if it's 18 months post-op before they are equal. I'm not sure I'll ever get everything back to how it was 2 years ago, at least without some heavier weight training, but I'm not sure I need to get it all back either. I'm not doing too badly now, so I'll be patient.

Julie - Driving or flying is a good question. I didn't have a choice - I'm a 4 hour flight away, so driving wasn't an option for me. In your situation, I think I'd be tempted by driving. Firstly, you could stretch your leg out on the back seat - legroom is more of an issue on a plane. Secondly, my OS pretty much told me that he didn't want me flying until 10 days post-op due to the increased risk of blood clotting. That might be different for you with a shorter flight, I don't know. As a result, I had my 4 nights in hospital (could have been 3, but they let me stay a 4th) and then had to have a further 5 or 6 nights at a hotel before I could fly home. The family made a holiday out of it, but it's a hassle, and pushes up the cost. Thirdly, navigating through taxis, airports, etc went OK, but isn't a pleasure a few days post-op. Fourthly, driving gives you more flexibility in planning for the future. I have made 6 trips to my OS, and flying means you have to plan follow-ups in advance to get reasonably priced tickets. Whatever you choose, I'd recommend spending at least a couple nights in hospital before trying to travel. Also, take some extra pain killers on your day of travel. If you fly, ask your OS about taking aspirin 24 hours either side of your flight as an anti-clotting measure if you're not already on a blood thinner (my OS put me on Coumadin anyway). Good 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 joew

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Re: ACI gets a tough challenge... multiple lesions
« Reply #66 on: August 03, 2008, 05:37:45 AM »
David,

That is great news about your ACI outcome.  Great surgeon, but no small effort on your part.  Just a few questions:

1.  Are you able or allowed to crouch?
2.  Are you definitely going to have your other knee done or just hold out and see how things go?
3.  When you measured your quad, did you just take the largest diameter (upper thigh) or measure the circumference mid thigh, say 10 or 15 cm above the knee cap?

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 #67 on: August 07, 2008, 04:24:49 AM »
Hi Joe,

1) I can crouch, although I've only tried it for the first time recently. I don't have any pain when crouching, but have to say that it feels somewhat weak and vulnerable. I'm not at all perturbed by that. It feels the same way that stairs felt when I first started them at 7 months, or like rising up from a sitting position without using my hands felt at 10 months. In both those cases, I saw alot of improvement over the following 2-3 months. I'm still seeing steady improvement now and am very optimistic that crouching will improve, probably to being normal. I think rebuilding muscle will help alot. Patello-Femoral ACI is a long road, probably 2 years rather than 1. However, things start to be pretty reasonable from around 11-12 months.

2) My right, non-op knee is holding up at the moment. In fact, as I slowly rebuild muscle after a long period of low activity, the more severe pain I had earlier has diminished somewhat. I still often have low level pain, which increases a notch during hard cycling, swimming, golf, etc. However, apart from no running or soccer, I'm back to living a pretty normal and active life. After discussion with my OS, we concluded that I should continue with normal sporting activities for a while. If it continues to survive, we'll do an MRI again in one year to assess it. If it gets more painful, I'll go ahead with ACI. My OS already took sufficient cells in my first biopsy to do both knees, and the cells are good for another 4 years, so he says we can do ACI at fairly short notice if needed. 50/50 chance in the next 12 months I think.

3) Measurements were 10 cm (~ 4") above the centre of my patella. i.e. mid-thigh.

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 bsonday

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Re: ACI gets a tough challenge... multiple lesions
« Reply #68 on: August 07, 2008, 10:00:45 PM »
David,

Glad to see your are doing so well.  I've been reading your posts for a long time, and since I'm only about 5 weeks into my patellar ACI, it's great to see a guy with a complex case getting back to normal.  Keep up the good work.

-Ben
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline David3

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Re: ACI gets a tough challenge... multiple lesions
« Reply #69 on: August 08, 2008, 12:24:13 AM »
Thanks Ben.  You'll do well - you're young! Just be patient, don't worry too much (easier said than done - there are lots of ups and downs) and be conservative with your rehab. Don't do too much too early and you'll get there!

Best wishes, 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 #70 on: November 13, 2008, 03:42:59 AM »
15-MONTH UPDATE:  A bit over 15 months now since ACI/TTO on 4 lesions: MFC/LFC/trochlea/patella. Glad to say there has been continued improvement since 12 months. Daily life is completely normal - brisk walking, stairs (even two at a time), activities of daily living, etc are fine.

For sports, I've stuck to cycling on my road bike (pushing myself reasonably hard, typically for 20-30 mile rides), some swimming and a fair bit of golf over the past few months and have full enjoyment of those activities with no problems at all - no pain or swelling during or afterwards. I'm also noticing that general strength around the knee is still improving - the feeling of weakness that was still very noticeable at 9-12 months has diminished alot. Walking down steep hills and going up or down stairs fast are now much more comfortable than at 9-12 months. I've also noticed that my knee movement has become smoother as my activity level has increased.

I've tried jogging for 50 to 100 yards on a soft surface now and again, mostly out of curiosity rather than any hope of running again soon. Although I've noticed improvement since I first tried a couple of months ago, I have to say that jogging doesn't feel natural yet. There's definitely an element of mental blockage there, and still some need for further muscle strengthening, so I think it'll be some time before I could jog any reasonable distance, never mind run. I'm not concerned about that - the rate of improvement of how my knee feels doesn't seem to have slowed noticeably yet, so I'm still enjoying the progress and can now firmly believe that there will be continued improvement until at least 2 years.

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.