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Author Topic: MegTX's Patellar ACI & Fulkerson 2/6/08  (Read 14636 times)

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Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #15 on: February 17, 2008, 05:30:11 AM »
Wow... everyone seems to think I'm some sort of tough gal because I was outpatient.  I didn't have any option!  :-D  I'll tell you, on Day 2, I'd have GLADLY stayed in the hospital for a pain pump!  That was HELL.  The only thing that makes me tough is that I didn't call an ambulance to take me to the hospital begging for morphine!  I started slipping in extra 1/2 Vicodins between my regular doses to get through Day 2 and Day 3.  Other than that, I have been glad to be at home.  My husband and family have been taking very good care of me.  (Though the egress from the shower is a tale unto itself!)

As for recovery & work... I am very lucky because as a computer geek with a VERY understanding boss, I'm able to take 2 weeks completely off work, and then I'll be working from home until I'm completely off crutches.  It's my understanding that I should be walking again sometime around week 8.  The car I'll be driving will be a standard (my automatic is going to our 17 year old who just started drivers' ed) and it's my R leg, so I can't go back to work until I'm completely clear.

I'm instructed to do the CPM at least 8 hours a day, either continuously or in 2 hour segments.  It was 40 degrees the first week, and now I'm instructed to add 5 degrees or so a day as I can tolerate up to 90 degrees.  (I hit 60 degrees today, which made me happy.)  I start PT on Tuesday after my appointment to get my staples out.

I'm here to tell you I will NOT be stopping the pain meds on day 12 like David3... that's one tough dude!!  I'm just now starting to stretch the timing on my meds to about 5 hours.  Pain meds & ice is what's getting me through all this.  It absolutely floors me that they sent me home with an IceMan after the scope in July, but they sent me home with just freakin' ice packs after  this mess!!!  Luckily I'd bought my own IceMan, so I had one anyway, but that just makes no sense to me.
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 #16 on: February 19, 2008, 11:44:53 PM »
**HELLO WEIGHTBEARING**!!

I'm so happy.  Got my staples out today.  And because we'd basically skipped a week of PT, we got a bunch of stuff in today.  I basically got told I'd been baby-ing the leg (I was scared to screw up the graft) and that the time for baby-ing the leg is over.  I am to focus a lot of energy on getting my quad sets good and firm, and working on side adductor and abductor lifts.  (Which adds another bit of good news... that I can lay on my side with my leg in the brace, which means I don't have to sleep on my back anymore!! YAYYY!)  Also some ankle exercises which I think will help with some shin cramps I've been having.

And I get to start putting about 40 lbs of pressure on the leg!  I am *so* happy to be starting the weightbearing portion of the protocol!  That makes me feel like I'm getting somewhere.

I'd gotten 68 in the CPM this morning before I went in, I managed 54 of ACTIVE ROM, which I thought was fabulous.  We didn't do much passive ROM work today, since there was a lot of intake work to be done.  I imagine we'll do that on Thursday when I go back.  I'm to push the CPM, they want me to 90 by next week.  I think I can manage that, I have been adding about 6 degrees per day, and that's without any real discomfort, just some "stretchy-ness" at the top of the bend for a while.  I think I can push a bit harder and get 90.  And then I can start the stationary bike (without resistance).  I'll *really* feel different then.

I understand that this is fairly aggressive protocol, but I have an isolated patellar lesion (my trochlea was clean, which I'm glad about) with the TTT.  My doc (Berman) works with Minas a lot, and apparently they've decided that a slightly more aggressive protocol is in order.

Oh, and I get to take a shower without a trash bag!!  And without the brace, so long as I'm careful.  I'll end up losing the steri-strips over the next few days, and in a couple of weeks I may even wrangle a soak-y bath if I can figure out how to safely get to it (the bathroom with a tub in my house has very tight quarters & navigation will be tricky).

And, my PT and I discussed expectations for outcomes, and some of it I'll need to discuss with my doc... like martial arts and snow skiing... but my expectations to get back to fitness exercise, bicycling, pick-up sports, and belly dancing apparently aren't too much to expect.  The snow skiing apparently isn't even a huge deal **IF** I get excellent leg muscle worked back up and stability.  The martial arts are really the only questionable one, and it's not a "no", it's a "maybe, talk to Dr. B".  If my Krav Maga is the only thing I cannot get back to, and everything else I can do, this is still a huge win.

It's a good day. ;D
« Last Edit: March 05, 2008, 07:16:03 PM by MegTX »
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 #17 on: February 23, 2008, 05:36:13 PM »
PT on Thursday (2/21) went well.  I'm getting about 85 degrees passive ROM.  My PT's doing pretty well staying in the "discomfort zone" and not straying too far into the "pain zone" with the manipulations.  I apparently hadn't been resting my leg at quite zero degrees, so he had to stretch me out a bit to get me to zero, and told me to be more vigilant about how I'm propping the leg when I'm out of the CPM.  I do NOT want to lose extension.  As it was, it went ahead and stretched to 0 with some discomfort, and loosened up when he worked on it, so I'm not too far gone.

At home, I've made 80 degrees on the CPM.  I'm pushing hard for 90, that's the goal before my next OS visit on Tuesday, and once I get 90 PROM, I can start on the exercise bike with no resistance, and that'll feel good, I think.  being able to put a little bit (40 lbs) of pressure on the leg really is making a difference in how I feel already.

Pain has dropped off significantly.  I'm going 6-8 hours between doses of Vicodin now, and am about to start cutting them in half for taking during the day.  It's pain I could probably deal with using Ibuprofen, but we want to stay away from that because it inhibits cell growth, and we DON'T want that.  So a 1/2 dose of Vicodin at 6-8 hour intervals is probably a good trade-off.

Oh, and I got to take a shower without a plastic bag, and get the rest of the freakin' betadine off my leg under where the brace was!  That felt wonderful!  It was a bit scary getting in and out of the shower without my brace, but it was well worth it!  I probably won't feel any cleaner until I can either get a tub bath or stand up for a full shower.   :D
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 #18 on: February 24, 2008, 06:19:55 PM »
OS just did an ACI on monday & things are going well.  i've got some comments posted under "stones ACI & fulkerson"  but no fulkerson/tto for me....


Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #19 on: February 27, 2008, 09:34:23 PM »
Well, this weekend was ups and downs.  Couldn't seem to get past 86 degrees on the CPM, and had days where I just felt drained and icky and spent most of the day sleeping and doing nothing productive.  Being able to put weight on the leg does make me feel better, but I really wanted to make 90 degrees on the CPM before I saw my doc and went to PT this week.

Saw Dr. B yesterday, and he said things are looking pretty good.  He judged passive flexion at about 85, corresponding with where I am on the CPM, and isnít concerned about not making 90 yet.  He suggested I start working on deep massage to work on scar tissue and getting the patella mobilised, that may be causing me to stall out without making 90.  I canít do a straight leg raise from the bed, but he lifted my leg up so it didnít have so much gravity to work against and I could lift my leg off his hand a bit.  He was pleased with my quad sets.

He also said the discoloration weíre seeing around my incision site happens sometimes, and takes a long time to go away.  (Itís kinda pink and purplish, like an inflammation but not really.)  He said once the skin all sloughs off and tans itíll fade out.  I pointed out that I hardly tan, he laughed but said it will fade out.

PT went well.  We did a bunch of the leg raises from the elevated position until my quad was shaking and I couldnít hold a set.  My leg lifts are doing better, and it seemed we got a bit more ROM with massage and stretching by the PT.  Tom said I can go on the bike next time, 86 is close enough to 90.  They were amused by my upset to not make 90 because Iíd been promised the bike at 90.  :-)

Last night I was pretty sore, and just propped it up with ice and rested.  Today I haven't done my exercises yet, just CPM, but have pushed to 90.  YAY!!
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 casey2291

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #20 on: February 28, 2008, 01:41:53 PM »
Hi Meg,
Sounds like things are going well for you.  It took me forever to be able to do a SLR.  I remember all too well the days of having to pick my leg up everytime I wanted to move it.  Hang in there.  How many more weeks of the cpm machine do you have? 
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 MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #21 on: February 28, 2008, 04:58:18 PM »
I'm expecting a call from the equipment company to pick up the rental CPM any day.  The insurance company only pays for 3 weeks.  But, I found an older model on ebay for $100.  ::grin::  It's not fancy, but it'll do the job, so I'll keep up the CPM as long as it seems to be helping.  I think that unit will go to 110.
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 #22 on: March 05, 2008, 02:12:47 AM »
Ugh.  Busy weekend, lots of running around, which was good for my morale, but didn't get a lot of my exercises and CPM done.  Got back on the CPM yesterday and today, and the CPM said I was doing 90 degrees, so no loss, but it was a little stiff.

Got to PT today, and the CPM may say 90, but either it's not REALLY 90 or I've been accommodating it when it gets to the top of the ROM in the CPM by moving my hip or something (the PT noticed me doing that when she was working my ROM) so I'm not really at 90.   :(  It was a painful session trying to stretch it out.  I did get to go on the bike, but just to swing back and forth trying to stretch, and I could see for myself that I'm not making it to 90.  I'm doing pretty good with strength, I can *almost* do a SLR from the table... if I'm sitting up I can manage it, but if I lay back the knee bends a little and I can't hold it completely straight while I'm overcoming gravity.  But it's still improvement.  I'm at 100 lbs of weight bearing as of last Thursday, and today my brace got opened up to 70 degrees and I can do ham curls (no weight).

I'm just so bummed out about the range of motion not increasing.  It really feels like my knee is physically "stuck" at just shy of 90 degrees.  Dr. B says I need to work on massaging the scar tissue and get the patella mobilised, that could be part of the problem.  I'm trying, and got the PT to show me more of what I'm supposed to do, but nothing feels right in my knee, and I can't find any of the normal structures when I feel around.  The entire right side of my knee is completely numb because of the nerve being severed (Dr. B says the size of that area will decrease over time to about a silver dollar area below and lateral to the patella) so I can't tell how hard I'm massaging anything or if I'm massaging the right things, and there's a rock-hard area just below and lateral to the patella that I can't even tell what it's supposed to be... scar tissue that's a problem, a ligament that got cut (I have no idea if Dr. B did a lateral release when he did the AMZ/TTT, he didn't say and I haven't seen the op report) or what.

I'm trying really hard to stay upbeat about this, I *know* I made the right choice with this surgery.  I just remember with my lateral release 16 years ago, I was at about this point in rehab, having hell with ROM when I had a fall and ripped up the scar tissue.  I'm hoping to hell that it doesn't take something that traumatic to resolve this scar tissue.  I was scared on the bike that I was going to slip and rock the pedals down too hard and rip through some of the scar tissue, but at the same time, half wishing it would happen, because then I'd get some ROM back once I quit screaming.

I don't know anything to do except keep doing everything I'm told to do, and not give up.  Has anyone else gotten "stuck" at this same point?  And what was it that finally gave and the ROM started advancing again?
« Last Edit: March 05, 2008, 07:16:49 PM by MegTX »
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 casey2291

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #23 on: March 05, 2008, 03:49:05 PM »
Hi Meg,
I had a period of about a month where I made little to no gains at all in my ROM.  Then I suddenly started to make slow but steady gains.  It has been a long process for me to get my ROM back. I am now four months out and am having problems getting my last 10 degrees or so of flexion which is most likely due to the swelling that I am still having.  For me, I started doing a lot of wall slides at home for 30 mintues at a time while watching tv and that seemed to get my knee moving.  Of course we all heal differently.  I would ask your PT to watch you do the patella mobs and massaging to make sure you are doing it right.  Also, watch as your PT does it to you.  Hang in there!
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 MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #24 on: March 07, 2008, 05:07:01 PM »
Ugh.  PT yesterday was awful.  One of the women had been working with me, and she's not as aggressive as my regular PT.  I had him back.  He commented that 86 (what I'd measured at) was almost 90, and that wasn't bad.  I said "yeah, but I've been exactly there for over 2 weeks" so he put me on the table and started killing me.  He massaged and bent it and massaged and bent it until I was fighting back tears most of the hour.  Put me on the bike and had me push it as far as I could and massaged it some more.  I thought I was going to pass out from it hurting.  He tried to get me to do a quad stretch, but it required me to stand on the other leg, and that hamstring knotted up on me.  I wanted a handful of vicodin and a shot of scotch when he was done with me.

He said that some people get adhesions of scar tissue no matter what we do, and that patellar repairs do it worse for some reason.  We're going to keep at it and try to not have to go back in for a scope, I see Dr. B again on the 20th which is apparently when he'd make a call that it'd be necessary if I didn't make more ROM by then.  So I'm going to have a lot of painful PT sessions ahead of me until then.  I've got some more stretches I can do at home while sitting, and I'm going to try doing them A LOT.  I do NOT want another surgery.  If I have to, I have to, but damnit, I want my knee moving!

My husband and I had been working on massaging it, but had been kinda scared, not knowing what we're massaging or messing with.  I talked to my PT about that, and he showed me that we just really can't do anything to mess it up... he was REALLY digging in!  All the hard stuff lateral and distal to my patella that I couldn't figure out what it is?  Scar tissue, and nothing to be gentle with, apparently!   :o  I went home, took a vicodin and iced my knee for an hour.  I'm too scared to take a drink with the vicodin, but it was tempting!  I'm not saying my PT's a sadist... but he might want to consider it, one of us ought to be enjoying this!  ::sigh::
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 #25 on: March 07, 2008, 11:40:58 PM »
Hang in there, Meg, if this gets you more ROM, you will think it's worth it!!  I am pulling for 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 casey2291

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #26 on: March 08, 2008, 12:04:18 AM »
Meg,
Sorry to hear that you had a difficult PT session!!  It might be helpful to take your pain meds and then work on stretching the knee.  I used to take Percocet and then spend as much time as I could tolerate stretching the knee.  Taking the meds before stretching was a big help.  I feel for you....I'm still working on getting my flexion back and it is NOT a fun task.  Keep working at it!!!
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 MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #27 on: March 14, 2008, 03:14:32 PM »
Well, got sick and missed PT on Tuesday, but went yesterday.  I'd been working hard over the weekend to flex the knee as much as possible and massage the scar tissue, and it felt to me like I was getting a few more degrees ROM.  PT was brutal, but he got 3 adhesions to pop and flexed the hell out of my knee with a lot of scar stretching (OW!) and got it to 94.  Since I was only at 86 last week, that's a pretty decent improvement.  Still nowhere close to where I should be, since I'm supposed to be at 110 by next week (I'm at 5 weeks postop now) but it's at least moving a tad more.  I intended to go home and just ice as bad as it was hurting when he got done, but he told me to ice it ON the CPM so I could keep the stretch he'd done going for a while longer, so I did that, and got my CPM up over 100.  Now, with the angles and the soft material the CPM sits on, I don't think it's actually bending the knee that far, but it's a higher setting than I've managed ever, that day before I headed to PT, the dial was at about 95.  So looking at it relatively, it's still an improvement.  Now, if I can keep this up over the weekend, maybe I can reach a few more degrees by Tuesday, and then we'll know this isn't just another stuck point.

In other news, I'm at 60-80% of weight bearing now.  We'd kinda lost track of it focusing on the ROM, I'd only been doing 40% (but had started going a little over, apparently, which is fine) so now I'm to start at 60% and work up to 80% as tolerated.  So I could be off the crutches by the end of the month.  YAY!!  That'll make all the difference for me, because I'm sick of not being able to fix & carry my own food & drink, clean the house (and about a dozen people who know me would faint to hear me say that, I *HATE* cleaning, but the place has gotten DISGUSTING), and generally just get around without the sticks in my way.  Not to mention the raw spot under my armpits.  I'll probably still use a cane when going out errands & stuff for a while, but I was used to that before the surgery.
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 #28 on: March 20, 2008, 12:55:38 AM »
Well, even though my CPM settings went from 100 to about 105, at PT yesterday I only made 92 where last Thursday it was 94.  I had my female PT this week, and I donít think sheís as aggressive with the motion as the male PT I usually have.  It was terribly disappointing, because I really felt like Iíd made another 5 degrees or so.

She said part of the problem is that everything Iím doing is while sitting up (CPM & other flexing) and she does the measurements with me laying down, and sometimes it affects how far you can bend, whether youíre sitting or laying.

The male PT said heíd talked to my surgeon over the weekend about my case, and because I have no issues from zero to about 90, that itís not really indicative of adhesions that need to be cleaned out, itís just that the scar area from the incision hasnít stretched as fast as weíd like.  So I see Dr. B tomorrow and weíll see what he says, but my PT seems to be of the opinion that weíll just keep doing what weíre doing.

Iím hoping that Dr. B will clear me for driving tomorrow, but Iím not holding my breath.  I still canít do a straight leg raise and keep the knee locked, it keeps popping up on me.  I think Iíd be able to drive ok, but I also know that we havenít technically gotten there with my PT.  Iím just wanting to get back to the office (never thought Iíd say that) and out of this chair!
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 #29 on: March 20, 2008, 09:40:09 PM »
Well, damnit.

Just got back from OS and PT.  The news isnít good.  OS is looking for AT LEAST 90 degrees *FREE* range of motion at this point, and I just donít have it. I have slightly more than 90 with massage and other work from PT, but no more.  He also wants to see more quad strength.  Iíve admittedly been slacking a tad on my leg lifts (just a tad) to focus on ROM, but PT had been happy with my strength and had also been focusing on ROM.  OS says if I donít get some significant improvement in ROM in the next few weeks, Iíll have to have another surgery to scope and/or manipulate the joint and get the scar tissue broken loose.

Went to PT after that depressing OS visit, and PT says we canít really get more aggressive than we have beenÖ it probably wouldnít damage the ACI graft site or anything, but thereís just a limit to how aggressive we can get.  My knee is having a hard lock right about 90 degrees, like a door stop on a door.   All the work Iíve been doing to try and bend it to that point and then scooch it a bit more, is having no real effect.  the aggressive PT is having no real effect.  I just donít know what else we can do.  PT said that they donít like to be negative, but her experience is telling her Iím going to be in for the scope.  The other PT said itís not a bad thing, either, as soon as the couple daysí being sore would be over, Iíd be at 130 ROM and back on track.

So Iím not happy about todayís visit, but at least I pretty much know what Iím in for.  I can expect to go through the hell of PT for another 2 or 3 weeks, busting my ass at home to increase strength and try to break down the scar tissue, but Iíll probably have to have that other surgery in a month or so anyway.

In good news, I got to ditch the brace and one crutch today.  Maybe I can get some good sleep tonight.  :-)  Oh, and I'm cleared to start trying to drive a little bit at a time.  I might be able to go back to the office in a week or two. :-D
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)