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Author Topic: Day One down the ACI Road  (Read 25402 times)

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jonhark

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Day One down the ACI Road
« on: August 15, 2007, 02:54:46 AM »
I had my ACI surgery today in Denver, Colorado with Dr. Wayne Gersoff. Overall I'm really pleased well the surgery went. My patella defect ended up being 1.5CM X 2.5CM. It had grown from the 1.0CM X 1.5CM it was back in January when I had a TTT and microfracture.....another knock against microfracture in my book. My alignment looked perfect from what he said.
I had a femoral nerve block and will have a pain pump for the first 48 hours to deal with the pain. I have no pain right now....I'm sure that will change in 24 hours.  I will not start the CPM for 10 days.
Interestingly, my OS took the perioustium from the femur and not the tibia. I asked about the new synthetic and porcine membranes that were being used. He hasn't used them because his success rate with periostium has been high.
I'm ready for the challenges that lie ahead. My benchmark for a successful surgery will be if I'm able to ADL w/o pain and get back into biking.
I'm very thankful that this surgery is available and has been perfected throughout the years. I'm looking forward to the day that I don't wake up and go to bed thinking about my knee.

Offline rainerng

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Re: Day One down the ACI Road
« Reply #1 on: August 15, 2007, 03:54:20 AM »
Hi Jon, congratulations on your ACI.  I too, had a defect in my patella and underwent a more conservative debridement procedure 2 weeks ago. I hope you update us on your recovery as the ACI may be procedure I may have to undertake in the future.
Ballroom Dancer
Jan 07 Fissure in Patella while dancing (prob due to VMO weakness)
Feb - May 07 PT
Jun 07 Injury got worse and given synvisc
1st Aug 07 Debridement surgery
8th Aug 07 PT with isometric knee exercises
13th Sept 07 PT with PRE's

Offline djs60

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Re: Day One down the ACI Road
« Reply #2 on: August 15, 2007, 06:02:45 PM »
Jon,

Good luck & keep us posted.

If it's encouraging, I am now 3.5 months out from my trochlear & patellar ACI (plus TTO), and am able to ride my bike a bit without pain (I'm supposed to avoid hills, which is hard where I am, so I've been doing more stationary biking).  My patellar repair was a bit bigger than yours - about 3 cm x 3 cm.  I still have quite a bit of quad atrophy to work on.

DJS
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

jonhark

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Re: Day One down the ACI Road
« Reply #3 on: August 15, 2007, 06:21:40 PM »
DJS,
Thanks for the post. I would be pysched if I could pedal a bike w/o pain in 3.5 months. I did attempt biking after my microfracture surgery but never was able to do it pain-free. My goal is really to do stairs and loading the patella w/o pain. I don't imagine I'm going to get back into running again.

Were your lesions kissing? How large was your trochlea lesion? Did you have the aching/throbbing pain before surgery (when driving) Is it now gone?

Thanks,

Jon

Offline Nick_Knack

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Re: Day One down the ACI Road
« Reply #4 on: August 15, 2007, 06:56:04 PM »
Congrats Man,

Hope you continue to make progress.
Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline djs60

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Re: Day One down the ACI Road
« Reply #5 on: August 15, 2007, 10:02:45 PM »
Jon,

Yes, I did have "kissing" lesions.  I think the trochlear lesion was about 2 x 2 cm. 

I did not have very much pain presurgery.  I would get swelling & stiffness after significant physical activity.  I could do ADLs without difficulty.

My goal in the surgery was to preserve my ability to bike/hike/be active and hopefully to prevent further deterioration of the joint.  I was actually a lot less symptomatic than a lot of others here, but things were moving in the wrong direction, and I felt that waiting to get worse didn't make sense to me, especially since I'm 46 yo, and my insurer won't cover ACI if 50 or older.

djs
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

jonhark

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Re: Day One down the ACI Road
« Reply #6 on: August 21, 2007, 05:56:07 PM »
Week One has come and gone. The pain pump came out on day 3. Remarkably I am in absolutely no pain whatsoever. I"m not taking any anti-inflammatories or pain killers. I spend most of the day with ice on my leg to reduce swelling and my leg elevated. The CPM starts on Day 10. Being that my defect was in the patellafemoral joint I probably won't get any pain or uncomfortability until I start flexing my knee. I do quad sets, patella mob's and side lifts 3xday. The knee is really swollen--par for the course with open knee surgeries.
This surgery compared to my TTT/microfracture has a fraction of the pain.


Offline Peg Leg

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Re: Day One down the ACI Road
« Reply #7 on: August 22, 2007, 02:29:04 AM »
Jon,

It's so good to hear that your pain is minimal!  I will be at the 8 week mark on Thursday, and I managed to ride the bike 1 mile in just over nine minutes, today!  There was almost no pain, just some tightness, which is much less this week!  Maybe that will give you something to look forward to!!  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

jonhark

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Re: Day One down the ACI Road
« Reply #8 on: August 28, 2007, 01:14:00 AM »
Two Week Update:
Things are going really well so far. I have absolutely no pain in the knee so far without pain killers. Today was my first day back to work. I keep my leg elevated and iced most of the day.
I started doing leg lifts in four directions last week. I can do unlimited SLR. My quads are starting to atrophy but still have remained decently strong. I am keeping my CPM at 60 degrees for the first 3 weeks. I really want to keep the graft as well protected as possible. I am also doing heel slides to work on my ROM which i can get up to about 90 degrees.

I had my ten day post-op appt. on Friday. My OS wants to be extremely conservative in my recovery. No biking for 8 weeks and no leg presses for 6 months. I'm fine with that as I'd rather struggle with regaining strength than overwork the graft.

An another note, I've noticed the more I crutch around and stay active the better I feel. I did some pull-ups and light free weights today. As long as I keep my leg in the brace and unloaded there are no problems. Diet is also critical for recovery. A diet high in protein with fruits and vegetables is the way to go when recoverying. So much of recovery is mental so the better mindset you're in the better.

jonhark

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Re: Day One down the ACI Road
« Reply #9 on: September 09, 2007, 10:37:54 PM »
4 week update:
Things are still going really well. The worst part is staying in the CPM for 8 hours a day. Being back at work I'm averaging around 6 hours during the week and try to make up for it on the weekend.
I've gradually increased the ROM to 80 degrees on the CPM. My goal is to gradually keep increasing until I'm at 110 by the end of six weeks. I notice the longer I'm in the machine the better and looser the knee feels. Swelling really isn't a concern anymore. I'm no longer using cryotherapy....but I do wear compression stockings all day.
I've been doing SLR in four directions, quad sets, toe raises and now terminal knee extensions from 30 degrees for my rehab. I usually only do it once a day now for about about an hour of total therapy. The key I'm finding is getting the glute med (hip flexor) strong.
My experience has been nothing but positive so far. I'm remaining cautiously optimistic as I'm sure it'll get more difficult once I jettison my crutches at six weeks. I have the 4 month point as a target for evaluating the initial success of the surgery. With a relatively small defect (2 CM) on one surface (patella) I should really have decent pain relief by then.

Jon

jonhark

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Re: Day One down the ACI Road
« Reply #10 on: October 09, 2007, 03:55:21 PM »
8 week update:

I continue to see improvement in my knee every ten days or so. I have started driving again and that achy throbby pain seems to have mostly disappeared. This is very encouraging as I remember driving to the hospital the day of the surgery and thinking to myself how nice it would be not to have that kind of pain.

I am sticking to a very conservative rehab protocol:

10 minutes no resistance biking

Leg raises with thigh weights

Terminal Knee Extension

Calf Raises

I can walk with no discomfort but really haven't been pushing the distance too much. I don't really see the upside in it. I am not doing steps and don't plan on it for quite some time.

Jon

Offline kevinnjaime

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Re: Day One down the ACI Road
« Reply #11 on: October 10, 2007, 05:17:46 PM »
Hey Jon,

I am at about 11 weeks and I was progressing at the same slow pace and I know it is anoying but be paitent.  I have begun leg presses, mini squats, step ups, a 5 minute walk on the treadmill and leg extensions.  I am feeling better every day but I still dont push it because I know I could blow the patch.  Just be patient I know it is hard.  I cant wait to go back to work.  It will give me something to do everyday.  Stay strong and 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 OldExTriGuy

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Re: Day One down the ACI Road
« Reply #12 on: October 31, 2007, 07:16:02 PM »
Kevin/Jon,

I think I have recently invested 50+ hours researching online cartilage repair procedures and personal accounts and what is jumping out at me is a pretty clear indication that slow and steady SEEMS to win the recovery race with cartilage.  Although the info I am looking at is anecdotal (at best) it certainly appears that the conservative approach you both are using is the way to go.  If/when I go through a similar process I will try my best to duplicate.

Thanks for providing your feedback on recovery.

Torn ACL 1982
Meniscus removal 1987
Meniscus removal 1993
ACLR 2006

jonhark

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Re: Day One down the ACI Road
« Reply #13 on: November 10, 2007, 11:44:55 PM »
12 week update:

Everything continues to progress well. I did 20 minutes on the bike today at light resistance with no pain. My quad and glute med muscles continue to strengthen.

I am keeping walking and standing to a minimum. I have taken a liking to the upper body bike machine at my gym. It allows me to do cardio without stressing the lower body.

I did have a little flare up this week at work (medical device marketing). I was standing and walking between OR's all day and the knee started to bother me (swelling, discomfort). I took a half day off the knee and slept a lot that night.....no more problems.

I have noticed that the following supplements do help with inflammation and discomfort: omega-3 fish oil (i buy smoked yukon salmon), glucosamine/chondroiton, SAMe, grape juice.

My suggestions to those considering this surgery are:

1) go for it. my result so far has been far better than microfracture

2) take it slow. keep walking to a minimum for the first six months. don't do any lower body cardio other than light biking.

3) don't consider stairs for six months as well. Nothing to be gained in doing them

4) work the glute med muscle as much as possible

jonhark

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Re: Day One down the ACI Road
« Reply #14 on: December 05, 2007, 03:53:42 AM »
16 week update.
Wow!! My knee is really feeling great these days. Absolutely no more aching and no pain with walking at all. I did some brisk walking this past weekend and had no problems....keeping it to a minimum of course.  I'm blown away with the progress from week 12 to week 16. I do have some slight crepitus with full extension. I view that as a positive as the cells must be hardening and maturing for it to create that kind of sound. I will see my OS tomorrow and confirm.

My rehab consists of biking 3 days a week for 20 minutes at light resistance

I've found the level of walking from everyday activities is adaquate. I don't take any other walks for "exercise".

Tons of Leg Raises and Pilates

No squats or leg press for 12 months

I'm goinig to stick with my plan to wait until week 22-24 until I start stairs. I think the critical part of this rehab is to consider that the graft isn't the only thing at risk until it fully matures. Consider the surrounding cartilage is also highly susceptible to further damage/cracking if stressed before there is adaquate fill in the defect. I really doubt the graft is durable enough to absorb the necessary shock until 18 months or so. That is just my theory....but garnered from anecdotes from Dr. Minas and my OS who've been doing these procedures since the mid-90's. In fact, Dr. Minas recommends no lunges or leg presses for 12 months.

I can't even begin to put into words how much of a mental boost it is to not have daily knee pain. I'm really looking forward to the potential improvements at six, nine and twelve months. The last five years have been miserable dealing with a progressively worsening knee.....the next 2-3 years should be delightful with a progressively improving knee.


















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