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Author Topic: Ben's Patellar ACI  (Read 15380 times)

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Offline bsonday

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Re: Ben's Patellar ACI
« Reply #30 on: October 15, 2008, 03:11:49 PM »
Overall, the knee feels a lot better than it did a month and a half ago.  Not hugely better, but I can walk really far without any trouble, I don't need a compression sleeve or anything, it's not warm to the touch, etc.

Now the question in my mind is what is causing this clicking and catching sensation?  I don't think it's overgrowth because Dr. Cole used porcine.  Does anyone know what adhesions feel like?  No pain (or maybe ever so slight pain), but the thing is a bit clicky when doing the stationary bike :).

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 SamB

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Re: Ben's Patellar ACI
« Reply #31 on: October 15, 2008, 07:45:13 PM »
Hi Ben, glad to hear you're doing well.  I've got some of that "clickiness" sometimes too, mostly after I've done PT or ridden the bike for awhile - I'm not sure what it is, but nobody (Dr, PT) seems too worried about it.

Hope you keep getting better!
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 bsonday

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Re: Ben's Patellar ACI
« Reply #32 on: November 09, 2008, 10:26:05 PM »
Help!  I'm freaking out a little bit about my knee.  Slowly over the last month, the clicks and pops I've been noticing are getting louder, "bigger", etc.  I've been noticing these clicks and pops ever since August, only a few weeks after surgery, and they have not gone away.  The knee does feel better and better, but time heals all, so that's sort of expected.

Anyone know what could be going on?  The doctor hasn't been answering emails other than to say he's going to scope me in December to check out what's going on, and that my symptoms are "not normal per se, but not uncommon either.  They should be clearing up soon."  I don't think they are clearing up--I think they are worsening.

They could be signs of:

1.  Adhesions?  Maybe massive ones.
2.  Scar tissue?  Wouldn't explain the "worsening" of symptoms, I don't think.
3.  Overgrowth?  Would explain a lot, but I had a porcine patch which is supposed to eliminate overgrowth.
4.  Delamination/failure?  Don't want to speculate at this point.

If anyone has any hypotheses, please let me know.  It's pretty hard to avoid being worried.

You're the 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?

jonhark

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Re: Ben's Patellar ACI
« Reply #33 on: November 10, 2008, 12:02:52 AM »
Ben--
I can tell you I do have overgrowth on my patellar graft. It was confirmed by MRI about three months ago. I do get a pop occasionally when I go from flexion to extension.It is a fairly audible pronounced pop.  It is clearly coming from the perieosteum over the defect.

I doubt you would be feeling better if you had a delamination of your graft at your early stage.

I also have other pops and clicks in my knee but not coming from the patella. They aren't painful so I'm not worried.

I didn't think the new membranes could have overgrowth. Therefore, my guess is you have either scar tissue or adhesions.

I'm having my overgrowth cleaned up when I have ACI/AMZ on my opposite knee in December.

Do these noises come with pain?? If not, I'm surprised your OS would scope. I'd think an MRI would be first course of action. Followed by a scope if something didn't look right....

Your in good hands with your OS, so I'm sure he has a good course of action.

Offline bsonday

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Re: Ben's Patellar ACI
« Reply #34 on: November 10, 2008, 02:34:06 AM »
Thank you so much for the note.  Greatly appreciate it and any other opinions. 

I am in a lot of pain when I try to go from flexion to extension--there is a painful catching at one range of motion and a painful pop if I try to extend through this range

Other than that, just lots of clicks and pops under the patella which are not painful.  But they are more like thuds.  They are big.

I'm going to try and rest and not do anything painful until I know more in a month or so, but until then, I'm kind of sick with worry.  I would do anything to make this work.

Thanks a TON for your input, and if anyone else has any thoughts, reassurances, etc., please let me know.

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?

jonhark

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Re: Ben's Patellar ACI
« Reply #35 on: November 10, 2008, 03:01:42 AM »
Ben--

"thud" is exactly how I would describe the sound of the sensation when I do open chain flexion to extension.

It comes and goes...intermittent in nature. I don't get it when doing heel slides or really any other time. It is only open chain. It really isn't painful but more disturbing than anything else.

It is distinguishable from a catching sensation that would indicate the defect isn't filled with cartilage.

I've consulted with many OS's about this and most of them said a scope was necessary as the risk is the overgrowth come dislodged along with cartilage.

You are really early in the recovery so pain shouldn't be that unusual with some ROM. Hopefully you aren't doing too much open chain loaded of the patella as this will irritate it.

Push for that MRI before the scope as itll probably show scar tissue or overgrowth and alleviate some of your concern.


Offline bsonday

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Re: Ben's Patellar ACI
« Reply #36 on: November 10, 2008, 06:55:44 AM »
Thanks again for the info.  Since I'm early in recovery (4 months), I suppose it's certainly possible to expect a catching sensation since the defect is not filled with cartilage.

I don't do any open chain loaded stuff with the patella, other than once a week or so, I sit in my chair and with NO WEIGHT attempt to go from flexion (90 degrees) to extension (0 degrees).

I really appreciate your input.
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 David3

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Re: Ben's Patellar ACI
« Reply #37 on: November 10, 2008, 09:55:02 PM »
Ben,

I went through the 'sick with worry' phase at about 6 months. I even called my OS's office to say that I thought one of my grafts had failed. I was getting a fair bit of clicking and popping and pain had increased over a 2 month period. My OS ordered an MRI, the MRI showed the cartilage was doing really well on all my grafts, but that I had fairly strong adhesions / scar tissue growing. I had them scoped in an LOA at about 7-1/2 months and have not looked back. I'm now at 15 months and doing really well.

I don't know what the cause of your clicking and popping is. However, the point is that ACI is a major procedure which can give rise to all sorts of uncomfortable sensations in your knee at 4 months - they do not necessarily mean that you have any problems with your graft. It's very difficult for us, as patients, to diagnose what's happening "in there". I'd agree with the other posts here - ask your OS if an MRI is warranted. I think there's a good chance that you're doing fine. By the way, my knee isn't perfectly smooth either at 15 months, but I do notice that it continues to improve and is noticably better than at 12 months. I find that cycling helps, since it's a smooth motion and gradually helps form the cartilage into a smoother profile.

Good luck.
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.

Offline bsonday

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Re: Ben's Patellar ACI
« Reply #38 on: November 11, 2008, 01:13:09 AM »
David, thanks for your input.  That is very reassuring.  I wish you the best of luck with your ACI and its continued improvement, and I will keep you (and everyone who reads these boards) updated.

For now, as you said, I will just try to relax :).

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 bsonday

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Re: Ben's Patellar ACI
« Reply #39 on: January 11, 2009, 09:31:18 PM »
Hey everyone,

I had my appointment and scope with Dr. Cole last Tuesday, 1/6.  Sorry for the delay in posting the results (on the off chance that someone was as anxious about the results as me).  I've been down with the stomach flu pretty much ever since I woke up in the recovery room.

To my relief, Dr. Cole said the graft looks "good".  Not perfect, obviously, but good.  Maybe he even said great.  I can't remember.  He shaved off a ton of scar tissue, leaving behind an angry-looking, pinkish-whitish area that is apparently my growing cartilage graft.  My patella is still sore from the scope (expected I believe?), but it already feels 100 times better.  I believe my knee finally feels better than pre-op.  It was amazing to get on my bike an hour ago, go up stairs, not flinch in pain every time I extend my leg, etc.  He said there is some remaining scar tissue which is over an area of the graft which is still too soft to mess with, so we may go back in later if this area bothers me.

Thanks to everyone for helping keep me sane during the worrying phase of the past few months.  Uncertainty certainly is the hardest part.  I'll try to upload some pics when I can get my hands on a scanner.

On another note, my lateral femoral condyle also feels better thanks to this last surgery.  It had been hurting me for a long, long time.  Dr. Cole had gone in twice before (cartilage biopsy and actual ACI surgery), looked at it, and said it was fine.  But it still seemed to hurt.  So this time, I put an "X" on my skin right over the place it really seemed to be hurting, and Dr. Cole went in and found a bunch of undissolved stitches, right next to the LFC, leftover from my very first "cartilage pieces removal surgery" with Dr. Kenneth Highhouse.  My strong suspicion that Dr. H. is an idiot has been confirmed (don't get me started on the other mistakes he's made).

Feel free to bother me with any questions you may have, as always.  I would like to throw one out to the crowd, however:  do you know if/how a patient can increase his/her chances of forming hyaline cartilage as opposed to fibrocartilage with ACI?

Talk to you soon.

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?

jonhark

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Re: Ben's Patellar ACI
« Reply #40 on: January 11, 2009, 10:13:15 PM »
Ben--

That's good news. Great to hear you already have immediate pain relief. Did Dr. Cole mention how/why you developed so much scar tissue?

From my research, the best way to encourage hyaline formation is to do activities that encourage smooth motion like biking. There have been studies that show fibro at 1 year post op and hyaline at 2 years post op.

I'm getting my scope pictures at 16 months post-op sent to my home. It'll be interesting to compare them to yours at six months.

Jon


Offline Room 101

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Re: Ben's Patellar ACI
« Reply #41 on: January 12, 2009, 05:18:41 PM »
Hi, Ben.  So glad to hear all was well with your scope and the graft is good.  It has to be such a weight off your shoulders.  Keep it up and hope all continues to go well!

Kim 
February 1 2008 - left knee AMZ/LR/Debridement/ACI biopsy
December 2 2008 - left knee ACI - Patela
May 25 2011 - Left knee mfx - trochlea  (ACI growth looked "pristine"), Right knee ACI biopsy
September 5, 2012 - Right knee AMZ/ACI - patella

Offline bsonday

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Re: Ben's Patellar ACI
« Reply #42 on: January 13, 2009, 07:49:57 AM »
Knee Pics!  (Arthroscopy)

If you want higher quality pics, please send me your email address.

The first picture has some patella pics before the shave-down (top left, top right, and 2nd row left), and the second picture has patella pics during (top left) and after (bottom left) the shave down.  The middle row left pic might be a patella pic too, but I'm not sure.  Enjoy!

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 bsonday

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Re: Ben's Patellar ACI
« Reply #43 on: January 13, 2009, 07:50:50 AM »
Knee Pics!  (Arthroscopy)

If you want higher quality pics, please send me your email address.

The first picture has some patella pics before the shave-down (top left, top right, and 2nd row left), and the second picture has patella pics during (top left) and after (bottom left) the shave down.  The middle row left pic might be a patella pic too, but I'm not sure.  Enjoy!

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 casey2291

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Re: Ben's Patellar ACI
« Reply #44 on: January 23, 2009, 05:42:08 PM »
Hi Ben,

Glad to hear that you had the scar tissue removed and you are feeling better as a result of it. 

I was just curious if Dr. Cole had you do anything specific post-op to prevent the scar tissue from growing again?   

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