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Author Topic: Can I join the A.C.I. party ??  (Read 11968 times)

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Offline thornburg

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Can I join the A.C.I. party ??
« on: November 19, 2009, 12:43:07 AM »
Hello all !

My name is Angie and I have just scheduled my A.C.I surgery for 12/2/2009. Let the journey begin!

I have begun the preparation mentally, physically and my home environment. Does anyone have any wisdom they would like to pass along to aid
me in my preparation. I am seeking any suggestions anyone is willing to share!

A bit about me ... I am a 40 year old female who is very active and trying to deal with the concept I will be down and out of my activities for many months to come. This is my first major knee surgery, I have only had 2 prior to the A.C.I scheduled. A lateral release in mid-80's and then my scope to prepare for this next step a month ago.
The A.C.I. was determined to be the only fix for my pain, after seeking 3 OS opinions. I live in Indianapolis and having the surgery here in town.

Thanks!


Offline ajschnelk

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Re: Can I join the A.C.I. party ??
« Reply #1 on: November 19, 2009, 03:32:54 PM »
Hello angie and welcome to the club! I am having ACI on December 1st for a trochlea defect. What is the location of your lesion? What has led to your decision...Do you have problems with daily activities or only when you're active? Mine is more of the later. I had a microfx done over 4yrs ago and it never really fixed my issue, (actually made it worse), so I have decided after 4yrs to go forward with the ACI.

I am having Dr. Cole in chicago do the procedure. Being that you're in Indy, is Farr doing yours? Are they planning to do the ACI with a TTO or AMZ?. From everything I've gathered over the years and specifically the past 6 months, the first few weeks are the toughest pain wise and of course the first couple months are as well due to being NWB. Once we lose the crutches and are able to walk, it won't be bad except for the fact of not being able to do much for the next 6-8months. This can be the frustrating part becuase you'll feel like you can do a lot more, but can't due to the graft being unstable. However, as far as the overall pain and recovery, you'll get a lot of different opinions. There are a lot of variables that come into play as far as recovery...location of defect, number of defects, previous surgeries, age, and overall health/strength going into surgery, etc.

Best of luck and feel free to email me if you'd like to chat leading up to the big day. ;)

« Last Edit: November 19, 2009, 03:37:41 PM by ajschnelk »

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #2 on: November 19, 2009, 04:00:10 PM »
HI ajschnelk -

thanks for the reply! I'll drop you an email and we can chat more. :) Yes, Farr is doing my surgery!

The knee has always given me trouble since high school and with time/activity and age .. this is where I have ended up.
I decided to seek out Farr when no other OS in town could figure what the problem was .. I had been down the PT road about 6 times for many
months at a time, never with any long term results.   So .. found Farr and said, what the heck .. lets see what he can do.

The pain got to the point where it hurt and ached 24 x 7 .. then add activity on top of the general pain .. it was influencing what I did on a daily basis. I reached a point when I walked my 2 dogs every evening within 10 min into the walk, pain increased and could feel the knee cap just rubbing.
Stairs were impossible . going up or down!
That is when I said, no more .. someone out there has gotta have a fix.

I'll look up what Farr said in his letter regarding the specifics for location and grade of lesion.

Talk to you more soon!

Angie

Offline marsbar738

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Re: Can I join the A.C.I. party ??
« Reply #3 on: November 19, 2009, 06:21:08 PM »
Hi Angie
I had ACI stage 2 on the 28th Oct just 3 weeks ago, I smashed my patella in July 08 and this is the 3 attempt to fix me.  The area of damage is approx 2cm round according to my consultant, and its the bottom part of the patella.  So basically I have problems bending from a straight leg, its the first 30 degrees which are my problem.

I am happy to answer any questions on the surgery and keep you update with my progress.  I am in the UK and and had the surgery on the NHS with Tim Spalding.  his web site is www.timspalding.com its worth a look, even if your in another country it will show you his patient info.

Let me know if I can help.  I understand the bit about being active as a police officer, I need to get fit to get back to work.

Tash

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #4 on: November 19, 2009, 07:55:25 PM »
Hi Tash -

wow, 3 weeks ago!  so, how is it going?   what can and cant you do of this point?  how is the pain 3 weeks into it?  You doing physical therapy yet and how often.

Honestly I dont know where my damage area is on my knee, however per the doctor notes:  "defect is 24mm medial to lateral and 60mm medial to proximal distal.  It is a deep grade III-A with intact trochlea."  No idea of the actual size. After the scope he said it was about the size little bigger than a quarter in an oval shape.   
My pain was all the time and really painful when in the bent position and any weight on the leg at all.  It now hurts just to walk!
 
I do have a question for you .. and anyone else who can guide me.  How does everyone get home from surgery in a car if your leg is in a brace keeping it straight??  I am struggling to figure out how I am gonna fit into even the backseat of a car with one leg locked out in straight position.
I just keep reading about the brace that locks your leg out .. trying to figure out how to move around with this thing.

More later,
Angie

Offline marsbar738

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Re: Can I join the A.C.I. party ??
« Reply #5 on: November 20, 2009, 09:58:55 AM »
The brace is the whole leg, and I am so looking forward to seeing the back of it.  Now I think I have had it easy, compared to some people.  I read so many links about the pain and thought it was going to be as bad as when I smashed the knee 16 months ago, but thankfully its bee great so far.
I had a nerve block in the leg during surgery, so apart from the noises and getting used to the feeling of the brace I had an ok first night sleep post op.  No real pain.
First morning, I had physio and I was able to bend the knee whilst laying on the bed to around 45 degrees, yes it hurt and my knee looked the size of a rugby ball, but I could do it.  Don't let the worry of pain stop you.  As I could bend my knee so well I have not used the CPM machine.  I was able to FWB from day one on crutches, and if I walk around the house its not a problem.  Walking to the shops which is 5-10 mins is enough to put my pain up to 8-10 and I can't touch my foot to the floor.  (this is still the case week 3) I have spent allot of time on crutches so physio was happy to let me come home as soon as the consultant was, so by 17:30 that day I was on my way home.  Just one night in hospital was enough.
The journey home.  well I presume you are in America,  and I am in the UK so are cars are small and I managed.  Just push the seat back all the way and take a cushion for the foot well to rest your leg on. 
I have hurt my right knee so when I get in now, I have found I cannot lift the leg up to get in so I turn backward to the car and lift my bad leg in backwards and the twist myself round and slide the leg as far in as I can, and gradually lower myself in.  I spent 4 months after my last op working out the best way to get in and out and that works for me.  I have never tried to get into the back of the car, I think that would almost kill me.
So pain for me has been ok, as long as I stay in the house, and do exercises and rest and ice.  I have been able to go without any pain meds since day 2 and only take them if I go out into the big wide world.
I have had my 2 week review and am allowed to progress faster than his guidelines to bend the knee to 90 degrees.  So 2 weeks and 1 day I got to 90 degrees and was allowed to do 3 set of 500 reps on an exercise bike no resistance.  I managed to do that 2 weeks 4 days, pain is interesting for the first few rotations but after that I am able to do it almost pain free.
Swelling is coming down really well and starting to look a little more like an english football rather than a rugby ball.  Scar, now I had a big scar from the first op, so this was not a problem but yes it will be around 6-10 inches long and it will not be pretty to start with but it fades and if your knee works afterward, I would be proud of the scar.
I have had 3 weeks of physio once a week, and do exercise every day.  500 reps exercise bike 3 times a day.  Stand on one leg (bad leg) locked out straight and balance.  straight leg raises. quad exercises and also still maintaining the 90 degrees of ROM.
I am now allowed to release the brace when sitting, but with no real weight going through it.  I can now sit in a chair, as when the brace is locked its difficult.  Also going to the toilet is not such a trial any more.  I will let you figure that one out for yourself.  When I need to stand I have to use my good leg to lift up my bad one and straighten it out so I can lock the brace back to 0 degrees.  I am not allowed to put any impact through the knee from 1 degree to 30 degrees as it is the first part of the knee bend that has been effected.
I have 3 weeks left in the brace and am so looking forward to throwing it away.  Sleeping in it, is difficult you just can't get comfortable, nothing has helped me, and I wake up with groin pain, back pain and hip discomfort, but I do normally sleep on my front so sleeping on my back is a problem anyway.
The brace once you get used to it gives me confidence and I can walk a few steps with no crutches and no pain when it is locked out.  If you lock your bad leg out straight and walk around you will get the idea of how it will feel.  Thankfully its cold here, as my leg gets pretty warm in it, so you might need your AC on.
I hope to go to the pool next week, but have no idea how I will get in or out the pool, and worry about falling.
I think I will go backwards big time when the brace comes off, as my problem is the initial bend and to walk I will need to be able to do that.  SO fingers crossed.  I know this is a long recovery and I seem to be doing well, but am prepared for the downside as well.  I know I will not be allowed to do any open chain exercises for 3 months.
Hope that helps
Tash
 :P

Offline Rennschnecke

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Re: Can I join the A.C.I. party ??
« Reply #6 on: November 21, 2009, 12:01:27 AM »
Hi Angie

Unlike Tash I have been travelling in the back of the car when keeping my leg straight.  I found this simpler.  I would get into the car backwards as if doing a squat on one leg (the good one), then I would slide myself backwards.  I could then keep my braced leg up on the seat with cushions/blanket around to make it comfy.  Buckling up isn't so easy though.  If you have some distance to go you may also want to think about taking some ice packs around for swelling.

Moving around if FWB was fine.  I just shortened to stride length to make it even.  In fact, I still have a tendency to walk straight as my knee complains when I flex the knee when FWB.  When it is straight it feels strong!

Like Tash, the pain wasn't too bad to being with and after having chronic pain I felt I should come off everything.  Unfortunately, my pain levels have increased so I've got to manage this more carefully.

Hope all goes well for you!
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

Offline marsbar738

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Re: Can I join the A.C.I. party ??
« Reply #7 on: November 21, 2009, 08:49:17 PM »
Rennschnecke how far along are you, as I am interested in what is around the corner for me.

regards
tash

Offline Rennschnecke

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Re: Can I join the A.C.I. party ??
« Reply #8 on: November 22, 2009, 08:26:04 PM »
Tash, I'm almost 5 months post-op but have had complications with scar tissue restricting ROM.  I don't think I will necessarily be a good model for you as you seem to be way ahead of where I was, but I'll let you know what I have experienced.

I was doing well for the first 8 weeks but only just got to 90 degrees on the CPM.  However, unlike you I was immobilised for the first week and wasn't allowed to bend the knee for the first week.  I got to 45 degrees by my 2 week check but struggled to get to 90 degrees for my 6 week check, which was at 8 weeks.  As I didn't get past that by 12 weeks I have since had an MUA and am now recovering from that.

Pain-wise, apart from the first day I was great for the first 8 weeks but then the pain on waking began to come back.  Now I have pain when waking and during/following exercises.  I have almost full ROM but little of that is available with weight-bearing.  But as I said this may well not apply to you.  It sounds as though you will not have any scar tissue problems while I am trying to research as much as I can about the stuff.

I suspect from what you have said so far that your recovery will go really well and you may find yourself in the position of having to hold yourself back because the cartilage growth won't be rushed.

Best of luck and keep smiling!
 ;D
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

Offline marsbar738

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Re: Can I join the A.C.I. party ??
« Reply #9 on: November 23, 2009, 01:13:46 PM »
Many Thanks, hope you continue to improve.  Not looking forward to trying to WB without the brace. 
Fingers crossed for us all

Tash :o

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #10 on: November 23, 2009, 01:27:37 PM »
Hello Rennschnecke -

Thanks for the tip about the back seat traveling!  I practiced yesterday with a board taped to my leg to keep it straight, not easy but think it will be managable to get home!   I have been doing one legged squats to strengthen my "good" leg!  When were you allowed to do WB?  Tash seemed to be able to do it much sooner than what I have read from others on this site.
------------

Rest of the A.C.I family -
Also .. what was the average length of stay for everyone post surgery?   I have heard I should except to be released within 23 hours.
anything special I should expect for hospital experience?   if you cannot tell, I was not given much pre-surgery info by the facility or doctor. 
Thank goodness for all of you!   ;)

Anything else I can expect that has not been mentioned so far around here?

I have my house about ready for the recovery process:  toilet seat riser (that was an embarssing purchase!), shower chair .. my dogs are going to grandma's (my mom's) for a bit of stay.   I have someone to help me and watch me sleep (ha!) 24x7 for the first week.

thanks again for all the info!

Offline Teepers

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Re: Can I join the A.C.I. party ??
« Reply #11 on: November 23, 2009, 04:36:10 PM »
HI I am 3 weeks post surgery for MACI, the one thing to be prepared for is boredom and frustration. I am NWB for 6 weeks, however after 1 week I was told to start bending the joint, I can now bend 100 -110 degrees with little pain. I found that I could get into the bath on day 3 by taking the weight on my shoulders when putting the bad leg down, once the sitches are out I started to have a shower instead. I have also found that you can do all the research you want but everybody reacts differently. I have tried to be as active as possible with 3 kids I have had no choice, I have also been lucky with the pain, although it does ache at night.
Things that have surprised me:
 1 The pain not as bad as expected
 2 Provided your careful you can do more than you think getting around
 3 It will swell alot to begin with especially when doing your exercises, however this calms down around week 2 onwards
 4 The physios have a protocle but don't get to fixed on it, everyone reacts differently no 2 injuries are the same.
 5 The brace is your best friend otherwise you would be in a cast, by about the back end of week 2 I was able to bend my knee in the brace so getting in the car was much easier.
 6 I spent the first 2 weeks inside, just going out for physio etc. This is the dull bit but I think it was worth it as I haven't had to much of a problem with swelling.

In regards to hospital stay I stayed 2 nights, but was offered a third however i went home and I wish I hadn't.
I started a thread 'MACI info' which shows how I have got on over the last 3 weeks feel free to give it a read.

Good luck 

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #12 on: November 23, 2009, 05:04:09 PM »
thanks for the info!  I'll keep you updated on how this goes!

I do know that I will not stay overnight post surgery, I guess unless unexpected complications arise.  I heard I'll be in a CPM before departing the surgical center.

I do plan on taking 4 weeks disability from work, so i'll be planted at home in bed or on the sofa with my laptop and TV.
Even thought I do a desk job, I don't want to push it to soon.

Offline Rennschnecke

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Re: Can I join the A.C.I. party ??
« Reply #13 on: November 23, 2009, 06:36:47 PM »
Hi Thornburg

As I had a patella and trochlea repair, I was allowed to WB in a straight-leg brace from Day 1.  I was in hospital for 2 nights, which was fine for me.

If you're in hospital for 23 h it sounds as though you'll spend one night there, but will officially be classified as a day-case for insurance.  I think that advice from others in a similar situation has been make sure you have adequate pain management, e.g. nerve block and plenty of meds on hand (just in case) as you don't want to end up in ER.

During time at home, you might want to have a box of goodies nearby to save you trundling to the kitchen all the time.  Make sure your ice machine is nicely stocked to keep your knee cooled.

I wouldn't try to overload your good knee too much before the op as it'll be so loaded while you're recovering that you may find it gives you pain in protest.  (Mine went on strike last night and I found it tricky to get up from the floor.)

Let me know how you get on with work and CPM.  I never managed to sort it out and now curiosity is driving me ... ::)
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

Offline ajschnelk

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Re: Can I join the A.C.I. party ??
« Reply #14 on: November 23, 2009, 10:17:30 PM »
Hi Angie
I had ACI stage 2 on the 28th Oct just 3 weeks ago, I smashed my patella in July 08 and this is the 3 attempt to fix me.  The area of damage is approx 2cm round according to my consultant, and its the bottom part of the patella.  So basically I have problems bending from a straight leg, its the first 30 degrees which are my problem.

I am happy to answer any questions on the surgery and keep you update with my progress.  I am in the UK and and had the surgery on the NHS with Tim Spalding.  his web site is www.timspalding.com its worth a look, even if your in another country it will show you his patient info.

Let me know if I can help.  I understand the bit about being active as a police officer, I need to get fit to get back to work.

Tash



Rest of the A.C.I family -
Also .. what was the average length of stay for everyone post surgery? I have heard I should except to be released within 23 hours.
anything special I should expect for hospital experience? if you cannot tell, I was not given much pre-surgery info by the facility or doctor.
Thank goodness for all of you! ;)

Anything else I can expect that has not been mentioned so far around here?

I have my house about ready for the recovery process: toilet seat riser (that was an embarssing purchase!), shower chair .. my dogs are going to grandma's (my mom's) for a bit of stay. I have someone to help me and watch me sleep (ha!) 24x7 for the first week.

thanks again for all the info!



marsbar738: Did you have an AMZ/TTO done along with the MACI or just an MACI?


I am heading to chicago a week from today for my trochlea ACI and they are sending me home the same day. I'm not sure if it's the best thing to do being that I have a 3.5hr car ride, but they are confident that I'll be fine. I will have the game ready ice system plugged in and plan to sit in the back of an suv.





« Last Edit: November 23, 2009, 10:19:41 PM by ajschnelk »