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Author Topic: ACI and HTO on 10/22/07-It's going to turn out great!!  (Read 37871 times)

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Offline casey2291

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Re: Surgery on Oct. 22-follow my progress
« Reply #15 on: November 05, 2007, 03:11:56 PM »
2 weeks post-op:  I'm having some problems with sharp pains in my knee.  I'm not sure if the pain is in the area of the graft or not.  It really feels as if the pain is higher in my knee and may not be related to the cells.  I'm not sure.  I contacted my OS this morning because yesterday, I had to significantly decrease my flexion in the cpm machine due to the pain.  I was up to 65 degrees in the cpm two days ago and yesterday I could only go to about 35-40 degrees before I was in severe pain.  I took pain meds yesterday and then was able to get to 60 degrees.  This morning the pain started at 15 degrees in the cpm and I was able to make it to 40 degrees.  I asked my OS if I should take the pain meds and push through the pain or decrease the flexion on the machine. He said to was ok to take the meds, but that I should not go beyond 65 degrees for the next 4-5 days and that I need to let him know in a couple of days how things are going.  After taking meds, I am now up to 61 degrees in the cpm.  I am hoping that maybe I have some scar tissue that is breaking up and that this has nothing to do with the actual ACI procedure.  On a positive note, my calf pain is now pretty much gone and I have stopped taking the meds for that.  It is a relief for that pain to be gone.  Now, if only this knee pain would go away. 
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 kathat

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Re: Surgery on Oct. 22-follow my progress
« Reply #16 on: November 06, 2007, 01:32:18 AM »
Bummer about the pain. I've had pain in my leg following surgery too. It's affected my extension and my PT is unsure of the cause, though he has expressed concern that I may have some loose cartilage in the joint. It sucks when pain gets in the way of things!!

3 1/2 hours is a long way just for staple removal! I'd do it myself too!!

How's the boredom - setting in yet? How mobile are you? What things have you found the most difficult to do?

Hope the pain settles.

Kathy

Offline casey2291

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ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #17 on: November 12, 2007, 01:00:47 AM »
3 weeks:  Things are going ok for me.  My sharp pains have not completely resolved yet.  It is still hurting on the medial side of the knee and it hurts when I get up to move around and sometimes in the cpm.  I still can't tell if the pain is where the cells were implanted or if it is higher in the knee.  It is hard to tell because prior to surgery, my knee only hurt when I was weight bearing.  The sharp pains seem to be worse in the morning and then again in the evenings.  I'm starting to wonder if my knee gets stiff at night and then it is sore when I get up in the morning.  And then if it is sore in the evenings after using the cpm machine all day.  Some of the pains that I get take my breath away they are so severe.  I've read a lot of the posts on here from others who have gone through this and I seem to get the impression that most people don't have any pain after the first week or so during the 6 weeks that they are non-weight bearing.  I would love to hear from others who have been through this and if this pain that I am having is normal.  I've been in touch with my OS several times.  He does not seemed concerned and has told me that it is ok to use pain meds so that I can increase in the cpm machine.  I did 65 degrees in the cpm for 5 days as recommended by my OS and the past couple of days I have increased and now I am up to 75.  Today, I was up to 75 degrees this morning without any problems at all and now this evening, I am back down to 70 because the knee is really tight and painful when I hit right around 70.  I'm not using any pain meds right now.  Instead when I feel pain while I am in the cpm, I use an ice pack and I am usually able to increase the flexion on the machine.   

I moved back home to my house today.  I'd been staying with my fiance and I decided that it was time for me to go home and be a little more independent.  I already miss having my fiance around.  He did an amazing job taking care of me and never complained once.  Tonight, I got myself some dinner and cleaned up my mess from dinner and went back to my room to get in the cpm machine and I sat down on the bed and realized that I really wanted an ice pack.  I then realized how nice I had it at my fiance's house and how it was great to have him to get me things when I needed them.  I then started to wonder if I was out of my mind for coming back to my house but, in the long run I think it will be good for my mental health to have to be a little more independent.  I was getting a little stir crazy at his house.   


Yesterday, I got out and about to go to Arby's for lunch and to the grocery store.  It felt wonderful to be out of the house.  I was so happy to be out because it was only the third time that I had been out in three weeks.  I drove my car and it didn't go as well as I had hoped.  It was akward getting in and out of the driver's seat and even though I put a couple of towels under my foot to keep my leg propped up when I was driving, I still felt like there was a lot of pressure being put on my knee.  It hurt at first and then it felt fine.  I felt kinda unsafe when I was driving just because I was so worried about my knee.  The plan was for me to drive my car back to my house today, but I decided that I didn't feel comfortable driving for an hour back to my house, so I just let my fiance drive me back and let him keep my car for the next couple of weeks.  I figured even if I did have my car, I probabaly wouldn't go anywhere.  I will just rely on others to take me places for the next couple of weeks.   I crutched all around the grocery store yesterday without a problem.  I did hit my foot on the ground a couple of times when I was crutching.  It hurt a little bit the one time that it happened, but I don't think it will do any harm to my knee.  I was quite tired when we were finished.  It is hard to stand for a long period of time because my back gets sore and my hip also starts to hurt just because the brace is so heavy. 

I'm still working my quads hoping that one of these days I am going to be able to do a SLR.  When I do the isometric quad exercises, I can feel the plate that they put in for the osteotomy.  It really kinda annoys me so I'm not sure that I'm doing as many quad exercises as I should be. 

I took my staples out on Thursday.  Actually, my fiance took them out.  I am not usually bothered by those types of things, but I just couldn't bring myself to do it.   It was not painful and my incision looks good.  My OS recommended putting vitamin E on the incision to help with the scar.

And here is something that only knee geeks can really appreciate.  Yesterday, I put my shoe on my operated leg and after a bit of a struggle, I finally got it on.  I then realized that I was all excited because I put my own shoe on and that I had a big smile on my face because I was proud of my victory.   ;D 

I'm still very confident that this surgery is going to turn out great. 

...only 24 days of non-weight bearing to go. 



 
« Last Edit: November 12, 2007, 01:06:58 AM by casey2291 »
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 casey2291

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #18 on: November 12, 2007, 11:09:26 AM »
I'm posting some pictures of my ACI surgery.  I think the pictures are awesome, however if you have a weak stomach, I wouldn't recommend looking at them. The pictures show my lesion and the graft covering of horse pericardium. 

http://www.flickr.com/photos/[email protected]/

« Last Edit: November 12, 2007, 11:11:42 AM by casey2291 »
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 kalyjoe

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #19 on: November 12, 2007, 09:22:29 PM »
It's taken me forever to get back here.  Yes, we did email a bit and I was wondering what you had decided to do.  I was happy to see you posting again. 

Glad to hear you are doing so well!  And thanks for the pics.  I think they are awesome too!  One reason I'm looking forward to my next surgery is to get new pics.l  ;D  I just think it's amazing what they do now and it's great to be able to actually "see" what's going on in there. 

I agree it will be tougher for you to be at home alone.  Your fiance sounds fabulous though and I'm sure he will still be helping out.  This whole knee ordeal isn't only tough on us, it's hard on those around us, yk? 

I'm trying to think back about the shooting pains early on and I do believe I had them as well.  I remember wondering if it had failed early on because of those, so I do think it's pretty normal to get them.  Just take it slow.  You and I are very similar in activity level and I know you are anxious to get back to your normal life.  Looking back now for me, I wish I had gone a bit slower.  I know that at the time, thinking ahead to a year down the road, I thought I'd be farther along than I am now and I can't help wondering if my impatience caused a setback.  So, learn from me if you must...and try to be patient.   ;)

I agree driving isn't a very smart idea with that brace on. Just think about it, if you were in an accident even through not fault of your own, you getting out of the car like that wouldn't go over so well, yk?  I drove a bit in my brace and constantly worried about that as well.  Imagine getting out swinging that brace and getting up on crutches.   :o 

Hang in there and keep us posted on your progress!! 

Kristi

2 x 1.2 cm defect of right medial femoral condyle
Microfracture, right knee, October 18, 2004.
MACI using CaReS, same knee, November 30, 2006

Offline kathat

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #20 on: November 12, 2007, 10:44:00 PM »
What fantastic pictures!! Thanks heaps. Well done on getting that shoe on. I know the feeling well!! I go to see my OS in a couple of hours and I am hoping I qualify for some form of cartilage surgery. I reckon one of my defects is in the same spot as yours. The other two are on the back of each patella and are down to bone. My MFC defect is not far off. I hope to find out the size of them today. I didn't think to ask last visit - gee, all the things you don't think to ask at these visits and then think of later! It's one of the most frustrating things about this whole specialist process. What caused your area? Mine is from patellar tilt and possible maltracking from overpronation. Keep up the good work - or rest, I should say ;)
Kathy

Offline casey2291

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #21 on: November 14, 2007, 03:09:10 PM »
I had a disaster with the knee.  I discovered on Sunday night that the cpm machine was not set up right.  I got in the machine and I forgot to unlock my brace.  I used the machine for about 30 minutes before I had any pain and realized that something was not right and that I should have had extreme pain if things were working right.  Plus, my roommate was looking at the machine earlier that day and said to me that it didn't really look as if my knee was bending and that my leg was just moving.  So, I put two and two together and emailed my OS.  He said that what I was describing sounded weird and told me to contact the company that I got the machine from.  I contacted the guy who set me up with the cpm and he came out to the house and it turns out that it was not set up right.  The machine was set up so that it was to short for the length of my leg.  So, he lengthened it so that now my knee is bending.  When he gave me the machine, he told me that all I had to do was put the foot tray up and lay down in the machine. So, that is what I did.  He did not tell me when I picked up the machine that it should be adjusted and he did not bother to have me lay down in the machine to make sure that it was going to fit my body.   I had no idea that the machine could be lengthened so I just assumed that I was using it correctly.  So, I have missed out on 3 weeks of the cpm machine.  I was extremely upset and very annoyed that this guy did not do his job.  My OS said that there is no clear answer as to what the missed time in the cpm will do to the cells.  Now, I am having extreme pain when I am in the cpm and have to start all over with my ROM work.  I am now back to 40 degrees in the cpm machine.  Even with pain meds, I am having a lot of pain when using the machine.   The pain is right where the cells are.  I feel annoyed with myself that I didn't catch this problem earlier, but at the same time, I see it as negligence on the part of the guy who gave me the machine.  I've never used one of these machines before let alone seen one, so how would I know if I was doing it correctly.  This is such a huge surgery and now because of one guy was too lazy to do his job correctly, it may be compromised.  I would think that if you were providing someone with a machine that was going to affect their recovery that you would make sure it was set up correctly....does he not have any integrity??  I didn't like the guy from the moment I met hiim.  He was very impersonal and seemed to be in a hurry to get me in and out when he set me up with my brace and gave me the cpm machine.  Yesterday when he was at my house, I got in the machine so he could look at what was going on.  He started to adjust the machine with me in it.  He was jerking the machine around causing me all kinds of pain.  What kind of person is not gentle with another person when they have a huge brace on their knee and are obviously injured?  Anyhow, I'm kinda over the whole thing now.  I figure what is done is done and now I just have to move forward and keep positive. 

Kristi...good to hear from you again.  I'm sorry that you think that your surgery failed.  I looked at your post-op diary and saw that your surgery is on the 29th.  I hope that things are not as bad as what you think and that it is something minor that can be fixed like overgrowth.  Be sure to let me know how things go.  Thanks for the advice about being patient.  I too struggle with being patient and not pushing myself too soon.   I am going to try really hard to take things slow.  Since I still can't even do a SLR yet, I have the feeling that I am going to be forced to take things slowly.  You are so right about how our knee problems are not only hard on us, but on those around us as well.  My poor fiance has been really stressed/nervous at times about my knee.  I feel badly that he has had to go through all of this as well.  He has told me how he just can't stand to see me in pain.  I don't like to see him stressed, but I think it is really sweet that he cares so much about me. 

Kathy....How did things go at your OS visit?  Did you get all your questions answered?  What did he recommened?  I'm not sure what exactly caused my lesions.  I have my theories.  I think that it was caused by my knees being out of line (hence the HTO) and me playing sports all my life.  Plus, I think there might be a little genetics involved.  My brother also similar problems to mine.  I often wonder if I would not have played so many sports growing up, if I would not have seen any of these problems until I was much older.   
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: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #22 on: November 14, 2007, 05:42:54 PM »
I wouldn't be too overly worried about not using the CPM for the first couple weeks. My OS didn't allow me into one until Day 10 and then it was limitted to 45-60 degrees for the first 4 weeks. I wouldn't do the CPM through a lot pain. You should allow for some discomfort but definitely not pain. Also, no need for the brace while in the CPM. The machine will limit your range and it is active assisted. As a rule of thumb, don't do anything through pain with this rehab. There is absolutely no rushing anything as this is an 18 month process. I'm at 14 weeks and continue to be amazed at how things slowly progress every ten days or so. If you read through those that have had graft failures or poor outcomes on this board--a lot of them pushed their grafts too hard, too quickly.

Offline kalyjoe

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #23 on: November 14, 2007, 06:25:26 PM »
Hi Casey!  I'm sorry that you had such an inept CPM machine guy.  Seriously, I was livid reading your post.  I agree with everything you said. It's ridiculous that people don't seem to realize how their actions affect others.  At any rate, I wouldn't sweat it too much.  It sounds like you were getting some range of motion so it's not like you've kept your knee stiff this whole time.  And everyone's protocol is so different and they all have different degrees of success....try to stay positive and think the best.  I'm certainly hoping for the best for you.   :)

As to Johhark's response, I too was told to keep my knee in the brace while in the CPM machine, but I was able to unlock it.  I would follow what your OS says as he is the only one who truly knows what is the best course of treatment for you individually.  It's great to have other people on this board to share stories with and get support from, but when it all comes down to it, we are all different and nobody is going to have the EXACT same experience.  We all need to keep that in mind when handing out advice and opinions. 

And by the way...your fiance sounds like a keeper.   ;)  Good for you. 

Kristi
« Last Edit: November 14, 2007, 06:27:07 PM by kalyjoe »
2 x 1.2 cm defect of right medial femoral condyle
Microfracture, right knee, October 18, 2004.
MACI using CaReS, same knee, November 30, 2006

jonhark

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #24 on: November 14, 2007, 07:04:25 PM »
Kalyjoe--
If it doesn't pass the "common sense" test, why do it? What value does the brace add if your range is dictated by the CPM Machine? You should put your leg into it while straight and remove when straight as well. We all are personally responsible for our our own care. I work with surgeons on a daily basis and have first hand knowledge to how busy they are. They don't get it right 100% of the time. Unfortunately it has taken me one failed microfracture surgery and a revision hip scope to figure that out.  My point is, listen to your body and always question the medical advice/protocol you're given. Chances are it is correct, but as a patient you should understand the purpose behind everything. This board is more than just a support forum. It is a way for us to gleen what does/doesn't work well for rehab. If you think about it, there is an optimal rehab protocol for all sites (PF, Femoral, Tibia). It just hasn't been refined and agreed upon by the medical community at large. Casey--be very selective about your PT choice as well. Make sure they are well informed that this ISN'T a microfracture rehab protocol and get your hand's on Carticell's rehab protocol and follow it to the "T". The success rate for the location of your defect is 85%....you have a great chance of having a successful outcome.

Offline kathat

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #25 on: November 15, 2007, 01:23:36 AM »
Casey,

Sorry to hear about your inept CPM guy. Things like that make me so cross. Thankfully it wasn't doing the opposite and bending your knee too much - probably would have had worse consequences.

I saw my OS the other day and my options are TKR or chondrocyte grafting, but he doesn't wish to do either just yet. He implied that my age was a factor. I can understand it for the TKR, but not the grafting. I have a way to go before I am recovered from the recent surgery anyway, as my quads are miniscule, so I have some time to discuss things further with him. My opinion would be to do the grafting then the TKR once the grafted areas break down again (about 10 years I have read). I imagine that is why he wants to delay things, as I would still be too young for a TKR in ten years time. I also won't be ready for such surgery just yet anyway. I want my kids to be a bit older and independent, and I want to save up long service leave, provided I can stay employed!!

My damage is - 1/3 of each patella is bare bone, including the ridge on the back which is a major load bearing part of the joint and usually has the thickest covering of cartilage. I also have an area of deep fibrillation (grade 6 on a 7 grade scale - my patellae are grade 7) on my right medial femoral condyle. I forgot to ask the size (still reeling from everything else!!). I am not sure of the exact location, though my OS implied that it was in a weight bearing area. The pictures he drew suggest that it is more in the trochlear groove, so I need to get that clarified - "weight bearing area" of the MFC could mean the area between the femur and tibia, or the femur and patella (in deep flexion). I am sort of hoping it is well in the condyle area so an unloader brace could help. I am sick of the aching, especially in that knee, and would like to find something that will help. I rang back later and asked for exact details of my defects to be sent to my PT, as he wanted to know. That way I can find out too, without having to remember to ask. I write a list of questions but then I am blindsided by something the OS says and my brain stops functioning!! Next time I think I'll give him the list of questions first!!

Kathy

Offline casey2291

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #26 on: November 15, 2007, 04:12:51 PM »
I contacted my OS today and told him about the extreme pain.  He said that I probably have an early adhesion on the knee.  He recommended that I use a heating pad on top of a damp cloth when in the cpm machine.  He said the best way to break this up is to use the cpm machine.  He is also going to have me start therapy now instead of waiting until 6 weeks post-op.  The pain today is not quite as bad as yesterday although it was pretty severe this morning.  However, right now the pain is completely under control with pain meds and I am using the cpm machine without any pain. 

Jonhark...I was told to use my brace while in the cpm machine because of the HTO that I had done.  I am supposed to unlock the brace when in the machine.  How is your pain at 14 weeks post-op?  Are you still in PT?  What are you able to do activity wise at this point?  My PT said that he has worked with a couple of carticel patients, however I'm not really sure that I believe him because he says he can't remember them.  But, I have worked with this PT before when I had my scope over the summer and I think he will be good for my rehab.  He pushed me a bit when I had my scope, but that surgery is so different than this one.  And when we talked about the carticel rehab he talked about taking things slow.  I've been to enough PT's for knee and back problems, that I have gotten really good at figuring out who is and isn't a good therapist.  If my current PT tries to push me more than I feel is appropriate, then I will switch PT's.

Kristi.... I'm pretty much over the whole cpm mistake and I'm pushing forward.  Even if I have an adhesion, I'm just going to stay positive and think in my mind that it is going to get taken care of with therapy and use of the cpm machine.  Are you getting ready to go back in for your scope?  Is the scope part of the clinical trial?  What is your next step if it has failed? 

Kathy...sorry to hear about your knee.  I was unaware that OS's would not do the chondrocyte grafting due to age.  My OS didn't say anything to me about my age.  I am 31 and will not be old enough for a TKR in 10 years.  I was given the indication that this should solve all of my problems until I was ready for a TKR.  What did your OS indicate would qualifiy you for more surgery?  Increased pain or increased damage to the knee?  I hope that you can get a brace that will give you some relief.  What was your recent surgery that you had?  Be careful that your PT doesn't have you doing anything to stress the knee out to much.  I have lesion on my other knee, both on the patella and the medial femoral condyle and he recommened that I don't bend the knee past a certain point. 

 
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: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #27 on: November 15, 2007, 05:04:38 PM »
Casey--
No more daily pain for me at 14 weeks. The aching/throbbing is non-existent.

I purposely am limiting my walking and activities other than what is necessary on a daily basis. Stairs will continue to be done on my good leg until six months at least.

I am doing 20 minutes with light resistance on the bike with no pain. My PT really focuses around getting the glute med, hip flexors, calves and quads strong. I'm not attempting anything that puts patellofemoral forces on the joint (this includes any type of squatting). I have not used a formal PT for my rehab. I've been through enough surgeries to know what works and what doesn't. I suggest using a PT until you get most of your range back then save your money and set-up your plan of attack.

Don't be so sure you'll need a TKR.  If you baby this thing for the 18 months and optimize the chances of full cartilage fill-in and maturation your knee might be as good as new in a few years.

Don't be shocked or stress out about pain at the graft site for the first ten weeks. I still get it occasionally and towards the end of the day if I do too much.

I also suggest you try an upper body biking machine or something to work your upper-body. I started 8 weeks out and it really doesn't wonders for your psyche and cardio system.

Offline casey2291

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #28 on: November 15, 2007, 05:14:39 PM »
I FINALLY did a SLR today!!!!!   ;D  Two weeks ago today, my OS told me that he didn't expect me to be able to do one for another two weeks and two weeks to the date, I am able to do one.  This is promising to me because I was starting to think that I was never going to be able to pick my leg up.  Guess all the isometric quad exercises are finally paying off.

Johnhark...thanks for the advice.  I will probably participate in the full physical therapy program with a therapist.  I too have done tons of PT, but I am kinda anal about having a therapist there to work with me and make sure that I am doing things correctly.  Plus, it really helps me to be disciplined to do my exercises at home when I know that I have someone checking in on me to make sure I am making progress.  Also, my gym membership is currently on hold because I am a member of a rock climbing gym and they only have a small workout room.  So, it helps for me to be able to go to PT and have access to all the workout machines.  It sounds as if your knee is doing well.  glad to hear that you are pretty much pain free!  Keep up the good work!   
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 kathat

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Re: ACI and HTO on 10/22/07-It's going to turn out great!!
« Reply #29 on: November 16, 2007, 01:26:46 PM »
Congrats on the SLR Casey!! It's always a good feeling when we make progress.

My recent surgery was bilateral lateral releases and chondroplasty. I had patellar tilt, which is the cause of my damage. I wouldn't worry about my PT pushing me too far - he is the one who got my OS to put me on work restrictions. I am only allowed to do 1/4 squats, no kneeling, avoid stairs. He checked out the crunching in my knees the other day and the look on his face was priceless!! They certainly crunch!! I think he's finally realising how much of a challenge my PT is going to be, as I am struggling with small steps like gutters and front door steps but I am unable to do any exercises to improve functionality. I don't really know what would qualify me for early surgery. It's yet another question I didn't think to ask at the time. I am guessing that increasing pain and decreasing function would be the biggest qualifiers. I suppose I will know when the time comes to push for more surgery.

It's encouraging to see so many of you with ACI making great progress. I am going to be well prepared whan the time comes for mine. At least I don't have to change surgeons - my OS specialises in TKRs and chondrocyte grafting, so I can keep him forever!! I got lucky there, especially in a smaller city like mine.

May your improvements continue.

Kathy