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Author Topic: MegTX's Patellar ACI & Fulkerson 2/6/08  (Read 14635 times)

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Offline MegTX

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MegTX's Patellar ACI & Fulkerson 2/6/08
« on: February 07, 2008, 08:50:00 PM »
Well, did it.  OS said surgery went well, didn't give me a lot of detail.  Woke up in pretty severe pain even with the nerve block.  Morphine and then Vicodin post op got it down to an ache before I was discharged.  Was doing well at home yesterday, but this morning the nerve block must have worn off, because I'm going through the roof anytime I have to move the leg.  I'm supposed to start the CPM today, and from a lot of the people I've read here, I'm hoping that the CPM will actually help with the pain, but I'm dreading the actual process of moving the leg into the CPM.  Getting up to go to the bathroom was enough to send me screaming through the roof.  10mg Vicodin is just not handling the pain right now if I move the leg at all.  I went ahead and started taking 1/2's between the regular doses to try and get this under control, and of course my IceMan is going nonstop.

I started a thread in the postop diary section, and also have a personal blog on my website thefisher.net if anyone's interested.

If anyone has suggestions to help further with the pain, I'm taking any and all input at this point.  I'm really hoping that the first couple of days will be the worst, and that this will start tapering off soon.
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)

Offline Peg Leg

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #1 on: February 08, 2008, 02:39:34 AM »
Meg,
Congrats on getting through the surgery; the worst is behind you!  Just keep taking those meds and don't let up for a couple more days.  It will get better with each passing day!  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

Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #2 on: February 08, 2008, 03:16:25 AM »
Thanks, PegLeg.  I'm taking the meds like clockwork.  I'm also a little amazed that the CPM does help with the pain.  It's like a bit of a massage.  I'm only at 30 degrees right now, OS wants me at 40, but it's only day 2 for surg and day 1 on the CPM, so I'll take it.  :-)  That and the IceMan will get me through the first few bad days.  I'm ok except for when I have to get up to go to the bathroom.

I'm on an email list with some guys that also had ACI & TTT, and they're amazed I was outpatient, and are calling me a tough cookie which is great for my ego, since I've felt like a crybaby wimp all day.  :-)  It's funny what gets you through the day, yanno?
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)

Offline stone00

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #3 on: February 10, 2008, 01:34:13 AM »
greetings-

i'm scheduled for an ACI & Fulkerson on the 18th of Feb.  Any advise would be greatly appreciated....

Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #4 on: February 10, 2008, 04:48:13 PM »
Hm.  Advice.  Let me think...

For starters, make sure you're getting an iceman, or find one on ebay.  My doc didn't actually order one for me, but I had one from ebay that I bought back when I had my scope.  There's nothing better for icing down than an iceman or cryocuff.  You're GOING to need it.

Make sure that your path is completely clear from your bed to the bathroom, it's going to be rough for a while getting back and forth and the last thing you need is to trip your crutches up.

You will need bed wedges or tons of pillows, both to prop the leg and to prop yourself up.

Have lots to do, reading, tv, computer w/ wireless internet, etc.  You're going to spend a lot of time flat on your back.

Toilet seat riser, grab rails for bath & toilet, and without a doubt a shower seat.

Fiber pills & lots of water to fight off the side effects of the Vicodin, you may even need Senokot or ExLax.

Beyond that, the standard list of making sure you have people to help, lots of fluids & good food, snacks, etc...  There's a really good prep list somewhere on this site, people have linked to it many times before.  :-)
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)

Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #5 on: February 13, 2008, 04:00:47 PM »
UPDATE from meeting with doc 2/12:

Surgery went very well.  Patellar lesion had grown from 2.5cmx2.5cm at arthroscopy (7/07) to 4.5cmx3cm.  It was also a crossover lesion, so we do have the potential for problems where he had to "tent" the cells across the ridge on the patella between the facets.  However, the trochlea remained clean, and the rest of the joint was in good shape, so that's good at least.  The AMZ (Fulkerson TTT) went well also.  The staples aren't quite ready to come out, I have an appointment next week for them to come out.    I couldn't get a PT appointment until next week either, but I'll be starting the protocol he and Dr. Minas use for patellar leisons with TTT.  Didn't get photos of the internal knee shots (I'll try to get copies when I go in next week) but I did snap a photo of the incision while the nurse was changing the dressings.

http://www.flickr.com/photos/notorius_meg/2263111284/

Dr. Berman always gets a kick out of me.  He sat down to talk to me about the rehab protocol and said that it's the new protocol that he and his colleague in Boston have worked on together.  I asked if it was Dr. Minas, and Dr. B sat back and asked me how I know about Dr. Minas.  ::laugh::  He forgets between times he sees me that I'm the patient that has researched the hell out of everything and read every article I can get my hands on.  :-)  I amuse him.
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: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #6 on: February 13, 2008, 06:03:08 PM »
You'll be in good hands with anyone who has trained or worked with Minas. He is an amazing surgeon. it is crazy how quickly defects grow in size. Mine went from 1.5CMX1.0CM to 2.5X1.5CM in about six months after my microfracture. Keep your head up. You should have pretty good pain-relief from aching by 4 months and being doing stairs w/o a problem by six months. Keep in mind this is an 18-24 month recovery for Patellafemoral defects.

Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #7 on: February 13, 2008, 10:36:25 PM »
Yeah, I laughed and told him I'd researched him before coming to him.  It is my KNEE, after all.  He laughed and said he wasn't sure if that was a good thing or a bad thing.  I have no way to verify it, but he said that he has worked and consulted with Minas, AND with Petersen in Sweden.  Dr. Petersen even came and operated at Dr. Berman's surgery center here in Texas.  I don't remember if he said he has worked with Fulkerson, but I think he said he knows him.  I'd imagine it's a fairly small peer community and they pretty much all know each other if they are reasonably active with new procedures and research.

If I lived in or near Boston, I'd stand in line and change jobs (to get insurance that worked with him) if necessary to see Dr. Minas.  Since I'm stuck in the hell-hole of Texas, I consider myself really lucky to have found Dr. Berman.  He has really impressed me, and so far I've no reason to be concerned with anything I've seen.
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)

Offline djs60

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #8 on: February 14, 2008, 09:48:42 PM »
Meg,

I'm now a little over 9 months out from my patellofemoral aci/TTO.  Looking at the op note, my patellar defect was 4 x 1.5 cm and the trochlea 3 x 2 cm.

I find that in the last month, the knee feels much better.   So, there's light at the end of the tunnel, although it is without doubt a long haul.

I see my OS (Minas) in April.  He had originally told me it would be a year before he'd let me try running again (but then he told my wife 1.5 years post op, and I think my patella was worse than expected in the OR).  I've  actually gotten more patient in my recovery, so I'm not going to push it, but I feel optimistic recently that this will all be worth it in the long run.

Good luck & hang in there,

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 stone00

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #9 on: February 15, 2008, 03:25:26 AM »
Easy on the comments about Texas, there is nothing wrong with the Lone Star State or my Dallas Cowboys.  I've got my procedure monday (ACI & Fulkerson) and i'm getting a little nervous b/c it sounds from you guys that the inital recovery takes some time.  i'm not concerned with the amount of time in terms of rehab. But the first couple of weeks b/c i've got a wife & 3 young sons running rampant in the house & i also need to get back to the office.  How long did you guys stay in the hostipal after surgery? 

Offline djs60

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #10 on: February 15, 2008, 01:41:12 PM »
Stone,

I was in the hospital for 3 days after my surgery.  I think Meg went home the day of surgery, but she is clearly much tougher than me :-)

I was out of work for 6 weeks.  I have a job where I'm on my feet a lot, and couldn't have gone back sooner, as my OS told me I could not be full weight bearing until 6 weeks because of the osteotomy (I had a tibial tuberacle osteotomy, which I think is the same thing as a Fulkerson).

It also makes a fair bit of difference if the affected leg is your driving leg.  My operated leg was the left, so I was able to drive by 3 weeks, I think.

I slept downstairs in our extra room x 3 or 4 weeks, as I didn't want to deal with the stairs, and I wasn't sleeping all that well, and didn't want to drive my wife crazy.

Good luck,
Dan
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 casey2291

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #11 on: February 15, 2008, 07:28:52 PM »
Meg...glad to hear that your surgery went well!! Hang in there!

Stone...My procedure was also outpatient.  I was happy to go home that same day.  My pain was well controlled and not having to spend time in the hospital was a huge plus for me.  I was off of work for 10 weeks, but I work in a school with young children and do a lot of walking, so I waited until I was off of crutches before I returned.  I didn't need any kiddos accidently knocking me over.  I think I could have returned to work right around 6 weeks post-op if I had an office job.  I think it would have been hard to return prior to that just because I was stuck in the cpm machine for 8 hours a day.   
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 stone00

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #12 on: February 16, 2008, 03:19:15 AM »
Thank you for the insight Dan & Casey. 

what is the protocol for use of the CPM?  how long do they want you using that on a daily basis?  i'm 31 & had my right ACL done when i was 13 (1990) & my left two years later, my OC back then didn't use the cpm & i can not tell you how much time and effort i put in to get my range of motion back.  From lowering the seat on the stationary bike, to laying on my back w/weights on my ankles; this was the toughest part of my rehab back in the stone ages.  i still do not have full range in either knee today.

As for the work issue, I  had no idea that you guys took that much time off.  I have a "desk" job so hopefully i can make it back rather quickly-or that is what i am hoping for.....

Offline Peg Leg

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #13 on: February 16, 2008, 08:32:00 PM »
Stone,

I believe David3 ( ACI Gets a Tough Challenge) went back to work at 2 or 3 weeks.  He has a desk job and was able to elevate his leg and ice at work.  All the best to you!

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

Offline David3

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #14 on: February 16, 2008, 09:30:11 PM »
Hi Stone, 

Very best wishes for your op on Monday. I had ACI / TTO and had the following progression:
* 3 days in hospital after operation
* Stopped using pain medication on day 12.
* Majority of time on my back during first 3 weeks, often in CPM. I used CPM about 6 hours per day for 6 weeks.
* Started work 3-days a week at about 3 to 4 weeks, full week by 6 weeks. I have a desk job, and kept my leg elevated the whole day, plus had great help with people getting me lunch, coffee, etc. And I iced at work.
* Driving at about 5 weeks (ACI was on my left leg). Could maybe have started a bit earlier.
* Slept downstairs for about 8 weeks, although could have started upstairs earlier (I waited until I could bear a fair bit of weight).
* Life started getting a fair bit better at about 4 months.
* Started stairs using alternate legs at 6 months (carefully!)

Meg - Hope you're doing well. Good to hear you found an ACI OS that you're really happy with here in TX - that means alot. Be patient - the first weeks are rough and inconvenient. However, as you can see from others on this site, there's every reason to be optimistic with patella ACI when combined with TTO. Best of luck - we're following with interest!

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.















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