Banner - Hide this banner





Author Topic: Words of advice wanted! Will be having an ACI!  (Read 8607 times)

0 Members and 1 Guest are viewing this topic.

Offline Murph324

  • MINIgeek (20-50 posts)
  • **
  • Posts: 35
  • Liked: 0
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

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
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

  • Regular Poster
  • ***
  • Posts: 93
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 35
  • Liked: 0
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

  • Regular Poster
  • ***
  • Posts: 108
  • Liked: 1
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

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
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

  • Regular Poster
  • ***
  • Posts: 93
  • Liked: 0
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 21
  • Liked: 0
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

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1011
  • Liked: 0
  • User's Text
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

  • Forum Faithful
  • ****
  • Posts: 268
  • Liked: 0
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

  • Regular Poster
  • ***
  • Posts: 108
  • Liked: 1
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

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
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

  • Forum Faithful
  • ****
  • Posts: 268
  • Liked: 0
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

  • Forum Faithful
  • ****
  • Posts: 268
  • Liked: 0
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

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
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 »

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #15 on: September 29, 2009, 04:57:37 PM »
Kristin,


What is the location of your defect?



Offline nikkiluv

  • Forum Faithful
  • ****
  • Posts: 268
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #16 on: September 30, 2009, 04:06:14 AM »
I have to be honest in that for me, most of the pain for the first month, and immediately post-op was from the DFO, or at least that's where I felt it. I probably had pain where I had the ACI too, but I never really paid attention to that because the bone pain was more intense, again, at least for me. I do know that people have had extreme pain from ACI and have ended up in the ER though, like I mentioned. Most of my soreness/pain began when I started weightbearing. The more I increased weightbearing, the more sore it became initially.

I know you mentioned that you will be (if you elect to) having your ACI and it will be outpatient. I've just heard of more people having it as an inpatient procedure (at least one night). From those that have had it as outpatient I have heard that their doctor only does the surgery at an outpatient place, therefore an overnight stay is not possible, or their insurance will not approve them for an overnight stay even if the doctor asks for one.

You mention that you may or may not have ACI in November...is your date already booked? I'm sure if you may be having ACI you've looked into the costs associated with growing the cells. If they prepare the cells for your surgery and you cancel or change your mind, you will be charged the cost associated with growing the cells, which is around $13,000, that you'd have to pay out of pocket.

 Before my surgery my knee was pretty bad, and although the degrees of soreness and pain varied, it was constantly there to some degree. I have quite the history with it, but it never was horrible and I pretty much could deal with it. It was actually pretty good for from August 2007-August 2008 and it really didn't bother me. It was in August 2008 I was at work, doing what I do every day a million times, and as I turned around my knee completely went out and that's when I tore my lateral meniscus. It was at that time where I started to experience the horrible pain on my lateral tibial plateau area. As I mentioned in my other post my job consists of standing on a concrete floor for 8 hours/day, which was usually what did me in. Stairs and climbing were a challenge. Thinking about attempting something like a treadmill made me cringe, just for the pounding and such associated with.

As of right now, I am 19 weeks post-op. I do feel confident that I will end up in a better place than I was before my surgery. I am still doing PT 2x/week (outpatient PT since July 2nd, the first 6 weeks before that I had home PT 2x/week as well). I have gained a lot of my hamstring and quad strength back, but still got a bit to go. My knee still gets kind of stiff and sore in the area of the ACI. It feels best immediately after I wake up, and usually the most sore at the end of the day. The reason for this (as I was told and know from what I've learned) is that overnight while I'm non weight-bearing the cartilage and tissues are able to absorb fluids to make everything more cushioned. Once I'm awake and in a weight-bearing position combined with gravity all day, the tissues and cartilage naturally lose some of that fluid it absorbed. Therefore, the amount of "cushion" I feel during the day isn't the same as in the evening. It's getting better, and PT definitely helps with their intense massage and ultrasound (ultrasound especially helps me the most) with the stiffness and soreness. Also, my knee felt a lot better over the last few months versus this past week or so, since the weather was nicer and more consistent. It's getting colder here in NH now, and it's been a bit damp and rainy these past few days, which doesn't help and changes the pressure inside my knee. Ice and tylenol seems to do the trick and help out a lot. I'm able to go up stairs pretty well, and am really close to being able to go down stairs normally. The problem like mentioned before is that right now I'm in the phase where "I think I can do more than I can because I feel oaky overall, but I can't because the cartilage isn't healed yet." So, it's just mentally hard sometimes to realize that I am making progress even though I sometimes feel like I'm not.

So, overall I do believe I feel better now than I did pre-op. I know it's still "early" in the ACI world for me, so again I'm staying confident and hope that the way I feel now will only get better and better as time goes on. I'm only 24, so I'm hoping that this will be the end of my knee saga for awhile and I'll be able to live life pain-free, because to be so young and feels so old really sucks!!

Hope this answers your questions! :)

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 ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #17 on: September 30, 2009, 02:43:50 PM »
Nicole,

Yes, I am aware of the cell growing process and will need to make a decision within the next two weeks if I plan on having it done in late Nov.  I don't have it booked, but there are a few days open that I can go with once I decide.  It's just a tough call given my symptoms, so my other options are to wait and see what happens during the next 6months to a year.  If I do have it done now, my goal is to have it late Nov, so that by spring rolls around my mobility will be fairly normal.  My microfracture was a success from the position of it filling my defect, however, it did not help much with the pain factor, so I'm not risking much by waiting...the trochlea groove is stable. 

You may be right about the outpatient/inpatient thing.  Although almost everyone I've talked to(within the last year) that has had trochlea aci was outpatient.   In addition to the outpatient piece, I (my wife) will more than likely drive home the same day, which is a 3.5hr car ride. Fun.Fun.

I know what you mean by the "i feel good", but can't do much time period...i was the same way after my microfracture.  I felt like I could do about anything after three/four months, but yet I had to wait until the 10mo mark before I could really test it.  I know it's more like 12-20mo before really testing with ACI, but i can relate and dread going through it again.

As far as your rehab goes, are you able to ride a bike outside of therapy? It seems like most seem to ride a bike (casually) around the 5 or 6month mark.   Regardless, it seems like you're pretty much on schedule for being almost 5months post.  ;)

Offline madel23

  • Regular Poster
  • ***
  • Posts: 99
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #18 on: September 30, 2009, 05:36:27 PM »
Hey there,

Did your doctor tell you why you still have pain even though the microfracture was a "success?"  I seem to be in the same situation, at 7 months post-op, with an MRI showing good fill, but still much pain. 

Offline nikkiluv

  • Forum Faithful
  • ****
  • Posts: 268
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #19 on: September 30, 2009, 06:39:26 PM »
I was able to ride a stationary bike as soon as I was about to achieve 90 degrees flexion, and roughly at about 4 weeks post-op. Although at this point it was mostly for motion as I couldn't really ride a bike "normally" at that point. It was about 6-7 weeks that I was able to ride a bike normally (not fast, and not with resistance), but I was able to make a complete revolution without getting "stuck" or having my knee feel really stiff.

I do have a stationary bike at home which I love, and do ride. I made the investment after my biopsy and before my actual ACI. I knew that it would be the first thing I'd be able to do following my ACI, and was told numerous times by my doctor, his PA, and others that "a stationary bike would become my best friend." It feels good to actually be able to do SOMETHING, and that's how I felt about it even when I couldn't do a full revolution. It was something more than SLRs and quad sets!

I'm completely okay if I never run again (I have never been a runner anyways). I just want to be able to live day to day and do things like skiing occasionally (maybe...I've had brand new ski equipment since 2003 that I've used MAYBE 5 times due to all my knee pain and surgeries since then), but mostly just day to day living without having to think about my knee! I'd be thrilled beyond belief if that's how I end up at the end of all this :)

As for your decision and such, I know it's a tough call especially with your symptoms. For me the deciding factor was of course my pain, my age, the timeframe that I had to do it, my awesome insurance benefits, the fact my job is so understanding and would hold my position for the long time I'd be gone, how quickly my defect went from okay, to bad, to horrible in such a short time, and what I plan on doing with my future.

My pain was bad enough for me to even be considering it. My defect was literally the ENTIRE surface of my lateral tibial plateau. It definitely got really bad in a short amount of time. I'm really young, and know that I am about to "rebound" from surgery and am more likely to be able to handle the demands of such a demanding surgery (crutching around, etc.), better over the older I get. I chose to have my ACI over the summer over the winter. Yes I did miss out on beach trips and such, but being in NH the weather can be awful and horrendous during the winter months. Chancing being on crutches in the winter and on snow and ice after such a big surgery wasn't for me. I've done it before and I lived in constant fear I'd fall. My job is extremely understanding (I've been there off and on for college summers since 2004, full time since 2007), and they just want me to get better over coming back too soon. Right now I get paid short-term disability. As for my insurance, I like to think I have amazing insurance. Having an MRI, x-rays, unloader brace, and biopsy surgery meant that everything for my ACI (hospital stay, home therapy, home PT, all my PT visits now) are "free," as I met my deductable and co-insurance easily. I didn't really even owe anything on the biopsy, either. So, that was also a consideration, not having to meet my deductable and co-insurance again if I had the surgery in a new year.

Mostly, the deciding factor was the time frame. I currently still live at home with my parents, in between graduating from college and going back to school. They were here so I was able to have the help that I needed during the challenging times immediately post-op. Also, I had plans of hopefully entering an accelerated nursing school program in January. So, if that worked out I knew I wouldn't be able to have the surgery for at least another year and a half from January. Also, I think the fact that I was "on a roll" with my knee surgeries (tearing my meniscus last August, surgery in October, getting referred to Dr. Minas and having my appt. in February, then the biopspy in March), I just said okay I'm going ahead with everything just get it all done and be over with it. I didn't wanna postpone something I knew I'd end up having at some point. I actually am very happy with the decision I made and don't regret it. It turns out that I actually got accepted into the accelerated nursing program in January, and the day I found out is the day I came home from the hospital after my ACI/DFO. I looked at that as a goal for me to work towards to get better, and a sign that things are finally turning around hopefully!

So, I know your situation is very different from mine, but those are a bunch of the factors I thought about. If your even considering it, then you must have enough pain that bothers you frequently. Like I said, once I made the decision to consider it I didn't look back and just went ahead with it. I guess you have to decide if your pain is really bad enough that you want to try something else to try and do something about it, or you can live with it and just see how things go from there.

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 ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #20 on: September 30, 2009, 08:25:26 PM »
Nicole:  Thanks for the info.

Yeah, my local OS is advising me not to go forward with it, but after meeting with Cole, he feels that he can improve things.  My local OS thinks that I COULD be better, but that it's not worth risking it since I don't have much pain with most daily activities.  I pretty much have no pain until my knee loads at 30 degrees.  This of course occurs when squatting, walking stairs, jumping, running hard, and when doing many sports.  If I don't load the knee hard at 30 degrees, I'm good.  I can stand and walk on my knee all day long, and day after day with no problems.  Even when I do stuff that creates pain, I never have swelling. 

My main reason for having the ACI would be so that I can become more active, which includes things like running (not marathon type running), downhill skiing, wakeboarding, hiking, etc.  And from what I've gathered and what Cole has told me, there's really only a 50% chance of getting back to full impact activities pain free and better than 80% chance of being pain free with normal day-to-day stuff.   I would be okay with not being able to do some of these things, but honestly that would be the primary reason for having the ACI and would be my goal from day one.  Then the other side tells me...why go through it if after 2yrs i'll only be able to do the same things I can do now...low impact stuff.   

I would be interested to know from people that are 2+years post ACI and are unable to do impact activities, the reasons why...is it strictly pain, or is it just the basic mechanics that are tough to perform due to the lack of strength and mobility of the leg and/or joint?

I am older than you at 33 and I haven't been the same person, athletically speaking, since the microfracture when I was 28.  If I do decide to do it, I was thinking the winter months would be best for rehab since I would be spending 90% of my time indoors anyway.  I would also hope to be off crutches by late December which is when the real winter weather begins here in Michigan.  I would hope that the crutches and snow will not be an issue, but I guess it could for a couple weeks. However, there are benenfits of rehabbing during the spring/summer as well...being able to get outside compared to being cooped up inside for 6+weeks is a huge advantage, mentally.   I also have two boys (one and four years old) and they definitely don't make my decision any easier. 




« Last Edit: September 30, 2009, 09:07:47 PM by ajschnelk »

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #21 on: September 30, 2009, 09:04:06 PM »
Hey there,

Did your doctor tell you why you still have pain even though the microfracture was a "success?"  I seem to be in the same situation, at 7 months post-op, with an MRI showing good fill, but still much pain. 

No clear answer.  From what I've been told and what I've researched, it's mainly due to the fact that the fibrocartilage is not has durable as true cartilage, so even with the defect filled, the tissue can be weak and cause pain.  It could also be due to an area or multiple areas that didn't quite fill as well.  My defect is about 80-90% filled, so what pain I'm feeling could be due to the small areas that didn't quite heal or a combination of the two.   One or both of these scenarios is probably what you're dealing with.   
« Last Edit: September 30, 2009, 09:06:10 PM by ajschnelk »

Offline madel23

  • Regular Poster
  • ***
  • Posts: 99
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #22 on: October 01, 2009, 04:37:23 AM »
ajschnelk,

Thanks for the info.  I really hope that's not the case with me, and that I just need more time.  I sure as hell don't want to go through surgery again.  I am in a similar situation to you, no problem with most daily activities, but distance running has been my life for the past 12 years, and I'd like to get back to it (I think I'll go crazy if not!).  The thought of doing an ACI, which is not even guaranteed to improve things, is horrifying to me!  I am going to see Dr. Cole in October, so that should be helpful, hopefully not too discouraging.  Good luck with everything on your end!

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #23 on: October 01, 2009, 04:50:08 AM »
ajschnelk,

Thanks for the info.  I really hope that's not the case with me, and that I just need more time.  I sure as hell don't want to go through surgery again.  I am in a similar situation to you, no problem with most daily activities, but distance running has been my life for the past 12 years, and I'd like to get back to it (I think I'll go crazy if not!).  The thought of doing an ACI, which is not even guaranteed to improve things, is horrifying to me!  I am going to see Dr. Cole in October, so that should be helpful, hopefully not too discouraging.  Good luck with everything on your end!


I hate to mention this to you, but I feel the same way today as I did 10months after my microfracture and that was 4+ yrs ago.  I actually ran often on a treadmill up until the last year or so....it's now too painful to do so, but I never got back to any high impact activities.  However, I remember hearing that it can take up to 2yrs before a microfracture fully heals, so you may want to give it some time, but if you don't seem to be noticing any improvement, it's probably not a good sign.  I had a new pain after my microfx and that new pain never did go away.  I still wonder to this day how I would be if I never had the microfracture, because what cartilage I did have covering the defect was removed. 

Did Dr. Cole do your microfracture?  Was it a scheduled microfx, or a surprise?


Best of luck to you.   
« Last Edit: October 01, 2009, 04:54:16 AM by ajschnelk »

Offline madel23

  • Regular Poster
  • ***
  • Posts: 99
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #24 on: October 01, 2009, 04:51:36 PM »
No, I've never seen Dr. Cole, but I will be in Chicago in a couple weeks and decided to make an appointment.  I still think things are improving, just really really sloooowly.  So hopefully by the 10-12 month mark it'll be better.  If not, I will have to see about other options--it would be nice if they'd come up with a way to reduce recovery time with ACI!  That is my main concern.

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #25 on: October 01, 2009, 05:17:36 PM »
I totally agree... is it the intial recovery time of 6-8 weeks or the long term recovery?  My only concern with the ACI is the first 2months, I will be able to deal with the 3-12months of recovery pretty well (i think).  Although, if you have a demanding job activity wise, it could be a tough 6-10months.   Keep me posted regarding the visit with Cole. 


Offline lady

  • Forum Faithful
  • ****
  • Posts: 303
  • Liked: 0
  • live well laugh often love much and play hard
Re: Words of advice wanted! Will be having an ACI!
« Reply #26 on: October 04, 2009, 10:31:41 PM »
My best advice with ACI (and any other surgery). Is follow docs orders to a T. It can very hard to want to do things when you are feeling "better" don't. And take the pain meds as ordered. I tried several time to lay off and really regreted it Years later and I still remember that was a big mistake. But I had 2 little kids at home and felt I couldn't be "high" all day.

My mistakes couldn't be helped. I need the surgery and I didn't have much help at home becuase of everyones work schedule, infact my husband had to get  a second job becuase I wasn't working. I had a 6 year old and a 2 year old at home. It was tough. Try to get as much help as you can even with tasks you think may be "easy".

I would stock up on some books you were interested in, maybe find some computer games or xbox type games. I was lucky that my family found some games I could play on the computer with my 6 year old. My dad when he could would take me for long rides so I wouldn't feel cooped up. I had my surgery in the winter and it is tough to get around on crutches on sheets of ice. When I was a kids I feel 2 weeks after major surgery on the ice. It was horrible. So I tried to only go out when there wasn't much ice.


oh and my mom inlaw made me cool lambskin covers for where your arm pits won't get sore. And she attatched a bag so I could put stuff like the house phone or if we were going out other stuff.
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #27 on: October 05, 2009, 04:11:09 AM »
lady,

I see that your ACI was a failure...when did you have the aci and do you know why it failed? 

Offline lady

  • Forum Faithful
  • ****
  • Posts: 303
  • Liked: 0
  • live well laugh often love much and play hard
Re: Words of advice wanted! Will be having an ACI!
« Reply #28 on: October 05, 2009, 09:11:16 PM »
I had it in January 1997. The 2nd person my doc preformed the surgery on and the last. No sure why it didn't work. My first sign of oh geesh what am I doing was when my insurance and hopspital were fighting over the $1000 a pop glue I needed. In the end the insurance company refused to allow the surgery unless I went with the free non FDA approved glue. And the hospital agreed. I was at the point of confussion and went with my docs judgement. (Dummy). Although I'm sure nothing bad has happened becuase of the glue I'm not sure if its part of the reason.

My doc didn't give me other options for surgery and at the time I had no way of knowing what was out there. The internet at that time wasn't what it is now so it was hard to get much info. I thought I had a great doc who had my best interested but now I relize he just wanted to preform the surgery more. I have found out the other guy he did's surgery also failed. He never told me about oats or other procedures. Which I found out he didn't the other guy either. He was my 2nd opinion and compared to the 1st I thought he was FABULOUS. Thats another story and rather very funny now.

I did everything to a T. I wanted it to work so bad. I had young kids and I didn't want to go through another procedure. Plus I didn't want to have to be out of work again. In the end a year later I was pretty sure it didn't work by 2 years later my doc was telling me to limit activity move to a house with less stairs, only swim for exersice and 5 years later had me looking for a desk job (i'm  a preschool teacher). I was devestated. He just kept pointing me off.  My stupitiy I stayed with the qukeroo so long. I really didn't want to go far (boston) because of my kids and how much time I would be taking for appt. and whateer else. It was stupid. I should have went to the best to begin with. I also stopped going to the docs. I think I say him a hlf a dozen times in 10 years. Everytime I went he told me what not to do. So I neglacted wat I needed to do the most. Anyways.....
I have kept up with info on ACI and I have learned it is much differnet and with the right doc with experience it is a great surgery. I would research the doc as much as you can and get a second opinion. Good luck. Where are you locate?
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #29 on: October 05, 2009, 10:15:04 PM »
I am in Michigan and will have have Dr. Cole in chicago do the procedure, if I elect to have it done. 

Offline lady

  • Forum Faithful
  • ****
  • Posts: 303
  • Liked: 0
  • live well laugh often love much and play hard
Re: Words of advice wanted! Will be having an ACI!
« Reply #30 on: October 06, 2009, 12:35:45 AM »
OMGosh. I just read my crazy post. I'm having trouble with my laptop key board but didn't realize how bad it was.

I wish you luck. You should read the threads where people take you through their journy of ACI. I have read them and think they are amazing. It really does seem like ACI has come along way. And like I said... you should have an exprierneced ACI doc and research thier success rate in this type of surgery. Ask them what they think the % of success is for your personal injury. Ask about OATS or other surgries.

Personaly I just declined an osteotomy ( for the 2nd time, now my doc knows I mean it). We have decided I will wear an unloader brace until I can't hold off a PKR anymore. Not sure if that was the right decission (my doc thinks it was a good way to go). My doc can only give me a 30% success rate and I don't think thats enough. Not to mention he said that if it does fail I will worse than I am now. No THANKS.

I just have to say how awful it feels to be in limbo. I think you should do something rather than nothing though. I would if my % of success was greater than 30%. That sounds funny coming from the person wearing a brace until the end of time. lol.

dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline lady

  • Forum Faithful
  • ****
  • Posts: 303
  • Liked: 0
  • live well laugh often love much and play hard
Re: Words of advice wanted! Will be having an ACI!
« Reply #31 on: October 06, 2009, 12:45:11 AM »
If this is your doc he sounds amazing. Check out the website I found if you haven't already.


http://www.cartilagedoc.org/rp.cfm
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #32 on: October 06, 2009, 03:25:11 PM »
If this is your doc he sounds amazing. Check out the website I found if you haven't already.


http://www.cartilagedoc.org/rp.cfm

Yep, that's him.  He's probably one of the top 3 that peform the ACI.  He's telling me that I'll have about an 85% of being pain free and about a 50% of being able to do high impact activities(basically everything).  This is the typical success rate with ACI today when dealing with an isolated defect. Mine is nonweight bearing, so I'm hoping to get back to almost 100%. 

Offline madel23

  • Regular Poster
  • ***
  • Posts: 99
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #33 on: October 06, 2009, 07:24:46 PM »
What does 85% chance of being pain free mean?  Aren't you already mostly pain free when not doing high-impact activities?  Running is a high impact activity, I'm guessing.

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: Words of advice wanted! Will be having an ACI!
« Reply #34 on: October 06, 2009, 09:59:41 PM »
What does 85% chance of being pain free mean?  Aren't you already mostly pain free when not doing high-impact activities?  Running is a high impact activity, I'm guessing.

Good question.  85% chance that normal day-to-day stuff will be pain free.  In my situation, this would inlude things like stairs and anything having to do with squatting.  There's not a day that goes by that I don't feel my knee, but since I don't have any pain with walking, the pain is always short lived and somewhat tolerable. 

Offline Room 101

  • Forum Faithful
  • ****
  • Posts: 379
  • Liked: 2
  • 2+2=5
Re: Words of advice wanted! Will be having an ACI!
« Reply #35 on: October 06, 2009, 11:16:12 PM »
Hey!  Dr. Cole did my ACI 10 months ago.  It was outpatient, and I happened to not have any issues.  I took 1/2 dose of Norco and that's it.  The Gameready was my life saver.  I agree with all those before me that said to fight for it.  I knew my insurance would not cover it, but I went with it anyway.  Totally worth it.  I am in a far better place already than before the surgery.  I had my AMZ done first and then my ACI 10 months later.  They were very different pains.  The AMZ was blood rushes for the first week and then really no pain... I was admittedly stupid and quit taking pain killers after 36 hours  ::) -- very bad idea. 

The ACI freaked me out because I completely lost my quad function as far as SLRs go.  I initially posted on here because after several weeks I still couldn't lift my leg without using my hands to help.  In hind site, it was just the location of the defect and my body being protective. 

As for being prepared, pretty much all the other replies sum it up.  I was bad about allowing help after the AMZ.  I just felt so useless, but I was much more mentally ready for the ACI having experienced the months on crutches earlier that year.  I go up & down stairs now and when I am done I think about the fact that i just went up & down stairs and didn't think about it  ;D -- I never thought that would happen...

Good luck,
Room 101
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 lady

  • Forum Faithful
  • ****
  • Posts: 303
  • Liked: 0
  • live well laugh often love much and play hard
Re: Words of advice wanted! Will be having an ACI!
« Reply #36 on: October 07, 2009, 01:39:19 AM »
That remindes me (thanks room 101). Strenghten your muscles as much as possible beofre you have surgery. Especialy your quad. Good lUck. Your doc looks great on paper.
dislocated patella and chopped off most of chondal 1985
chondroplasty/medial meniscus repair 1996
ACI  quater size defect-surgery failure
lateral meniscus repair2002
chondroplasty, lateral Meniscectomy2006
synvisc & orthovisc injections 2008/2009
drained and cortizone injection 2008















support