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Author Topic: MegTX's Patellar ACI & Fulkerson 2/6/08  (Read 14637 times)

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Offline David3

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #30 on: March 20, 2008, 10:29:26 PM »
Hey, really sorry to hear that Meg. However, I think this will really get you back on track.

I had a somewhat slow increase in ROM after my ACI. I have my notes and see that I could reach 89, 100, 108 and 117 degrees at 3,4,6 and 8 weeks respectively. It took me ages to get past 120 degrees. I was still increasing and at about 135 before my scope last week (7-1/2 months).  The reason I mention this is because I recall my PT saying that she could tell it was mainly swelling limiting my ROM, since there was no hard stop. Early scar tissue, she said, was just like hitting a sudden stop in ROM, as you say, like a stop on a door. If that's what you are experiencing, a scope is maybe the best thing and will probably really boost your recovery. I think your OS is being very responsible - leaving scar tissue for too long is not good. 

Another scope is not what any of us want, but I think you have a great recovery to look forward to if you have to go that route. Very best wishes.

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.

jonhark

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #31 on: March 20, 2008, 11:24:16 PM »
Meg--
That is too bad about the scope. Some of us just build scar tissue faster than others. Regardless of scar tissue, the really important thing is to protect the graft at this stage. DON'T let your PT push your ROM and cause any pain from the graft site. Adhesions can be fixed by a damaged graft can't.

Once your able, I would really work extra hard on glute med and quad strengthening (on both sides). I would recommend doing SLR with your torso at 90 degrees. Really focus on quad contraction. Once you start walking you'll want to have as strong as quads as possible. In fact, i would keep waliking to a minimum until your quads and overall leg strength is where you want it to be.

Look on the bright side---if you get scoped you'll get to see how your graft is doing.


J

Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #32 on: March 21, 2008, 03:19:20 PM »
Thanks, guys.  At this point, I welcome a scope.  We've been really aggressive in PT for several weeks now, ever since I got stuck at 86 and just didn't move for so long... we finally got a few adhesions to pop and got up to 94, but now it seems stuck there.  My PT who has lots of experience with this says that the patello-femoral grafts just tend to scar up and get adhesions more than condyle grafts, and though they keep tweaking the PT protocols to try and stop it, they still have about 30% of the patients who do this no matter what.

What's more frustrating than the fact I'm going to have to have the scope is that my OS seems to think that we've NOT been going at this aggressively enough, telling me to do it more, or work harder... and so I have to have another 2 or 3 weeks of hellish PT before he'll call the ball on the scope.  Both of my PT's and I know what needs to happen, we're the ones who have been hitting this hard stop in my ROM and not being able to get any kind of motion on it, and putting me in some pretty severe pain trying.  And like my main PT says, the graft is ok, they've been more aggressive with other patients than they have with me and the grafts have been fine when they finally scoped them, but there's just a limit to what they can try to do.  I am already dreading PT, if they get more aggressive I don't know what I'm going to do.

My PT says that once we do the scope, I'll be hellishly sore for a few days, and then I'll have somewhere in the neighborhood of 130 degrees and we can get going with my rehab again.  I'm ready for that, damnit.  Sign me up.
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 #33 on: March 25, 2008, 10:05:41 PM »
After all the depression this weekend… I went to PT today ready to just gut through the next two weeks, get my doc to agree that there is no progress, and then schedule the scope to clean out the scar tissue.  PT started out normally… no more ROM, though my knee did *seem* to be moving a bit easier in the same ROM we’d had.  Did massage, and some manipulation, then got sent over to the bike.

Was rocking the pedals back and forth like I have been for weeks, since I can’t make it around, but noticed that I seemed to be making it further around than I had been last week… like **almost** making it around backwards.  Then all of a sudden my hip popped up a bit and my foot slipped forward a bit, and it went around backwards.  I’d been told to be sure to not “cheat it” by pulling my hip up or moving my foot forward, so I went back to doing it right.  PT noticed while she was massaging someone else’s leg, and said it looked like it was almost going around, and I told her it had once, but it was a cheat.  She said to go ahead and cheat it a bit if it would let it go around.  So I did.

After a few minutes of going around, I got a resounding POP deep in the knee, which made me flush and catch my breath.   (also felt like I was going to hurl for a second, but it passed quickly)  And then it was easier to go around, and I wasn’t needing to cheat as much.  PT noticed and said it looked like it was going easier.  I told her I’d gotten a pop, and then tried, and lo and behold, I could even go around front-ways!  When I went to get off the bike, I noticed I had a bend quite a bit more than I’d had previously.

Went over to the bench & told the PT, who looked and agreed.  She felt the knee, said it didn’t feel hot and there was no indication that anything was wrong, the pop was just a scar adhesion giving way and not anything ominous… she had me get up on the table and measured my ROM…

::drumroll::

Free ROM…

100 degrees!

::faint::

I’m not holding my breath at this point, but this is a seriously good development.  That’s well over 10 degrees’ progress in one ‘POP’.   If that was the major scar adhesion, then I’ll be able to keep stretching it out.  If there are more scar adhesions, we may be able to get them to pop in the same way, now that I can go ’round with the bike.

I am now clear to go 100% weightbearing as tolerated (and off the crutches and onto a cane), cleared to use the stationary bike at home, and have 100 degrees free rom, which is only about 10 degrees behind where I should be in the protocol.  As long as this is the beginning of momentum again, and not just a one-time jump, things are back on track and I’m good.  And won’t need an additional surgery to clear out the adhesions.

PT told me to keep it moving and not let it freeze up before I get back on Thursday.  Not a frakking chance, lady!!  It’s sore and I’m going to give it a little break while I work on the computer for a bit this afternoon, but I’m back on the bike this evening while I watch TV, damnit!!
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)

dileigh

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #34 on: March 29, 2008, 06:30:47 PM »
Glad that it finally popped and got you going again.  Hope I can be 100% weightbearing at 2 months!


Diana

Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #35 on: April 02, 2008, 01:50:14 AM »
Well, after the great breakthrough last week, I was so busy this weekend I didn't keep up all my exercises and stretching and didn't get on the bike at all... I THOUGHT I'd maintained the progress, but alas, I've backslid.  Back down to 95 degrees today in PT.

So I'm faced with a decision... I *was* going to head back to the office tomorrow... I've been working from home, my boss is fine with me working from home as long as I need to, so that's not an issue... BUT.  I'm going stir crazy.  My hubby and kids are driving me nuts and I need adult conversation that isn't centered around my husband's stress (not going into specifics, but he's stressed out, and I'm sick of being here for it 24/7).  I can finally drive again, there's no real reason for me to be here vs. there.

EXCEPT.  With this new backsliding, I'm thinking I should set my watch to beep every couple of hours and go do 10 minutes on the bike and stretch it out good, and push for more ROM.  I can't do that at the office.  All I could do there is some walking and some stretching.

But then part of me wonders if that wouldn't be overkill anyway, and I just need to get up early, do 15-20 on the bike in the morning, stretch it out good... then stretch it periodically through the day and then do 15-20 on the bike every evening and that be enough.

Any thoughts from those who've done this 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 #36 on: April 08, 2008, 10:40:35 PM »
Well, the going back to the office thing got decided for me.  I worked the first week of April at home, still, but last Friday I got a call from my boss, and we had a huge layoff.  My boss had 9 people working for her, and she had to lay off 4.  I still have a job, thank goodness, but I thought it best to get my butt back to the office sooner rather than later.  Then yesterday my VPN (the secure link to my office computer network) would NOT stay linked up and I had deadlines to meet, so I went on in, and then again today.  It was actually nice getting back to the office, I have missed it (never thought I'd say that) so I'm back in the office now, at least until I have to have a scope/manipulation.

At the office, I can actually do more bending of the knee, because my chair is on rollers.  At home, I'm in a chair that goes straight to the floor, so I can't get good leverage on it without putting it on the ottoman and doing heel slides with my strap.  Which I do, but at the office I can bend it back and then roll my chair against the bend and put more pressure on it.  So at least I won't be neglecting my ROM work at the office.  I do need to take something in to prop my leg up on under my desk, though, because I'm getting a LOT of swelling not being able to prop it up on the ottoman 1/2 the day like I do at home.

PT went OK today, the bike seemed easier and I was able to cheat less, but either my toe pops down or my hip pops up at the top of the rotation.  I'm back to the 100 degrees we got after that adhesion pop, but no more.  I'm going to keep working on it and we'll see what happens Thursday, if we don't get any significant progress, I'm going to put pressure on my doc to do the scope/manipulation.  I was at 86 at 3 weeks, so my ROM has been essentially stagnant for 5 weeks.  I don't see any point in waiting until I am scheduled to see him on May 1 to do something about it.  Maybe I'm being too impatient, but it seems like an utter waste to be going to PT 2x a week to be put in a lot of pain and get absolutely no result from it.  I didn't want to do the surgery unless it was necessary... but if it's necessary, I don't want to wait a long time to get it done and get back on track.
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)

dileigh

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #37 on: April 09, 2008, 02:53:27 AM »
Glad you made it back to work, I think.   I have access from home, but not complete access during the day since I have to log into a computer that's not in my department.  We were unable to set up a system to let more than one person log into my computer, and one of my assistants is using it while I'm out.

Do you have ice at work?  I have a pack stashed in the freezer from the scope.  Wish I knew what to tell you about PT.  Progress seems to occur in fits and spurts.


Diana

Offline casey2291

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #38 on: April 09, 2008, 07:48:21 PM »
Meg,
Sorry to hear about your troubles with your ROM.  I too had trouble with my ROM and it came back VERY slowly for me.  If I remember correctly, I was stuck right around 100 degrees for almost a month before I started making progress.  My knee eventually decided to start moving, but I still ended up having a scope to remove scar tissue.  I didn't want to have to go back in for more surgery, but the scope was a piece of cake compared to the ACI surgery and I'm really glad that I had it done.  I am definately starting to see improvements in my recovery.  My OS waited until I was 5 months post op before he would scope me.  I also used a dynasplint for my extension.  Maybe you could try a dynasplint or something similar for your flexion.  Has your PT mentioned anything about that 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 #39 on: April 09, 2008, 09:02:51 PM »
Glad you made it back to work, I think.   I have access from home, but not complete access during the day since I have to log into a computer that's not in my department.  We were unable to set up a system to let more than one person log into my computer, and one of my assistants is using it while I'm out.

Do you have ice at work?  I have a pack stashed in the freezer from the scope.  Wish I knew what to tell you about PT.  Progress seems to occur in fits and spurts.


Diana

I *am* glad to be back at work.  I went today at lunch and got a little campsite folding table to tuck under my desk to get some elevation when I'm not working on ROM.  That'll help.  I actually have a portable IceMan type thing, it's a PolarCub that has a handbulb that you squeeze to circulate the icewater instead of a motor, and it's a smaller cooler... I have to have my husband get it down from the top shelf of the closet it's in and bring it to the office.  Then I can get ice from the ice machine here at work and be ok.. it's not as efficient as the IceMan, but it's a damned sight better than ice packs.  Saved my life when I was nursing my knees through belly dance performances a few years ago.  :-)

It's a shame they can't set you up with a laptop and VPN access, that's how I'm set up, and I can do everything from home that I would do sitting in my cube.  It's nice.  And, with the layoffs and some other things that are going on, my boss is encouraging us to coordinate and do 1-2 days telecommuting anyway.  I may end up telecommuting on my PT days, just to make it easier.
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)

dileigh

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #40 on: April 09, 2008, 09:15:24 PM »
Yeah, me and the IT guy discussed VPN.  The problem is my accounting program requirements.  For security we didn't put any programs on the server, so I can't access it that way and the program won't allow 2 people to be on the same computer at the same time unliess I buy the $700 upgrade.  Everything else worked perfectly.  No money in the budget for the company to buy me a new laptop either.  I do have some access, just not the main program.

Again, I'm getting more vibes from work emails that my management of the area is needed more than me working on reports.  Hard to do that from home.  Decision making in moments, redirects, problem solving, that kind of stuff.

Hang in there on the ROM, I'll probably be joining you shortly......


Diana

Offline MegTX

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #41 on: April 09, 2008, 09:48:22 PM »
Meg,
Sorry to hear about your troubles with your ROM.  I too had trouble with my ROM and it came back VERY slowly for me.  If I remember correctly, I was stuck right around 100 degrees for almost a month before I started making progress.  My knee eventually decided to start moving, but I still ended up having a scope to remove scar tissue.  I didn't want to have to go back in for more surgery, but the scope was a piece of cake compared to the ACI surgery and I'm really glad that I had it done.  I am definately starting to see improvements in my recovery.  My OS waited until I was 5 months post op before he would scope me.  I also used a dynasplint for my extension.  Maybe you could try a dynasplint or something similar for your flexion.  Has your PT mentioned anything about that to you?  Hang in there! 
 

No, I had to look it up to find out what you were referencing.  It looks cool, though.  I wouldn't mind trying something like that.  I hope my doc doesn't wait until 5 months to scope me!  Sometimes I feel like I'm just being impatient, that I should give it more time.  But sometimes I look at it, and the weeks are just ticking by with no noticeable improvement.  It's hard to know what to do.

I also know I'd probably be having different results if I were still with my original PT.  He's got strong hands and is more aggressive with my therapy.  Puts me in a hurt-locker, but we get somewhere when he works on me.  But I've been going in at a busy time (late afternoon) and he's been busy with new patient evals and one of the other PT's has been working on me.  She's good, and she's nice, but she's not as aggressive as he is.  So I don't make progress with her like I do with him.  I'm tempted to ask the receptionist if there's a better time for me to change to when he's available.  My times were set back when my hubby had to drive me and we were working around his school schedule.  Now I'm more open.
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 #42 on: April 11, 2008, 04:52:19 PM »
Well, it looks like we may be making progress ( ::crossing fingers:: ) . 

Was back to work this week, and having a lot of pain and swelling, so I haven’t been working as hard as I’d like on range of motion & strength, but I have been pretty consistent about bending the knee as far as I can frequently throughout the day, stretching it, so it’s helped I think. 

Tuesday's PT went OK, we measured right at about 100, so I was back up to the max we’ve gotten.  Yesterday, I felt really stiff, but when I got on the bike I really worked hard at stretching it and not cheating.  I got my foot to stay in position on the pedal and my toe to stop popping down on the rotation.  Actually was managing a normal action in my ankle, which was good.  My hip is still popping up a bit, but I’m managing to minimize that more and more, and am getting better flexion.  So, when the PT was flexing the knee, my main PT walked by and said that it was at least at 105.  But, when I got on the table and laid back to bend it and measure it, it was only 102… that position has always made me measure a little less than sitting up, but it’s what all the other measurements have been against. 

So, all in all, it was a pretty good session, and with all the pain and swelling I’ve had, to have some measurable progress anyway is encouraging.  We’ve decided to hold off on pressuring the doc for the surgery to clear out the scar tissue.  I see him again on May 1, so we’ll keep at it and see how far we can get and what he says then.

I've about decided that this is all a lesson for me in patience and not controlling everything.  :-/
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 #43 on: April 16, 2008, 08:53:41 PM »
More very slow progress, which is encouraging.

The bike is my friend, and it's getting easier to pedal without "cheating" quite so much.  My toe isn't getting pulled down as the leg bends anymore, I'm actually keeping the ball of my foot on the pedal and flexing the foot & ankle the way I'm supposed to on pedaling now.  The hip is still pulling up a bit at the top of the cycle, but nothing like it was, and if I concentrate and pedal slowly I can sometimes keep it down.  I got the PT to measure my flexion at the top of the cycle and it was 110, which I've never managed before.

We're still only at about 102 when I'm laying on my back on the table and pulling my heel toward my butt.  I cannot for the life of me figure out why I hit such a severe pain point when flexing in that position that isn't present when I'm sitting on the edge of the table being flexed, or when I'm on the bike.  But, that's the "position of official record", so I'm technically only at 102.  But it's still better than the 95 I was stuck at.

Walking is getting better, but if I try to walk without the cane, I'm limping horribly.  With the cane, I'm not leaning on it that much, but just that little bit keeps me from limping, so I'm staying with it.  I'm trying to keep up with my strength exercises, but I'm so swollen and tired by the time I get home every day, I just collapse.  I've got to get my quads up stronger, though, they're a bit weaker than I'd like.  Still doing ok as far as my PT's concerned, but not as good as I know I could be.

All in all, I'm much happier with my progress now.  I just need to step it up some more.  I see my OS on 5/1.  I don't want to have him lecture me again.  ;-)
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)

dileigh

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Re: MegTX's Patellar ACI & Fulkerson 2/6/08
« Reply #44 on: April 16, 2008, 11:43:11 PM »
Any progress, no matter how slow must be a good thing right?   It seems like it took forever to get that last 15 degrees to get to 90 on the CPM, but I'm finally there.

So how's it going back to work?

Diana