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Offline Army John

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ACI date set
« on: March 14, 2008, 12:04:24 PM »
After some jockeying around with dates, I am set for my ACI on April 3rd.  I am not looking forward to it, but at the same time I am because I want to get on to the road of recovery.  My pre-op appointment is in a few weeks so if anybody can think of a "I wish I had asked that question before surgery", please send it my way. 

Thanks... John 
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline MegTX

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Re: ACI date set
« Reply #1 on: March 14, 2008, 03:01:57 PM »
I wish I had gotten more detailed instructions on what I could and could not do post surgery.  I got to my first PT appointment 2 weeks post op and was told I'd been babying the knee too much, that I could have been moving it around a lot more.

Also, since I'm now 5 weeks post op and seem to have some scar adhesions, some detailed information on massage and other things I might have been able to do from the start to minimize that would have been nice.

I think they get used to patients that aren't well informed and don't follow directions very well, and it doesn't occur to them to tell us what we can do to be part of our recovery.  :-(

I hope everything goes wonderfully for you, and that your recovery is swift and without adhesions!  Keep us updated!
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: ACI date set
« Reply #2 on: March 14, 2008, 06:39:06 PM »
Patella Mob's are critical. I didn't do them after my first procedure (TTT) and got adhesions. I don't seem to have that problem this time around and I'd do them many times a day.

Get a PT  to help with passive motion as well.


dileigh

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Re: ACI date set
« Reply #3 on: March 14, 2008, 11:26:34 PM »
Guess I get to do mine first after all.......10 days and counting.  Had my preop appointment this morning.

I asked the ususal, how long off, how long in the hospital, was told by a PT to ask about infection control, but OS said that's not a concern with this surgery. Have you asked your PT if they've ever done the rehab for this type of surgery?  Like nurses when you're in the hospital, you spend more time with them anyway.  One I just remembered now, but forgot before- what is the next step if this doesn't work?

Got my shower seat and some more books, working on other stuff to keep me busy. 


Diana



Offline casey2291

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Re: ACI date set
« Reply #4 on: March 15, 2008, 11:23:04 AM »
Hi John,
Glad to hear that you got your date set for your surgery.  I know the feeling of dreading it but also just wanting to get on with your life.  The one thing that I can think of that I didn't ask pre-op and for whatever reason my OS did not put on my discharge papers after my surgery, is what the settings should be for the CPM machine and how many degrees it should be increased each day.  Good luck!!!!!!!!!!!
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 Army John

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Re: ACI date set
« Reply #5 on: March 16, 2008, 02:36:34 PM »
Hey everybody-

  Thanks for the comments.  Since this is my 5th surgery on this knee, I have learned I am very good at swelling and building scar tissue.  My biggest concern has been that they won't let me get my leg moving quickly enough.  I have the approval for the CPM machine, so that is a good thing.  I have read several protocols on the internet about ACI rehab and there seem to be some wide opinions. 

  Mentally, I was prepared for 6 weeks of NWB and no more than 40 deg ROM on the CPM machine (for the first 6 weeks).  If I am allowed to get to PWB sooner and allowed to progress beyong 40 degrees, I will be happy.  The PT folks here at FT Drum, and in the Army as a general rule, are generally pretty agressive on the rehab programs.  The clinic here does have experience with this procedure- I already asked them.

  Petella mobs are definitely critical.  With the removal and reattachment of the patella for the surgery, how did this affect your mobs? 

  Take care.... John
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

jonhark

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Re: ACI date set
« Reply #6 on: March 16, 2008, 05:00:06 PM »
John--

If your surgery is on the patella you should be able to be FWB with your leg locked in extension. That is because the patella doesn't sit in the trochlea groove when the leg is locked out zero extension. If there is any damage to the condyles then you are looking at anywhere up to 3 months until your full weight bearing.

Patella Mob's are recommened immediately after surgery. Although, you'll find they are going to be tough if you have lat rel and TTT in the same procedure. They are definitely critical though.

I didn't start CPM until day 10. My OS really wanted me to keep the leg straight for ten days to prevent any damage to the graft at such a critical time.

From there it was 45 degrees until week three than around 15 degrees a week until I reached 90 degrees around week six. There are definitely varying degrees of opinions on the CPM. I got my ROM back pretty quickly although I would say focus more of your efforts on quad and glute strenght and less on ROM. It will come with time.

4 way directional straight leg raises and glute wall slides are really the critical exercises to focus on in the first three months.

Offline SamB

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Re: ACI date set
« Reply #7 on: March 19, 2008, 08:40:14 PM »
John,
I'm also probably going to have an ACI in the near future (as soon as the Dr. at Mayo gets back to me).  Can you tell me how the Army is looking at your recovery?  I'm in the National Guard, and we're scheduled for a mobilization in about a year.  I'm trying to be optimistic, and hoping I can go along with my unit, but I have a hunch that that is probably overly optimistic.  Do you know how the recovery will be, and what will be required to deploy?

Good luck on your surgery.  I hope to join the ranks of everyone here that has had an ACI surgery soon, so I can commence with a normal life again.

Thanks,
Sam
11/20/2007 - Removal of loose bodies, debridement, Left knee
4/15/2008 - Cartilage biopsy for ACI
6/17/2008 - Left knee ACI

Offline Army John

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Re: ACI date set
« Reply #8 on: March 20, 2008, 12:31:33 AM »
Sam,

  The standard protocol they are talking is 12-mos.  My BDE is schduled to deploy again late fall, but I will be deploying late.  I am essentially targeting a APR 09 deployment date.  Based off of everything the OS and PT have said plus what I have read on here (and elsewhere), I guess I will be about as good as I am going to get at the 12-mos mark.  I believe by then I'll be able to wear all of the extra gear and be functional and pain free.  Now if I was deploying to the Green Zone, I think I could deploy earlier but I am in an artillery battalion and we will be performing a maneuver mission. 

  I don't know what optimistic is.  I think you have to account for the realities of what you'll be required to do to protect yourself and account for the physical demands of wearing the full kit and being on your feet.  I do know it's not worth sacrificing the full potential of your long term health for a single deployment.  I have deployed twice before and know that you can actually be a burden on your unit if you're not fully functional.  I guess if I were you, I would plan on giving yourself a year to fully recover before you can fully contribute to your unit.

I hope that helps
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline Army John

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Re: ACI date set
« Reply #9 on: March 20, 2008, 12:33:56 AM »
John--

If your surgery is on the patella you should be able to be FWB with your leg locked in extension. That is because the patella doesn't sit in the trochlea groove when the leg is locked out zero extension. If there is any damage to the condyles then you are looking at anywhere up to 3 months until your full weight bearing.

Patella Mob's are recommened immediately after surgery. Although, you'll find they are going to be tough if you have lat rel and TTT in the same procedure. They are definitely critical though.

I didn't start CPM until day 10. My OS really wanted me to keep the leg straight for ten days to prevent any damage to the graft at such a critical time.

From there it was 45 degrees until week three than around 15 degrees a week until I reached 90 degrees around week six. There are definitely varying degrees of opinions on the CPM. I got my ROM back pretty quickly although I would say focus more of your efforts on quad and glute strenght and less on ROM. It will come with time.

4 way directional straight leg raises and glute wall slides are really the critical exercises to focus on in the first three months.

Jon-

  Thanks for the info and the recommendations.  I know I am guilty of wanting to get my ROM back as soon as possible.
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline Army John

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Re: ACI date set
« Reply #10 on: March 29, 2008, 02:24:17 AM »
Well I had my pre-op but it was with a PA and not my OS (he was in surgery).  It was confirmed that I would also be having a TTO.  What I could not confirm is if there are two implantation sites.  My paperwork says patella/trochlea carticel implantation.  I guess either way, there's no real change to the post-op therapy plan-- it's still long!  ;D  Anyway, 6 days and counting. 
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline djs60

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Re: ACI date set
« Reply #11 on: March 29, 2008, 02:31:31 AM »
John,

When I had my patella/trochlea aci/TTO, my surgeon told me he was definitely doing the trochlea (which he knew was down to the bone, and that he would decide on the patella when he got it well exposed in the OR.  He told me the patella can be difficult to evaluate arthroscopically.  Indeed, when he got the knee open, he found there was only a very thin covering of cartilage on most of it, so he grafted an extensive area.

Good luck on 4/3!

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 Army John

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Re: ACI date set
« Reply #12 on: March 29, 2008, 01:07:11 PM »
DJ-

  Thanks for the reply-- what you said makes sense.  My OS is really good and he did a really good job explaining everything to me but admittedly, I probably didn't ask the right questions.  I am very comfortable the the ACI procedure and what it entails but I really didn't pay attention to the details of the TTO procedure.  After my surgery in January he descibed it in great detail to me and and again to my wife, because I was still a little loopy from surgery.  I googled TTO last night and I guess I didn't appreciate the complexity of it.  When he told me my was patell was out of alignment, I made an assumption that he would just reposition the patella after the implant- since it is laterally displaced during the procedure .  After reading everything last night, I now remember him discussing the cutting of bone and screws and plates!! 


Again-- thanks for the response..... John

 
« Last Edit: March 29, 2008, 07:59:57 PM by Army John »
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08

Offline casey2291

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Re: ACI date set
« Reply #13 on: March 31, 2008, 04:37:48 PM »
Hi John,

Just wanted to say good luck on your surgery!!!

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 Army John

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Re: ACI date set
« Reply #14 on: April 01, 2008, 02:38:10 AM »
Thanks Casey!  ;D

It's just a few days away.  I had my pre-admission this morning so everything is now set for this Thursday.
L knee meniscal repair- 6/89
L knee scope- 11/95
L knee ACL reconstruction- 2/96
L knee scope (included a lateral release, cartilage biopsy, and the ever fun bone shaving)- 1/08
L knee ACI/TTO- 4/08
L knee scope/manipulation- 7/08