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Author Topic: Words of advice wanted! Will be having an ACI!  (Read 8605 times)

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Offline Murph324

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Words of advice wanted! Will be having an ACI!
« on: September 10, 2009, 05:17:50 AM »
In June 08 I had the Lateral Release.  In Jan 09 I had the TTO w/ Microfracture. I will be going in for a scope/biopsy in a few weeks, then having the ACI in January (approx.).  I am interested in hearing about what others have gone through with this procedure....

Curious if anyone has had either of the other procedures plus the ACI to compare (recovery, pain, ect.).  Also, curious to hear about recovery, including time or recovery, Brace & equipment to expect, PT, and how long before you were back at work. 

Please share anything that you feel I should know!  Thank you!

Kristen
03/04/08- Left Knee Injury
06/18/08- Lateral Release
01/26/09- TTO/Microfracture
10/16/09- LOA/Cartilage Biopsy
01/06/10- ACI
03/24/10- LOA/Hardware Removal
06/04/10- LOA w/ Drain/Lateral Release

Offline casey2291

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Re: Words of advice wanted! Will be having an ACI!
« Reply #1 on: September 13, 2009, 01:25:40 AM »
Hi,
I had ACI/HTO almost 2 years ago.  My advice to you would be to make sure you have someone to help you out for the first or week or two after surgery.  When I had my ACI, it was my third surgery so I thought that it wouldn't be a big deal for me to be somewhat independent since I previously spent 6 weeks on crutches, but I was totally wrong.  I needed a lot of assistance from my husband to help me out.  My other piece of advice is to make sure that your CPM machine is set up correctly.  I picked mine up before my surgery and was not given proper instruction on how to work it and it was three weeks post-op before I realized that it was not working quite right.  If you pick it up yourself or have it dropped off at your home, make sure that whoever gives it to you actually observes you using it.  Good luck to you!  I hope your surgery is a success.
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 redlotus

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Re: Words of advice wanted! Will be having an ACI!
« Reply #2 on: September 13, 2009, 04:03:14 AM »
I had my ACI (MFC and patella) a little over a year ago.  I had a TTO at the same time.  I second the advice to make sure you have someone to help you out - I found I was very limited for quite some time in what I could do on my own.  Make sure you have a raised toilet seat and a shower seat (or something to use as a shower seat) before hand.  I set up a little "command central" near the couch and bed that had non-perishable snacks, movies, remotes, baby-wipes (great for "hand washing" or just freshening up - trust me, you'll want to!), phone chargers, access to outlets, etc.  I also invested in one of those grabber things that you can use to snag stuff out of reach, and that came in handy A LOT.  Lots of pillows, lots of movies/books/games. 

As for pain, one of the biggest issues for me was blood-rushes, where I'd have my leg up for awhile then put it down and get a sudden rush of pain.  Also muscle spasms were an issue for me.  I won't lie, there was quite a bit of pain, but if you stay ahead of it with meds it's managable (which you probably know since you've had a TTO and MFX). 

You'll get a CPM most likely - personally I found that the CPM helped my pain a lot.  Then it depends on what surgeon you have as far as things like braces go.  I had Dr Minas in Boston, and I had a hinged brace like this one: http://www.bledsoebrace.com/products/img/or.jpg that I wore whenever I was up and about.  I also had a padded brace that kept my knee straight while I slept. 

I was able to get a Game Ready system, which was a LIFESAVER with the pain and swelling.  I highly recommend it if you can get your insurance to cover the rental. 

If you look around this board you'll find lots of people's threads that detail their ACI recoveries (mine included) and they'll give you a good idea of what to expect. 

Good luck, and keep us posted!

Offline Murph324

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Re: Words of advice wanted! Will be having an ACI!
« Reply #3 on: September 14, 2009, 05:30:52 PM »
My surgeon is Dr. Gomoll (Dr. Minas' partener).  So far all the advice seems very similar to what I went through with my last surgery.  Good and bad.  Good cause I feel more prepared, bad cause I don't want to do it again!  Anything to be pain free at this point!  What is the Game Ready system?  I've heard a lot about it.  Thanks for all the advice!
03/04/08- Left Knee Injury
06/18/08- Lateral Release
01/26/09- TTO/Microfracture
10/16/09- LOA/Cartilage Biopsy
01/06/10- ACI
03/24/10- LOA/Hardware Removal
06/04/10- LOA w/ Drain/Lateral Release

Offline courtem10

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Re: Words of advice wanted! Will be having an ACI!
« Reply #4 on: September 14, 2009, 06:40:19 PM »
Hi Kristen,

I had a lateral release, AMZ (very similar to TTO) & Patellar ACI in April of this year. Since I had all the procedures together I can't really distinguish pain from one thing to another. Overall, it was a pretty painful experience. After surgery I took 2.5 weeks off from work. I wasn't able to drive for another month or so. Even though I had the surgery on my left leg, it was so difficult getting into cars with the brace, so I really had to wait a while to get back behind the wheel. I wore the brace for a total of 3 months, and it was opened up at various points as I gained range of motion and flexion with my knee. I was on crutches for about 2 months, going from totally non-weight bearing to partial, then ditching one crutch then finally both. I started physical therapy exactly 1 month after surgery and went rougly 2-3 times per week. I stopped going regularly at the end of july because my insurance stopped covering my visits. Now I am trying to fight for more visits, but I haven't gone back since. So far I am pretty happy with my results, but it's still very early. I was an extremely active 25 year old prior to this surgery, and I am hoping to return to most of my activities. But I know with the running especially that may not be realistic bc it's so bad on the knees. So my daily 10 mile runs may be a thing of the past :( The game ready system is basically an ice machine-  you wrap the actual pack around your knee and it's attached to a connector hose which is attached to the water/ice & it automatically drains and fills back up for you so you can ice your knee easier. Let me know if you have any other questions. I remember how terrified I was to go through this, and talking with people and getting all my questions answered prior was the best medicine.

Courtney
7/08 Left knee microfracture
12/08 Left knee ACI biopsy
4/09 Left knee ACI/AMZ

Offline ajschnelk

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Re: Words of advice wanted! Will be having an ACI!
« Reply #5 on: September 14, 2009, 08:14:01 PM »
From what I hear, it's not too different then what you've already gone through.  Everyone tells me that it will be very similar to the microfx with a little more pain.  Otherwise, rehab will be very similar. 

I had a microfx 4yrs (throchlear groove) and I am considering giving ACI a try in November.   

Best of Luck!
 

Offline redlotus

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Re: Words of advice wanted! Will be having an ACI!
« Reply #6 on: September 14, 2009, 10:34:19 PM »
http://www.gameready.com/products/controlUnit.htm

Definitely try to get one if you can!  I can't imagine having to go through the recovery without one!

Offline etrusc0

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Re: Words of advice wanted! Will be having an ACI!
« Reply #7 on: September 18, 2009, 07:46:40 PM »
Kristen,

I disagree, this one will be much more work.  I had two microfractures one was an open microfracture on my patella, which was tougher but still not as bad as the ACI.  The ACI surgery is more pain and more rehab.  The pain is managed with pain meds so no issues there, but you will need help.  Be prepared for the first 3 weeks.  I took 1 week off work, 1 week I worked from home a little, then I had a friend drive me into work for the next few weeks.  I sit down at a PC and elevated my leg, then used the CPM at night 8 hours, while I slept ... not easy all the way around.  I am not trying to discourage you, just know that you will be in for much more than a microfracture.  There is a reason the mfx is outpatient and ACI is not.  A few people here have basically created a diary of their experience, I found those to be pretty accurate, you can learn a lot there.

You have a good doc so you are in good hands.  The scope for the biopsy will be nothing - walking again in a day or two.  I'm guessing in January it will be MACI rather than ACI especially with Dr. Gomell.  That alone should be a little easier than using the periostium, plus they are getting slightly better results with it, no overgrowth and the cartilage results are stronger. 

As for the rehab and equipment - CPM 8 hours a day, I used it longer than most for 16 weeks, but I had some scar tissue initially that I had to work hard to break up.  PT was light mostly around just bending the knee, I think the PT protocol up to 9 months can be found online.  I did have a brace that locked straight when I was moving about and as mentioned above basically took two weeks off work, but that definitely depends on what you do.  If you can sit and Ice at work then that may be enough, if not 3 may be better, if you need to walk .... it won't be easy.

Good Luck.  I'll check back in a few days if you have more questions.

-Mark

Left Knee
93 - broken femur, damaged cartilage
99, 01 - microfracture
05 - ACI - Patella, Trochlear, MFC (Dr M.)
11 - Osteochondral Allograft MFC (Dr M.)

Offline casey2291

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Re: Words of advice wanted! Will be having an ACI!
« Reply #8 on: September 27, 2009, 10:00:41 PM »
I also disagree that microfracture is similar to ACI.  Even though the rehab sounds somewhat similar, the rehab is much longer and much harder than microfracture.  I went into my ACI thinking that it would be very similar to my microfracture recovery and I was very surprised just how much harder the recovery was and just how much help I needed during the first several weeks post-op.  I was not prepared for just how difficult it was.  You have to be ready to commit yourself to at least a full year of rehab and a lot of hard work.    Even though it is a long and hard recovery, I found it to be worth 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 nikkiluv

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Re: Words of advice wanted! Will be having an ACI!
« Reply #9 on: September 27, 2009, 10:53:43 PM »
Hi Kristen,

I had an ACI and distal femoral osteotomy done by Dr. Minas on May 18th of this year. I have kept up my diary since then, in great detail. I suggest you check it out if you'd like to hopefully gain some insight into what it may be like. I never had microfracture before, but I have spoke with people who have, along with reading numerous diaries. I wouldn't ever compare the two, and think that ACI is a much more demanding surgery. The first 6 weeks I was in a CPM, a Bledsoe brace locked in full extension worn 24/7 unless I was bathing, doing my exercises, or in the CPM, along with being only toe-touch weightbearing (essentially non-weightbearing). I was able to ditch the brace at 6 weeks (I was told that at my 6 week post-op), and could start weightbearing. The next 6 weeks I spent still on crutches, increasing my weightbearing by 1/3 every two weeks. Then, I was on one crutch for about a week or two, and then finally was able to ditch the crutches completely.

Then, about 3 months into it once you're off the crutches and are starting to walk and get around better, etc. then comes the time where you feel like you can start doing certain things, and you won't be able to. You won't be able to because the cartilage will still be in the extreme early stages of healing, and won't be able to tolerate squatting, pivoting, etc. For me, the "awkward" stage is what's killing me, since it's hard to not be able to do things now that I feel "better." I'm no longer on crutches or in a huge post-op brace (I'm currently in an unloader brace which is 1,000 times lighter, less bulky, and functional compared to the Blesoe!), so I don't feel physically handicapped but I am.

I'm also still not back to work, as I work retail in a warehouse, and I'm a full-time cashier. So, I stand on a concrete floor for 8 hours/day, having to lift things etc. Since my job is so demanding Dr. Minas won't even think about clearing me until at least my 6 month post-op appointment, which is currently scheduled for November 5th. Right now if I went back I would only risk increased swelling, inflammation, pain, and damage to my cartilage implant.

I'm definitely not trying to scare you or talk you out of it. I just feel it's important for me to at least share my experience and not try to sugar coat it. It was extremely hard and there were of course times I regretted doing it, but now being 19 weeks post-op tomorrow i definitely feel like I made the right decision. Although it is still really early in the ACI rehab and I still have a ways to go, I do think I'll be better off once I'm fully rehabbed than I was before the surgery. Right now I still have soreness and stiffness in my knee, but it's a different kind of feeling than before the surgery, and definitely not the excruciating pain I was in before either.

So again, here's the direct link to my diary if you're interested http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=47374.0
 
Hope this information was helpful…good luck with everything!

Nicole
03/25/05 - RK debridement
12/22/05 - RK medial meniscal repair
10/31/08 - RK partial lateral menisectomy
03/13/09 - RK ACI biopsy
05/18/09 - RK ACI/DFVO
01/06/11 - ACI failure confirmed
*Currently awaiting call for fresh Osteoarticular Allograft Transplant cadaver match & removal of femoral hardware

Offline courtem10

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Re: Words of advice wanted! Will be having an ACI!
« Reply #10 on: September 28, 2009, 05:39:29 PM »
Nikki- are you going to now be using that unloader brace permanently for athletic activity??
7/08 Left knee microfracture
12/08 Left knee ACI biopsy
4/09 Left knee ACI/AMZ

Offline ajschnelk

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Re: Words of advice wanted! Will be having an ACI!
« Reply #11 on: September 28, 2009, 08:10:40 PM »
Okay, maybe saying it will be the same as a mfx is pushing it.  ;)   I guess I was referring to the overall rehab process...12months of intense rehab.  Of course there will be more pain since it's an open procedure, which will make the first few weeks much tougher, but like mfx, it's a long haul.  I remember rehabbing my knee post mfx for almost 2yrs and even then my OS said to give it 3yrs before claiming it failed. 

It's my understanding that most ACI procedures are outpatient nowadays. My OS is telling me that I'll have it in the AM and will be released in the afternoon.   

Although, i do think it all depends on the individual, location (Patella ACI being much worse) , and whether or not an AMZ, TTO, HTO, etc. is being done as well.  If the patella tendon is not elevated or moved and the OS is using Bioglide rather than periosteum, you could have a much smaller incision and a much easier recovery.  Folks that I've talked to that had it done this way said it wasn't much different from their mfx.   THere are some on this board and other boards that are attempting to run 10 months post aci and I couldnt' do that 10months after my mfx. 


Again, I think the defect location has a lot to do with it.  An isolated MFC, LFC, or Trochlea defect is much easier to deal with than multiple lesions that include the patella.     


Kristin: If I decide to have ACI in november, I'll be sure to post and let you know how it compares. Best of luck! :)

 
« Last Edit: September 28, 2009, 08:33:01 PM by ajschnelk »

Offline nikkiluv

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Re: Words of advice wanted! Will be having an ACI!
« Reply #12 on: September 29, 2009, 05:31:26 AM »
Ajschnelk,

I wouldn't say that most ACI procedures are outpatient. Even the Genzyme/Carticel people say you'll have a 1 day stay in the hospital. I think a big thing with people who had it as outpatient was managing their pain level. I think I know a few people on here even ended up in the ER to get pain management. It's definitely not a walk in the park!!

Also, using the Bioguide only changes the fact that you don't have to have a second incision for the periosteum. You'll still end up with at least a 4 inch incision on the knee. I DEFINITELY do not think having a Bioguide makes for a much easier recovery!!! It doesn't change the way that the cartilage grows and how it heals. You'll still have a CPM, be on crutches for 2-3 months, going through tons of rehab. The cartilage hardens over 12 months no matter what you do. Just because you feel great doesn't mean you're fine. In fact, like 4-7 months is the most challenging in ACI recovery, because you'll feel great and like you can do things because you'll be off the crutches, etc., but you can't. The cartilage is still too soft until at least 6 months. At 6 months the cartilage still has a "putty-like" consistency, and recoills after impact. It isn't until around 9 months that the cartilage is considered "hard," yet even at this point the cartilage can still mature up to 18 months. I'm a full-time cashier at a warehouse and I'm still out of work on disability leave because if I went back to work right now (and I'm 19 weeks post-op today from ACI and a DFO), I'd only risk increased swelling, pain, inflammation, and damage to my graft.

Also, I personally think it's too early to start running again at only 10 months post-ACI, especially if the cartilage can still be maturing and hardening up to 18 months post-op. After all I've been through with my past knee surgeries, and this one being the longest, most challenging, costly surgeries I've ever had, I'm not about to risk it all and throw it down the drain just because I want to run again. It's my personal opinion yes, but I'm going to do everything I can to conserve the cartilage I have left, along with the new cartilage that's created.
« Last Edit: September 29, 2009, 05:58:32 AM by nikkiluv »
03/25/05 - RK debridement
12/22/05 - RK medial meniscal repair
10/31/08 - RK partial lateral menisectomy
03/13/09 - RK ACI biopsy
05/18/09 - RK ACI/DFVO
01/06/11 - ACI failure confirmed
*Currently awaiting call for fresh Osteoarticular Allograft Transplant cadaver match & removal of femoral hardware

Offline nikkiluv

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Re: Words of advice wanted! Will be having an ACI!
« Reply #13 on: September 29, 2009, 05:57:25 AM »
Courtney,

I don't think or expect to permanently be in an unloader brace. Maybe just 1 year maximum. All of the rehab protocols from Dr. Minas say to wear the unloader for at least 6-9 months post-op. I also had a DFO, so that combine with the unloader only help to increase the joint space at the moment to create a happy environment for my cells to thrive and harden without additional pressure. It says underneath the comments section to wear the unloader with all activity until MD assessment at 1 year post-op. I go for my 6 month post-op November 5th and that's one of the questions I plan to ask is about the brace. I'll definitely let you know for sure when I find out!!! :)
03/25/05 - RK debridement
12/22/05 - RK medial meniscal repair
10/31/08 - RK partial lateral menisectomy
03/13/09 - RK ACI biopsy
05/18/09 - RK ACI/DFVO
01/06/11 - ACI failure confirmed
*Currently awaiting call for fresh Osteoarticular Allograft Transplant cadaver match & removal of femoral hardware

Offline ajschnelk

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Re: Words of advice wanted! Will be having an ACI!
« Reply #14 on: September 29, 2009, 04:44:43 PM »
Ajschnelk,

I wouldn't say that most ACI procedures are outpatient. Even the Genzyme/Carticel people say you'll have a 1 day stay in the hospital. I think a big thing with people who had it as outpatient was managing their pain level. I think I know a few people on here even ended up in the ER to get pain management. It's definitely not a walk in the park!!

Also, using the Bioguide only changes the fact that you don't have to have a second incision for the periosteum. You'll still end up with at least a 4 inch incision on the knee. I DEFINITELY do not think having a Bioguide makes for a much easier recovery!!! It doesn't change the way that the cartilage grows and how it heals. You'll still have a CPM, be on crutches for 2-3 months, going through tons of rehab. The cartilage hardens over 12 months no matter what you do. Just because you feel great doesn't mean you're fine. In fact, like 4-7 months is the most challenging in ACI recovery, because you'll feel great and like you can do things because you'll be off the crutches, etc., but you can't. The cartilage is still too soft until at least 6 months. At 6 months the cartilage still has a "putty-like" consistency, and recoills after impact. It isn't until around 9 months that the cartilage is considered "hard," yet even at this point the cartilage can still mature up to 18 months. I'm a full-time cashier at a warehouse and I'm still out of work on disability leave because if I went back to work right now (and I'm 19 weeks post-op today from ACI and a DFO), I'd only risk increased swelling, pain, inflammation, and damage to my graft.

Also, I personally think it's too early to start running again at only 10 months post-ACI, especially if the cartilage can still be maturing and hardening up to 18 months post-op. After all I've been through with my past knee surgeries, and this one being the longest, most challenging, costly surgeries I've ever had, I'm not about to risk it all and throw it down the drain just because I want to run again. It's my personal opinion yes, but I'm going to do everything I can to conserve the cartilage I have left, along with the new cartilage that's created.


Nikkiluv,

I totally agree with what you have said and while I wouldn't chance doing any  impact activities at 10months, I know many do.  Even carticel states that typyically running is allowed at the 8-9month mark and high impact stuff can be done 12-18mo.  Obviously it depends on the location and number of lesions.  I'm assuming you had biogide used since Minas did your surgery.  It's been proven that biogide almost eliminates hypertrophy (overgrowth) compared to using periosteum, this eliminates the unnecessary pain associated with overgrowth and creates better growth for the cartilage.  It's also shown that the cells mature into the subchondral bone better than with the periosteum.

The three OS's I've talked to all say that the surgery will be outpatient.  I have decided on Dr. Cole in Chicago to do the procedure if I elect to have it done. I have very little, if any, pain with daily activities... it's only painful when I attempt to do high impact stuff, so it's a tough call. 

I quickly read through your diary and I see that you had quite a bit of pain and totally see where you're coming from.   I wonder if your experience is due to the lateral tibial plateau location.  This doesn't seem to be a common area for ACI.   I have an isolated defect on my trochlea and most people I've talked to said that the pain was not too bad and that the first couple days are the worst.  markld, said other than the longer rehab that his aci of the trochlea has been less painful (was only on pain meds for a couple days) than the mfx.  The trochlea area is a non weight bearing location, so I'm sure this makes a significant difference when it comes to the pain level and overall rehab.   

It sounds like you have turned the corner and are on schedule for a successful recovery.  How bad were your symptoms prior to ACI and do you feel that it was a success thus far (from a pain level standpoint)?

Best of luck!
« Last Edit: September 29, 2009, 04:54:17 PM by ajschnelk »