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Author Topic: Does ACI last?  (Read 10211 times)

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Offline casey2291

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Re: Does ACI last?
« Reply #30 on: April 23, 2008, 02:37:28 PM »
I think you have found yourself two really good OS's.  I always think it is good to have several opinions when it comes to major surgery like ACI, so don't feel bad about keeping both appointments and then making the decision about which OS fits you and your situation the best.  I discussed ACI with several OS's before I finally made the decision on which OS to go with. 
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 bsonday

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Re: Does ACI last?
« Reply #31 on: April 26, 2008, 12:47:26 PM »
Hey everyone,

I'm trying to get mentally prepared for my appointments with Dr. Levy and Dr. Cole coming up soon because, well, what they say will have a huge impact on the rest of my life.  Any tips?

I've had my heart "fractured" 5 times--no breaks yet--once when I first hurt my leg a year ago, once recently when I was told by a reputable doctor that I should just "get used to a less active life", once when my girlfriend of 3.5 years dumped me, once when my dog died, and once when the first company I ever invested in went bankrupt and took my 2 grand with it :) (at 17 years old, this was my entire life savings).  So I guess all in all, life hasn't been too bad.  Besides, I now have a great dog, a better girlfriend, tons more wisdom and perspective, a waaaaay better golf game, and I bought apple stock like three years ago.  They even let me use the golf cart for free if I bring my crutches :).

Nevertheless, I've learned not to put too many eggs in one basket happiness-wise, so any idea how I should approach this?

Thanks again for reading my attempt to be funny and serious at the same time.

Best,
Ben
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline Army John

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Re: Does ACI last?
« Reply #32 on: April 26, 2008, 01:23:42 PM »
Ben-

  Just try to have an open dialogue and tell your OS what you'd like to achieve.  What your plan for your life is.  Surgery is never a magic bullet and your expectations may not be attainable or reasonable-- hopefully they are but maybe they aren't.  Maybe these new docs will tell you that you're expectations are or are not realistic.  They see many more knee joint problems than you do and they know the long term implications better than you.  Trust their advice.  Their goal is to get you back to where you were.  I'm in the Army, as is my OS, and his goal is to get me back to where I was.  He said nothing about a decrease in activity; I had a very large patellar lesion, a normal trochlear lesion and I also required a TTO. 

  I always try and remember that surgeons typically don't have great "bedside manners".  They operate and then "pass you off".  It's not as cold as it sounds but they fix the problem via surgery and the rest is up to you and your therapist-- but it's really up to you.  If you want the most favorable outcome, you need to remember the rehab is the most important part of the process.  You can find the best OS in the world but if you don't rehab correctly, it doesn't matter.  The surgery is the easiest part of the process.

  Like you, I am active, I want to remain active, and I don't want anybody telling me to be less active.  What I have done is find activities that allow me to remain an active lefestyle without  pounding on my knees.  The elliptical trainer replaced the treadmill.  The pool replaced the long runs or hikes.  Softball has replaced lacrosse. 

Best of luck!

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 celinenj03

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Re: Does ACI last?
« Reply #33 on: April 26, 2008, 02:31:31 PM »
Ben, Army John has given you some great advice and wise words. I personally met Dr. Levy and I can tell you he is very nice, but very straightforward. I really liked that about him. Sometimes the news is hard to take, but I would rather know upfront what I'm dealing with and go from there. I asked Dr. Levy if ACI would get me back to sports. He gave me no indication of that to be honest. He said you don't have ACI to return to sports. It's to save your knee, I am supposing from an early TKR or maybe even TKR altogether.

Now that's not to say you can't do a lot of things. I don't even believe it's to say you can't do sports. I think everyone is different. Ages, weights, even male vs. female, your alignment, the state of your knee in other areas, etc.

While I was there, a pro or semi pro athlete was there and had aci done by Dr. Levy. I imagine that guy is returning to sport, it's his job and he didn't look like he was giving it up. (tremendous shape he was in otherwise)

As far as that "reputable" doctor telling you to get used to it. That is up to you whether or not you want to get used to it. I had a doc tell me I can't do anything except deal with the symptoms now.... But this doc also did not do ACI or a lot of the other surgeries. He was mainly an ACL reconstruction specialist.

I assume you are young? Sports are probably very high up in priority at your age. But as you settle down, have kids, you will become a weekend warrior and your top priority will become keeping up with your kids. So like it or not, you will change and you probably would have changed anyway, injury or not.

We can understand your frustration. So just come here anytime you want to talk or vent. There are many a fallen athletes on this board. But I don't know anybody here who will take it lying down. Everyone is always trying to get even better so you are in good company here.

All the best with your appointments. When do you see Dr. Levy? I'm curious to see what you thought of him and what he offers you.
Terrible Triad - 1/16/06 - Basketball
3/15/06 - Scope/Cleanout of to achieve full ROM
5/3/06 - Surgery-ACL Reconstruction-Allograft
9/12/07 - Large Loose body removed;Grade 4 Lesion on LFC
9/17/08-Microfracture, Lateral Release (all right knee)

Offline bsonday

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Re: Does ACI last?
« Reply #34 on: April 26, 2008, 03:58:41 PM »
Thanks for the great advice.

I see Dr. Levy Wednesday, and Dr. Cole a week from Monday.  I will let you know what they say.

I'm 6'5", 190 lbs., and I'm in great shape.  My knee is just fine other than the patellar cartilage, and the other one is perfect.

I really hope to, at the very least, get back to playing a lot of beach volleyball.  Sand is very gentle on the knees because it's so soft.  I can deal with no basketball and no mogul skiing, though.  Beach volleyball, however, is an addiction.  Ultimate frisbee might be as well :)...
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline casey2291

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Re: Does ACI last?
« Reply #35 on: April 27, 2008, 01:17:37 AM »
Good luck with your appointments.  I too am interested to hear how you like Dr. Levy since he is my OS.  Like Celinenj03 said, he can be very direct and a couple of times I have had to look beyond his bedside manner and remember that it is his surgical skills that I am after and not how he responds to me during an office visit.  I think he goes above and beyond as a doctor and I've been extremely impressed with both him and his staff.  I will be interested to hear if Levy and Cole have differing opinions on how to treat your knee. 
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 bsonday

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Re: Does ACI last?
« Reply #36 on: April 30, 2008, 08:44:08 PM »
Hey everyone,

Thanks again for reading.  I saw Dr. Levy today, and the appointment went well.  He seemed optimistic about my knee, but I forgot to ask him direct questions about things like getting back to sports.  This seemed to be implied, though, because he said that I should make a great recovery based on my age (22) and that I don't have things like a stressful job, kids, obesity, other illnesses, etc.--I can really concentrate on getting my knee back in shape.

He thinks doing an ACI is the way to go, but he wants to go in and look around first and do a cartilage biopsy to send to the Genzyme people.  This is scheduled for a couple of weeks from now.  He was also very optimistic about fighting the insurance company, which is the first optimism I have ever heard in this matter.

I felt very comfortable with Dr. Levy and he seems very knowledgeable.  He knows Cole, Minas, Farr, Peterson and the gang quite well.  My only two concerns are:

1.  Because my dad is a bit sick, I might be going back to Michigan this summer in which case Dr. Cole is a better option because Chicago is closer to home.  This is my main concern.

2.  According to Dr. Levy's assistant, he has only done 3 patellar ACI's in the past two years.  I'm not sure if this is a lot or a little, but I will know more once I have my appointment with Dr. Cole.  This is not a huge concern to me, but it is still important.

Thanks again for reading and leaving your thoughts.

-Ben
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline casey2291

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Re: Does ACI last?
« Reply #37 on: May 01, 2008, 12:03:02 AM »
Hi,
Glad to hear that you liked Dr. Levy.  I too wonder if a couple of patella ACI's is a lot in a two year time span.

The person who deals with the insurance end of things at his office (Millie) is really good at dealing with the insurance companies. 

If you have follow-up questions for Dr. Levy, you can always send him an email.  He is great about responding to emails.  I had lots of questions before my ACI and he answered all of them for me via email. 

Good luck with your appointment with Dr. Cole!  Please post his opinion on your knee as well and how many patella ACI's he does a year (if you ask). 

 
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 bsonday

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Re: Does ACI last?
« Reply #38 on: May 01, 2008, 01:38:14 AM »
I will be sure to post how many patellar ACI's Dr. Cole has done once I figure that out.  In case anyone is curious. Dr. Levy has also done about 20 femoral condyle ACI's is the past two years as well, according to his assistant.
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline bsonday

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Re: Does ACI last?
« Reply #39 on: May 08, 2008, 01:11:38 AM »
Hey everyone,

Lots of news since I last posted.  As a brief note, it turns out I will probably be around Michigan this summer, so it makes more sense for me to go with Dr. Cole for that reason.  Regardless of that, though, I had my first appointment with him on Monday afternoon as scheduled.  I was a little bit nervous about the situation when I first arrived in his office because there were tons of people, tons of assistants, tons of waiting rooms, etc.  I thought that perhaps I wouldn't even get to see Dr. Cole personally, and that this would be an assembly line-like appointment.  I was wrong.

I first met with his assistant, an MD who seemed quite competent.  I asked him, "How may patellar ACI's has Dr. Cole done?" and his answer was simply "Tons!"  We talked for 10 or 15 minutes, and I basically told him that my motivation for getting an ACI done is that I want to get back to sports.  He said that there is a good chance of that and then he went to get Dr. Cole.  Dr. Cole came in, and although I could tell that he was in a hurry, he answered each and every one of my questions intelligently and caringly.  After one question he said, "Ah, you are referring to that paper that came out two months ago.  Well the answer is that..."--basically, he is really on top of his stuff.  He then told me that regardless of my summer location plans, he could be my OS, and that he has people come in from all over the world with no problems at all.  Finally, he told me that he has a full-time staff whose job it is to fight insurance companies and that their success rate is close to 100%.  I guess when Dr. Cole wants to do an ACI, Dr. Cole almost certainly gets to do an ACI.  I felt a ton of weight being lifted from my shoulders--no need to worry about summer plans, battling the insurance company by myself, the competence of my doctor, etc.  I highly recommend buying the plane ticket to Chicago to see Dr. Cole for any of the rest of you out there simply for these reasons.  Finally, Dr. Cole told me that he recommends patellar ACI with a Fulkerson AMZ (exactly as I suspected), and that the next step would be for him to go in surgically and inspect my knee and remove some cartilage for the ACI biopsy.  He asked me what my schedule was like, and I jokingly told him that I came in from New Jersey so that any time in the next two days before I fly home would be great.  He recognized my joke, but then told me I could have it done the next day (Tuesday).  I am now 28 hours post-op, feeling great about the whole situation, and my leg isn't that sore at all.  Step 1 is complete.  After I came out of anesthesia yesterday, Dr. Cole stopped by and chatted for a few minutes, shook my had a couple of times assuringly, and wished me a good trip home.

Now we have an insurance battle for a few weeks, and I understand that my main role will be to sign papers and accept faxes and such that Dr. Cole's insurance-fighting staff members send me.  Piece of cake.  After (and if) we win the battle, he sends the cells to Genzyme, they come back 6 weeks later, and then I have my patellar ACI done.  By the way, the patellar lesion turned out to be 1.5cm x 1.5cm approximately, and the rest of the knee looks just fine.

So, that's the plan!  I'm ecstatic that I have gone from feeling like my knee is screwed to having a good game plan in only three weeks.  Thank you Dr. Cole, and thanks to you all.

Best,
Ben
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline Peg Leg

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Re: Does ACI last?
« Reply #40 on: May 08, 2008, 01:37:18 AM »
Ben,

That is great news that things worked out so well for you!  I am glad that you have a game plan AND an OS that you really like and have confidence in.  Good luck with the Ins. and the waiting!

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

dileigh

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Re: Does ACI last?
« Reply #41 on: May 08, 2008, 02:39:05 AM »
Wow, that was quck!  Good luck with the insurance.  Then you get to start stocking up on entertainment, etc. while the cartilage grows.


Diana

Offline casey2291

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Re: Does ACI last?
« Reply #42 on: May 08, 2008, 03:10:36 AM »
That's great news for you.  I'm glad that you found an OS that you feel confident with and has done lots of patella ACI's.  What insurance company do you have?  Just wondering b/c patella ACI might be in my future one day.  Good luck with your scope recovery and planning for your next 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 bsonday

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Re: Does ACI last?
« Reply #43 on: May 08, 2008, 03:23:32 AM »
Hello again,

Yes, this whole process has been quick--I've been lucky.  I'm glad, too, because I have the kind of personality that if something is wrong, I want it fixed as soon as possible and it bothers me not to be proactive.

My insurance company is Aetna, and they don't cover patellar ACI's by default, but I believe they have been convinced to cover a few.  MegTX, I believe, had Aetna and they covered hers.  Even if they do cover it, though, they will only pay 80%.  I'm a young guy who has tried hard to save money, but this is still gonna hurt pretty bad since 20% of $40,000 or whatever is a big number.  But what is the price of a new, good knee that I will use for the rest of my life?  A few hundred grand at least, I estimate.

Thanks again for reading and leaving your comments, everyone.  I think my mental health has improved greatly just from having all of your support.

Best,
Ben
Removal of loose bodies (cartilage pieces)--7/2/2007
Lots of rehab (quad strengthening) which didn't help much
Biopsy for ACI, 1.5cm x 1.5cm patellar cartilage lesion found--5/7/2008
Patellar ACI with Fulkerson, slight lateral release (to get under the patella)--7/2/2008
Happiness--Early 2010?

Offline Army John

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Re: Does ACI last?
« Reply #44 on: May 08, 2008, 02:42:44 PM »
I tell ya, for all of the tings I have to put up with in my Amy career, I am glad battling insurance companies or having a co pay is not on that list.  My ACI (2 lesions) and a TTO cost me $12.  I had to pay for the use of the TV when I was in the hospital.

Ben-- sounds like things are coming together for you.  Best of luck!  I'm 5 weeks post-op today and am anxiously awaiting being allowed to being weight bearing, next Thursday.

Definitely stock up on movies and books.  I spent my time preparing for my comp exam, which I took yesterday.  I hope I passed because I never want to experience that pain again.  I'd rather lick razor blades than do go through that one more time.
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















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