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Author Topic: Day One down the ACI Road  (Read 25403 times)

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Offline David3

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Re: Day One down the ACI Road
« Reply #15 on: December 05, 2007, 08:31:29 PM »
Great news Jon!  I'm not quite there yet (I'm at 18 weeks), but hopefully heading in the right direction. Here's to continued progress!
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: Day One down the ACI Road
« Reply #16 on: December 07, 2007, 02:11:59 AM »

That's really good news!!  I am at 23 weeks and aside from my patella problems, I feel really good about my implant site, too.  My quads are a bit stronger the last couple of weeks and I feel there has been a bit more improvement overall. My biggest improvement is in my gait; even when I'm not in the brace, I walk better overall, which is great news!!  Keep up the good work and let us know what the Dr. says!

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


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Re: Day One down the ACI Road
« Reply #17 on: January 06, 2008, 06:36:09 PM »
Almost at the five month mark--

I'm still very happy with the results so far.

Things were feelling really good last week. I just started doing stairs (both down and up) without pain. Over Christmas I did a fair amount of walking around Charleston, SC. The knee would get a little hot but no pain whatsoever.

I did push the biking a little bit too much this Friday and for the first time in about two months felt some discomfort from the defect site. This morning it is fine.

Lesson learned---scale back the resistance and wait another three months before I attempt to step it up a little bit.

I do have a little bit of clicking through extension at 60 degree and terminal extension. My OS isn't concerned about it. There is no pain with it.

The graft at five months is still somewhere between a yogurt and putty state. I'm not going to draw any conclusion until 9-12 months when the graft should be a rubber state like surrounding cartilage.

I think this recovery from ACI is as much mental as physical. It is a long-haul of 18-24 months potentially so I'm not sweating this day-to-day.There is always that temptation to lose it and bear through the pain and do the workouts we all want to do.

 It is tough not being able to do my past leg workouts or long bike rides....but I'm substituting that would upper body workouts, core workouts and upper-body biking. I'm a shell of the athlete I used to be but at least not in constant pain with an achy knee

Offline casey2291

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Re: Day One down the ACI Road
« Reply #18 on: January 06, 2008, 07:22:01 PM »
Sounds as if you are doing really well.  Thanks for keeping us updated on your progress.  It is encouraging for those of us who are not as far along as you yet. 
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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Re: Day One down the ACI Road
« Reply #19 on: February 04, 2008, 03:32:04 AM »
6 month update:

Things continue to feel as expected for six months out. I had a five and a half drive today in an SUV which left my knee bent the entire time. Remarkably there was no aching or pain....only some heat in the knee.

The recovery really is as advertised for the the patella---it is sometimes one step forward and two steps back but after every 4-6 weeks you should be able to do things you hadn't previously.

For me, I'm now able to do steps without pain at six months. This is very encouraging for me. It is really a foreign feeling for my knee as steps have been really painful for so many years. I was also able to a short hike with some inclines and steps over the weekend....also a good sign. I still am avoiding steps sense in pushing this thing.

I continue to be very conservative with rehab--biking only 15 minutes or so to warm-up my legs. I do a ton of pilates, leg raises, ab work. I haven't started squats or leg presses and won't until the 1 year point. My one suggestion for an exercise to master is the flutter kick. It is great for overall leg and quad strength.

The patella defects are a long haul (up to 3 years) and I plan on giving this all the chances it needs to fill-in and harden. I consider myself about a quarter of the way done the rehab until full improvement.....this is exciting but also exhausting at the same time. I have a small defect in my left leg and will wait the full two years before deciding to go forward with the TTT/ACI.....

Best of luck to everyone rehabbing....

Offline Chondrosoldier

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Re: Day One down the ACI Road
« Reply #20 on: February 04, 2008, 03:55:51 PM »
3:30AM!; the solution to hangovers and upsets.

Good deal brother, keep up the posts as it seems you've had a textbook case, hope people can learn from you.  Nice change from the regular absurd posts:

"6 months out: just tried running a half marathon today and my knee hurts really bad, is this normal?"

Keep up the good work.
1997 L Traumatic dislocation/ACL
1997-2001 L recurrent sbuluxation
2001 L TTT Realignment
2006 L Patellar Carticel biopsy/debridement
2006 L Carticel 4cm patellar reimplantation
2007 R Carticel biopsy/debridement
 Insurance Battle
2008 R TTT 4CM Patalla/3CM Trochlea Carticel implant


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Re: Day One down the ACI Road
« Reply #21 on: March 16, 2008, 12:40:30 AM »
7 month update:
Overall very happy about my progress. I had a little bit of a setback last week caused by standing all day at work and walking too much on concrete-like sand on the beaches of Florida.

All the discomfort is gone as I really took it easy this week.

My only concern is continued warmth in the knee. It isn't every swollen which makes it all that much more bizarre. I also have  a pronounced click or catch when biking and around 30 degrees of extension. My OS thinks it is the fat pad but I think it is clearly coming from the lateral facet of my patella. My guess is there is a connection between the warmth and click that's occurring. If it doesn't improve then I'm going to insist upon an MRI and/or Scope at nine months. I have too much riding on this surgery to be successful to not be overly cautious.

Today I did some PT at the gym that simply hasn't been feasible for three years. I did moderate biking, half-squats, and leg presses with no pain. The elliptical is still a little-iffy so I plan on staying away from it for another couple months.

I have made a concerted effort to do straight leg raises multiple times daily. Now that I'm at the seven month mark I'm going to start getting a little more aggressive and committed to rehab. My quad is definitely getting stronger but has a long way to go. As the patella is embedded in the quad muscle and tendon it becomes so critical to get this thing firing all the time. I took the recommendation from a fellow knee guru and have been holding my leg up straight throughout the day at my job(when sitting at my desk). My VMO is noticeably stronger and larger already. It beats keeping my leg propped up on a box.

Also plan on being conservative in my activities outside of rehab as too much walking can and will aggravate the knee as there is a fair amount of stress placed on the knee when walking on concrete.

I'm really excited about the the potential of having the 95% solution to this knee in about a year. For all of those with patella arthritis I strongly urge you to give this surgery strong consideration. It is a mental and physical commitment but does work in due time.


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Re: Day One down the ACI Road
« Reply #22 on: May 04, 2008, 05:48:27 PM »
Well, I'm at 8.5 months now. I have noticed an improvement from my last postinig onf 7 months ago.

Improvement continues to be gradual and slow.

I've added a little more resistance to the bike and am able to walk longer distances w/o problems.

I don't have any swelling but i do get spells of warmth in the knee. There is absolutely no throbbing in the knee. Continuous loading of the patella is what causes problems.

I had an MRI about a month ago and it showed good integration of the cartilage into the existing cartilage. I did have some bone marrow edema--which was a result of over-doing stairs and squats. I have since cut back on both and no problems.

My OS said to expect continued cell proliferation for another 3 months and then hardening/maturing for the next 12 months.

So the conclusion is if the MRI shows cartilage fill then we can only expect this thing to improve over the course of the next 15 months.

I am having my other knee scoped in August. I"ll probably wait until the 18 month post-op of my other knee to go forward with the knee reconstruciton. Fortunately, my non-Carticel knee has far fewer symptoms and probably a much smaller defect.


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Re: Day One down the ACI Road
« Reply #23 on: July 23, 2008, 01:50:43 AM »
11 month update>>>

Things continue to improve. I spent the weekend in Chicago and walked around the city with no swelling or pain. I really think I'm going to continue the improvement for years to come.

I had a follow up with my OS today and he said a minimum of 12-18 months for good improvement and continuied improvement for 3-4 years. I mentioned I still had some warmth in my knee and his response was that is normal and the bodies vascular response to a surgery site. It could continue for months.

I had my other knee scoped today. I have a grade 2 lesion of about 12mm^2. There is a cartilage layer existing over the bone so ACI isn't warranted for now and I wouldn't do it because removing good cartilage for a 75% chance of a good result for a repair cartilage isn't worth the risk.

 I could do an AMZ but that will depend on how I feel in the coming weeks. The debridement may have done the trick. I woulld really like to get my carticel leg close to full strength before considering another major surgery.

Good luck to all having or had this surgery and stay patient as this is completely worth it.



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Re: Day One down the ACI Road
« Reply #24 on: November 03, 2008, 04:49:32 AM »
15 month update--

I have to say my biggest improvement in terms of 3-4 month periods has been in the last 90-120 days.

I did a really brisk walk today for about an hour. Hills and stairs are really no problem. My gait is now perfect.

I really can't wait for the 2-3 year mark...who knows, maybe I'll be jogging???

My only complaint is a little bit of overgrowth. I can get a lumpy feeling once in a while in my knee. No catching or anything like that. I might consider a scope down the road to clean that up.

I'm strongly considering the same surgery: ACI/TTO on my other knee before year's end. I have a small patella defect in that one. Unlike my other knee, I'd like to get it done before my symptoms get really bad.

An overlooked part of this process is that the recovery time is extended the longer symptoms have been occurring as well as the occurence of  other previous surgeries such as microfracture.

My assessment: If you have a patella defect and are offered ACI/TTO...go for it!!! The first three months aren't fun but you should really see improvement in three month periods onward....up to 3 years.

One other word of advise: Rehab is important but don't overdo it in the first 12 months. Cells take 12 months to proliferate and another 12 months to mature. Reduced pain in your defect site should guide your acticity level and not the other way around. You'd be surprised how strong muscles can become just from doing thier regular ADL's: stairs, squatting to get something off the ground, walking, etc.



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Re: Day One down the ACI Road
« Reply #25 on: December 15, 2008, 05:27:34 AM »
Tomorrow it is off to Chicago for Pattela ACI/AMZ #2 with Dr. Cole.

I had my right knee done 16 months ago. So far, the result has been positive with a return to daily activities with only very minor pain. I recently have been able to get back into long bike rides and hikes.

I no longer have any aching or pain with squats or stairs. I guess that is the ultimate indication this has been a success.

Therefore, I decided to get my other leg done.

 My defect is somewhere around 1.5 cm^2 to 2.0 cm^2. Really small  and manageable at this stage. The decision was tough as the defect has some fibrocartilage left in it and really doesn't give me sharp pains except for stairs. But, history from my other knee has taught me that these things getter bigger with time and activity. There is also some catching that occurs in the knee. After a full day of activities I get some aching and some general pain from the defect.

I will also be getting my other knee scoped for overgrowth at the same time. So, I'm sure the following week will be miserable.

By next Christmas these knee problems should all be a distant memory.

Good luck to all recovering or considering this surgery.

Offline djs60

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Re: Day One down the ACI Road
« Reply #26 on: December 15, 2008, 05:26:05 PM »

Good luck with surgery #2, and keep us posted on how you do.

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


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Re: Day One down the ACI Road
« Reply #27 on: December 17, 2008, 04:14:33 AM »
Well folks....12 hours post-op and still no pain....kind of surprised by that. Didn't have a nerve block either. I"m sure I"ll wake up tonight or tomorrow in a world of hurt.

Great news on my 16 month post-op knee. Dr. Cole said it was one of the best looking patella ACI's he has ever scoped. I"m assuming he was referring to the cartilage fill and firmness. He did pull out a bunch of scar tissue as well.

ACI and AMZ on my other knee. Turns out the patella defect grew to 3 cm^2 from approximately 2 cm^2 back in July...though still small compared to the average carticel defect.  There was still fibrocartilage in the defect....but I knew ACI would be invevitable someday with increasing symptoms of pain, crepitus and catching.
Scary knowing I have an eggshell kneecap for now but this a long-term solution that hopefully will give long-term pain-relief and results.Being 31
and having a desire to get back into an active really factored into my decision more than anything else.


Offline bsonday

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Re: Day One down the ACI Road
« Reply #28 on: December 17, 2008, 05:09:57 AM »
Glad to hear you are doing so well, Jon!

I will be seeing Dr. Cole in a few short weeks to get some big news about what is causing my catching and grinding noises under my ACI kneecap.  Hopefully, like you, he gives me a clean bill of health and zaps away some scar tissue.  Haven't really been able to push it and do any exercises other than straight leg raises since I get somewhat painful catching with everything else.

Sleep well and take some pain pills!  Talk to you soon.

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?


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Re: Day One down the ACI Road
« Reply #29 on: December 17, 2008, 06:01:39 AM »

I'm sure scar tissue is exactly what is going on. Apparently mine was so thick that regular arthroscopic sisscors couldn't remove it. Yesterday before surgery the scar tissue started to make unbelievably loud popping sounds. My roommate looked at me funny as I was waliking up the stairs

Youll probably walk out of your scope pain-freen after debridement. I will tell you my progress from six to sixteen months is pretty remarkable. Don't be discouraged even with some pain after your scope. No one on this board I'm aware of has ever had an OS say their cartilage doesn't look good after a scope. It is a 24-36 month proceess for your cells to truly harden and become hyaline cartilage. You are done with the AMZ which is truly one of the nastiest orthopaedic surgeries one will ever endure.

Let me know how the scope goes.