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Author Topic: Day One down the ACI Road  (Read 25404 times)

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dileigh

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Re: Day One down the ACI Road
« Reply #30 on: December 17, 2008, 10:23:58 PM »
Wow, at only 9 months, I can't imaging having to go through everything again with the other knee.  It just finally feels mostly back to normal...

At least you have a pretty good idea what to expect, even though no two surgeries are exactly the same.  You have a doctor you can trust from what I've heard and that helps all by itself.

Good luck with the new one.


Diana



jonhark

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Re: Day One down the ACI Road
« Reply #31 on: December 19, 2008, 12:10:18 AM »
Diana--

Trust me---the last thing I wanted was another big surgery. Fortunately--there has been absolutely no pain so far and I'm past the two day point.

I think the line between a focal defect and arthritis is pretty blurred. I had noticed the symptoms in this knee progressively get worse over the past couple years. My big fear was letting this thing linger for another couple years then get told I have a defect half the size of the my patella.

OS said my other knee looked perfect with the only difference being the graft is a little softer than the surrounding cartilage. It will harden further over the next 12-24 months.

It is also nice having an insurance company that approved the surgery within 30 days. That isn't the standard for most insurance companies and patella aci.

Yes, my os is great. The last go round on AMZ was miserable. I honestly can't even feel the screws this time. knock on wood.

Glad to hear you are feeling better....

J








Offline casey2291

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Re: Day One down the ACI Road
« Reply #32 on: December 21, 2008, 06:00:29 PM »
That's great news that your new cartilage looks good from your 1st ACI surgery.  Good luck on your recovery.  I can't imagine going through it again.  I too worry about letting my other knee linger with symptoms and it becoming too bad to do anything with.  I have noticed worsening symptoms in my "other" knee for the past several months.  I hope that you continue to stay pain free! 
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

jonhark

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Re: Day One down the ACI Road
« Reply #33 on: December 22, 2008, 01:50:23 AM »
Thanks Casey. Knock on wood this has been a really pain-free easy recovery. I'm 5 days post-op and I flew 3+ hours back home. I've been getting full night's rest as I'm not in any pain. I'm completely off the pain killers. Granted, I'm keeping the CPM to only 45 degrees.

I wouldn't hesitate to get ACI again if I were you. Getting the defect filled while your symptoms are manageable isa huge positive.  My other knee was awful for so long. The chronic trauma to the subchondral bone along with a failed microfracture have probably added 6-12 addiitional months to the timetable for recovery.....even though my new cartilage looks good. That's what my OS said, at least. There have been way too many success stories on this forum not to think you could do it again.

It was great news when Dr. Cole said my ACI looked perfect and one of the best patella cases he's ever seen for 16 months post-op. Makes me feel excited that this was all worth it and someday I'll be hiking these peaks in Colorado.

J

Offline casey2291

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Re: Day One down the ACI Road
« Reply #34 on: December 24, 2008, 12:42:46 AM »
Hi,

I'm glad to hear that you are pretty much pain free so quickly post op.  It makes me think that maybe (a big maybe) I could go through ACI again.  I'm hoping that maybe I have just been working out too hard lately and now that I am recovering from my hardware removal that my knee is just overly stressed.  I have talked to my OS about the lesions under my patella and he will not operate on those because they are small and actually taking some celebrex calmed them down significantly.  I have not talked to him about surgery for the lesion on my femoral condyle because the pain has always been managable, but with it getting worse I might have to eventually talk to him about it.  I know that there is no way that I will opt for microfracture again. 

Enough about me.  I'm glad that you are doing so well.  Keep us updated on how you are progressing. 

I too hope to be out there hiking peaks and hopefully climbing to the top of them as well. 

Happy Holidays!
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

jonhark

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Re: Day One down the ACI Road
« Reply #35 on: January 04, 2009, 03:43:34 AM »
2.5 week update:

I think the worst is over. Unless you consider I have another 5 weeks left in the brace for sleeping.

All things considered I'm right on track with my rehab. Rehab is focused on gaining ROM, protecting the graft site, and stimulating cell proliferation by stimulating synovial properties in the joint. Staying at 40 degrees on the CPM for 6-8 hours daily, abductor exercises, e-stim for quads and plenty of heel slides.

I'm doing PT at home for the first six weeks. My extension is at 0 degrees already and flexion got to 90 degrees immediately. It is probably around 100-110 now. I'm going to wait until week 4 to push it much farther.

Really no significant pain at this point with any of the exercises at graft or TTT site.

Decided to be really conservative this go-round and wait to come off crutches at week 8 and stay in the brace for 8 weeks as well. CPM will stay at 40 degrees for six weeks.

Slow and steady wins the race with patella aci. Speaking of which my other knee with had patella aci 16.5 months is holding up really well doing all the crutching and having to perform overtime duty.

Anyways, will report back sometime around 8 weeks when I come off crutches.

For thiose of you reading this post and looking for answers on how to treat medium-sized patella defects (3-4cm^2)....I think it is a no-brainer to get ACI with TTT.
Don't listen to the naysayers!!! This surgery does work for those  patient and dilligent with their rehab protocol.

Jon




Offline Room 101

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Re: Day One down the ACI Road
« Reply #36 on: January 06, 2009, 10:02:00 PM »
Hi, Jon.  Sounds like things are going just great for you.  It also seems as if you pushed through the first ACI a little more aggressively but that it worked out just fine.  Did you have specific setbacks that are making things a little more conservative, or is it just experience that counts?  We have been talking in my diary, but I just read all of yours again and it seems as if things went quite well the first time also.  I am just curious and trying to learn from others... I tend to be quite aggressive, so slowing myself down isn't always easy.  I just have to keep a constant reminder in my head.

Thanks for the updates.

Kim
February 1 2008 - left knee AMZ/LR/Debridement/ACI biopsy
December 2 2008 - left knee ACI - Patela
May 25 2011 - Left knee mfx - trochlea  (ACI growth looked "pristine"), Right knee ACI biopsy
September 5, 2012 - Right knee AMZ/ACI - patella

jonhark

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Re: Day One down the ACI Road
« Reply #37 on: January 08, 2009, 01:46:55 AM »
Kim--

More or less the realization that i have a crater in my the middle of my patella is what has scared me into the most conservative rehab protocol. I was certainly less educated about the surgery and rehab before the last go round. My OS's guidance was fairly minimal as well so I had to feel my way through it.

The big difference is that im keeping CPM at 40 degrees and plan to wait until 8-9 weeks to kick the crutches. Still plan on waiting six months to attempt stairs. I didn't notice my biggest improvements until after 12 months. This thing can't be rushed and you only get one go-round.

Unfortunately I've developed an infection over my incision. That has slowed me a little and I have to be on antibiotics for a week. Surgery really sucks, huh?


Offline Room 101

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Re: Day One down the ACI Road
« Reply #38 on: January 08, 2009, 02:35:04 PM »
Hi, Jon.  So sorry to hear you have an incision infection.  That just doesn't help at all, and I hope it clears quickly for you.  I agree w/ OS guidance.  What I was told wasn't on the sheet, and then they say to follow the sheet.  I go back today, and am happy about it. 

I have been scouring this web site for others' stories, and while all of us are different, it helps to know what works for people that have been through it.

I am happy I ended up here for sure.

Take care,
Kim

February 1 2008 - left knee AMZ/LR/Debridement/ACI biopsy
December 2 2008 - left knee ACI - Patela
May 25 2011 - Left knee mfx - trochlea  (ACI growth looked "pristine"), Right knee ACI biopsy
September 5, 2012 - Right knee AMZ/ACI - patella

Offline bsonday

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Re: Day One down the ACI Road
« Reply #39 on: January 22, 2009, 08:23:22 AM »
Hey Jon,

I'm assuming that things are still going well for you and that things are more or less routine by now if that's even possible with an ACI :).  Your words of encouragement over the months have been extraordinarily useful, and if I am ever able to return the favor, please let me know.

Did you ever get a chance to look at my arthroscopy pictures and compare your scar tissue pictures to mine?  I'm curious about what you might see.  I still haven't heard back from Dr. Cole yet about things which might cause large amounts of scar tissue, and I'm guessing he may not know either.

Talk to you soon, and keep up the good work.

Best,
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?

jonhark

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Re: Day One down the ACI Road
« Reply #40 on: January 23, 2009, 03:53:02 PM »
Ben--

I'm three days short of ditching the CPM (6 weeks). I'd say everything is going as planned. I've started doing SLR's with no problem. My quad is getting stronger and it doesn't cause discomfort when I contract as it did around the two week point. I've kept the CPM at 40 degrees the whole time which has helped keep pressure off the graft. Plan on doing 2 weeks with crutches then slowly getting back into walking.

I did look at your scope pictures. I did notice the patches of white and red. I'll be getting my scope pictures next week when I return home. I don't feel any scar tissue with heel slides yet. Dr. C used "seprafilm" when closing the incision. This is a layer of synthetic film that is supposed to prevent adhesions. I don't think it is used intra-articular though. My surgery report indicated 100% take of ACI graft. There was a small fissure and a flap that he debrided. Looking forward to seeing these on the scope pics. My knee has held up relatively well given the recent reliance on it. I deem the surgery a success but it definitely isn't to the point where it feels 100% better or "brand-new".

Jon

Offline Room 101

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Re: Day One down the ACI Road
« Reply #41 on: January 23, 2009, 05:25:09 PM »
Hi, Jon.  I feel that SLR line was there for my benefit  ;D -- kidding. In all seriousness, it sounds like things are going well, and that's great. 

Thanks for the update,
Kim
February 1 2008 - left knee AMZ/LR/Debridement/ACI biopsy
December 2 2008 - left knee ACI - Patela
May 25 2011 - Left knee mfx - trochlea  (ACI growth looked "pristine"), Right knee ACI biopsy
September 5, 2012 - Right knee AMZ/ACI - patella

jonhark

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Re: Day One down the ACI Road
« Reply #42 on: January 26, 2009, 05:04:18 AM »
Kim--

My defect is a third your size so I would have no excuse not to be able to do a SLR yet...

The thing about this recovery I noticed is that everyone is different and has different symptoms. I can do SLR's fine but maybe you'll be able to do bent leg stuff sooner. It all depends upon defect location and a host of other factors.

I'm sure you'll be breezing through this thing in a couple months. Just don't let a bad day get you down and a good day get you too up.

Jon

Offline Room 101

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Re: Day One down the ACI Road
« Reply #43 on: January 26, 2009, 04:00:46 PM »
I was totally kidding, but you just hit it on the head... I get really up after good stuff happens only to be slapped back to reality!  It's definitely not a "smooth" ride  :)

Take care,
Kim

February 1 2008 - left knee AMZ/LR/Debridement/ACI biopsy
December 2 2008 - left knee ACI - Patela
May 25 2011 - Left knee mfx - trochlea  (ACI growth looked "pristine"), Right knee ACI biopsy
September 5, 2012 - Right knee AMZ/ACI - patella

Offline Gibbon35

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Re: Day One down the ACI Road
« Reply #44 on: January 27, 2009, 10:51:22 AM »
  It's definitely not a "smooth" ride  :)

But it will be a smooth knee :)  Did you see what i did there...do ya do ya??  ???   

Oh I need help