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Author Topic: Can I join the A.C.I. party ??  (Read 11967 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 »

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #15 on: November 24, 2009, 01:52:05 PM »
ajschnelk -

eek, 3 hour car ride post surgery!  atleast you'll have good drugs to pass the time by!   :) 

Good luck if we don't write much before you head to Chi'town.   Seems like we will be lock step with each other for rehab - we'll stay in touch
and support each other thru the boredom and pain!    :-\

I am just ready for to all to begin, as I am sure you are!  the waiting is getting irritating now.   I woke up this morning my normal knee pain, the lovely daily ache that I am so ready to get rid of.


Offline ajschnelk

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Re: Can I join the A.C.I. party ??
« Reply #16 on: November 24, 2009, 04:43:02 PM »
yes, we'll definitely have to keep in touch as we recover.  Unlike you, I don't really deal with much daily pain...I'm one of the rare ones having it done in hopes of becoming highly active again.  If I had to make a decision based on my daily pain, I would not have it done.  I can walk endless miles pain free, it's the strong loading, stairs, and high impact stuff that causes me pain.  I can deal with the pain, the part I'm trying to prepare myself with is the boredom and 6-8wks of being on crutches. 

The silver lining is that I'll be able to spend the month of december home with the little ones. :)

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #17 on: December 02, 2009, 01:58:29 PM »
surgery day has arrived, let me go get this done!

wish me luck!

Offline Room 101

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Re: Can I join the A.C.I. party ??
« Reply #18 on: December 02, 2009, 10:33:06 PM »
Hope everything went well for the 2 people having surgery this week!  I have been in Hawaii for 10 days, and will update my diary soon.  I definitely concur about back seat riding.  It was necessary.  I actually needed my hubby to help me by holding my leg for a while when getting out... so it wouldn't go crashing to the ground... I hope you guys recover well and look forward to following your rehab!

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 thornburg

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Re: Can I join the A.C.I. party ??
« Reply #19 on: December 04, 2009, 11:47:00 PM »
48 hours post. Textbook procedure per Doc. Defect was low kneecap, 70% of kneecap. New post at blog http://thornburg99.wordpress.com/

How soon could everyone do PT exercises? I can't lift leg unassisted.

Offline ajschnelk

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Re: Can I join the A.C.I. party ??
« Reply #20 on: December 05, 2009, 02:23:16 AM »
glad to hear...I'm 24hrs ahead of you and mine went as planned as well except for the AMZ. I had that done as well.  My defect was much smaller than what my OS(based on the pics) had thought it was going to be with it just under 2x2cm. My pain was bad for one day and is currently not too bad.  I could probably stop taking the pain meds, but will probably keep popping them to be safe.  best of luck with the recovery.

Offline Rennschnecke

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Re: Can I join the A.C.I. party ??
« Reply #21 on: December 07, 2009, 12:56:38 AM »
Glad to hear that everything went well for you all! :)

PT – well I started some immediately, e.g. ankle pumps, quad sets and SLRs.  I was immobilised for 1 week so no CPM and I didn't feel too bad with the brace (but not brave enough to ditch pain meds as I've had a dreadful year yo-yoing with pain from trying to drop my doses stepwise.  Going for a tapering approach this time.

Don't worry too much about comparing yourself with others though.  Your op will differ by size, position, aspect and possibly other procedures which makes comparisons complex.  I know that some people had problems with quad strength for leg lifts for a while – they sometimes shut down from pain.

Hope you continue to improve! ;)
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 thornburg

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Re: Can I join the A.C.I. party ??
« Reply #22 on: December 07, 2009, 01:51:07 AM »
thanks for checking in Rennschnecke!

each day seems better and the pain level has dropped dramatically in the last 24 hours!  I am tappering down the pain meds now.

first post-op doc appt tomrrow, anxious as I have lots of questions!

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #23 on: December 09, 2009, 01:12:04 PM »
first post-op follow up (5 days) and first week status:

its been a week now since surgery!  is it a milestone?  ;)

OS said all looks really good!  I need to hit exercises harder and stay in the CPM machine and push it to as much as I can tolerate.  I was at 30-35 degrees when I saw him, the goal is 90+ by 12/16 when I have staples removed.  No bending that knee unless its in the CPM machine, he said!

Straight leg raise:  still not successful!  I keep trying and was told if not successful by next week, going to PT to get the quad firing.  Very frustrating!
He said it is due to the nerve block and amount of swelling I am having, need to wake that muscle back up!

Pain level is down greatly!  down to 1/2 a pain pill post rough exercise session.

so, all is progressing as expected it seems.  next steps to be provided at next appt on 12/16 when I get staples removed!!!!! 

more later ...

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #24 on: December 09, 2009, 08:24:51 PM »
question for all ...

how many of the ACI'ers had ONLY the ACI ?  I feel "strange" not having the AMZ with my ACI.  I have read so many post on here about the ACI with other procedures, but very few who had only the ACI?  I gotta trust in my OS and I do, just seems to be one of the "lucky" and unusual ones.

just curious!

thanks!

Offline ajschnelk

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Re: Can I join the A.C.I. party ??
« Reply #25 on: December 09, 2009, 08:50:31 PM »
question for all ...

how many of the ACI'ers had ONLY the ACI ?  I feel "strange" not having the AMZ with my ACI.  I have read so many post on here about the ACI with other procedures, but very few who had only the ACI?  I gotta trust in my OS and I do, just seems to be one of the "lucky" and unusual ones.

just curious!

thanks!

To be honest, I'm very surprised you did not have an AMZ/TTO done.  My OS says that he automatically does it with any patella defect and will do it just to increase the chances of reducing overall pain.  THe only reason why he did mine is becuase he noticed that I had a soft spot on my patella, but no real damage or defect area.  The whole purpose is to unload the pressure of the patella.  Maybe the location of your defect had something to do with it.  I'd definitely ask especially since you already said  your OS had it listed as a possible procedure going into surgery.

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #26 on: December 09, 2009, 09:50:01 PM »
I did ask and was advised the way my knee is positioned, if the AMZ was performed it would have actually added more
pressure to my patella and defect region.   So, he advised to leave it as in his view did would have not offered any benefit, perhaps make
things worse.

I often wonder of my lateral release in the mid-80's help to prevent the need for the AMZ as it was to relieve the patella
pressure way back then, just me the patient wondering?

I am going to dive into the topic more when I see him next week.  i'll share any info I get!

take care!

Offline Rennschnecke

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Re: Can I join the A.C.I. party ??
« Reply #27 on: December 15, 2009, 12:31:25 AM »
Hi Thornburg

I've have just had ACI – no other procedures.  This was probably because my defects were due to trauma not uneven wear and pressure.  I've seen a paper that indicates a higher success rate for those with an alignment corrective procedure compared with those without.  However, some surgeons may refrain from carrying out some procedures prophylactically as they may introduce additional complications.  Your lateral release may well have meant not other procedures for you at this time and the fact that it was considered by your surgeon but rejected means he made the decision on some rationale and did not simply overlook it.

Hope you get reassurance from your OS at the next appointment.

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 #28 on: December 16, 2009, 03:47:28 AM »
Rennschecke is probably right on with his statement above.  I didn't really have any wear or alignment issues, but Cole tends to do the amz routinely when doing aci.  He shared a long term study that he did and it shows that an amz will unload the patella by 30% and feels that regardless if there are tracking or wear issues that the reduced pressure will only help support/protect the aci graft when fully matured. 

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #29 on: December 16, 2009, 09:40:01 PM »
Two Week post-op follow up:

I got my staples out and the knee looks good, he says!  However, I got a 'lecture' that I am way behind on my ROM.  :(   I am only at 69 flexion (as I sit in the CPM now) and I need to be at 110+ by next wednesday (a week!).   I am allowed to bend the knee as long as no weight is on it.  I need to sit on the edge of a bed or counter top and let the leg hang, getting the knee to 90 degrees.  I also need to not wear my brace when I am around the house.  I need to start putting weight on the leg.  I am headed to PT next Tuesday (12/22) to get this quad working and we will work on ROM there too.
So, visually he said swelling is normal and the incision looks good.  Just now to need to really focus on bending and ROM.

He said by the next time he says me in 2 weeks, I should be able to ride a stationary bike at least one revolution.  EEK .. that seems like quite a goal!

I did ask about the decision not to do the AMZ, he explain how the knee cap was lying and the position of my defect/wear area, it just did not make sense to do the AMZ.  He felt in could do more damage as the alignment and spacing looked fine in his opinion.  I gotta trust that!

I'll am just so nervous about bending the knee .. afraid to damage the area he patched up.   I assume everyone feels this same nervous/fear too?
Anyone know or heard of someone one who actually has damaged the patch?  I wonder how often that happens or are we all so scared, we are more careful than we truly need to be?

I'll keep updates coming .. hopefully I will reach my goals !!!!

Offline Room 101

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Re: Can I join the A.C.I. party ??
« Reply #30 on: December 17, 2009, 01:02:30 AM »
Hi, thornburg.  Glad all went well at your appointment.  The great news is the incision looks good and has no infection... good luck with all your ROM goals.  I was on the opposite path as you.  I was limited to 40 degrees for 2 weeks and then 60 degrees for 2 more.  I wasn't allowed past 90 for 3 months.  Don't fear bending the knee with no weight (in CPM or hanging).  All will be well.  There isn't any compression at that point.  Just be careful when you're up & about  :P  -- I know there are graft failure stories on this site, but I don't believe as early as CPM or anything, but I probably pushed any out of my mind to stay in a positive light  ;D 

I worried a lot when I started more aggressive PT and was off crutches.  I think it's perfectly sane to be that way.  I actually am still really careful, especially with all the ice & snow we've had already.  Dr. Cole always kept me pretty stress free to be honest.  He kept assuring me that it would take quite a twist to break anything.  That was after the brace came off and all.  Just keep doing what you're doing and as long as you're moving around with the brace on as the doc said, you'll do great. 

Keep up the good work, and don't stress or worry too much.  You'll do great by following your doc's directions  :D

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 ajschnelk

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Re: Can I join the A.C.I. party ??
« Reply #31 on: December 17, 2009, 03:08:14 AM »
Thornburg - every doctor seems to be different in terms of flexion.  I have not gone past 45 in the cpm and I'm at day 15.  I was told to try the dangle method over the bed to get it to 90, but I have not yet felt comfortable enough to try this.  I may or may not try it before my appt. on friday.  Like Room101, I believe after friday they will have me increase the cpm 5degrees per day up to 60 through week four. 

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #32 on: January 14, 2010, 02:55:06 PM »
6 Week Post-Op Update

Saw the doc and took x-rays, all looks good on the "inside", so far.   The spacing looks good and he seem pleased with what he viewed at this point in the process.

I am officially off crutches, unless I feel need 1 for extra support on those long walking trips through Target.  I am cleared to do more exercising like stationary bike, swimming with flutter kicks only, walking in the pool, eliptical (about a week or so), walking and all the leg lifts my heart desires.   NO stairs or inclines or loading of knee for 6 months!  I have 1 week of PT left, then on my own!
I now just need to focus on strengthening my leg/quad and not loading the knee!   He said, listen to you knee!  It will tell you when you are doing too much or is not ready for a particular exercise.

I feel pretty good, still have my bad days.  Usually after I have over did it the day/night before.   It is really a challenge to remember not to load the knee.

Anyone got any feedback from their experience on how the next 6 weeks should go or suggestions!   I guess this is the part of recovery/rehab that every warned about, the time when damage can still occur but yet feeling ready to do more ????   I did not get a RX for patience pills !   ;D

Thanks!

- thornburg

Offline Room 101

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Re: Can I join the A.C.I. party ??
« Reply #33 on: January 14, 2010, 08:22:46 PM »
Hi, Thorn.  Sounds like you're doing great.  Nice work!  It gets very difficult to hold back, I can tell you that.  I have learned great discipline and patience comes and goes.  I stayed in physical therapy for around 5 or 6 months.  I think it helped contain my enthusiasm.  My therapist and my trainer were very good at wearing me out 4 days a week without bearing weight.  Enjoy the biking and walking and just be mindful.  It was the toughest part of the rehab, mentally.  I was somewhat in the same boat from months 6-12 also... although I could do limitless walking/biking and start moderately loading my leg. 

Take care,
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 Rennschnecke

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Re: Can I join the A.C.I. party ??
« Reply #34 on: January 15, 2010, 01:43:32 AM »
Hi Thornburg, you're doing just great! : ;D ;D

I had complications at this stage.  Loads of scarring limited ROM so back to OR at 14 weeks post-op – haven't felt tempted to overdo it as far as cartilage is concerned so maybe it'll be OK in the end.  I hope so!

That said, I had decided to adopt an evolutionary approach by having a programme for 6 weeks and slowly progressing that 10% every other session then review.  Your PT may do that anyway to take the thinking off your mind.

Enjoy your new-found freedom! :)
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 thornburg

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Re: Can I join the A.C.I. party ??
« Reply #35 on: February 22, 2010, 08:59:52 PM »
3 month post-op update:

Hello All ACI'ers!  Well, I am 3 months post op on my left knee and saw the OS today.  He said all looks good, swelling is down and ROM looks good too.  Strength is slowly (very slowly) returning too.   I am to keep doing what I have been doing, guess we can call it status quo!

I am up to 45 min on recumbent bike ( stop there due to boredom) and 10 min on elliptical machine.  the "spinning type" bike did that a few times and knee was not ready so backed off that style for a bit.  May try it again in few weeks.  I am walking almost normal, no limp and can last about 45 min before the knee gets tired (my dogs are happy for this too).  Been swimming a whole lot, several times a week .. the knee really likes swimming!  < Just keep swimming >  ;-)

Goal is to increase time on elliptical machine and see if I can get the quad a bit more defined.

anybody got an 'new' exercises that I can try when at gym .. getting bored with STL, balancing on the one leg, hamstring curls!

Next follow up is 6 months .. where he said I can do stairs and more than 30 degree WB bend with my next visit ... I am sooo looking foward to May now!!!

Thanks for listening!  I'll drop in again in a few months!

- thornburg

Offline Rennschnecke

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Re: Can I join the A.C.I. party ??
« Reply #36 on: February 22, 2010, 10:23:48 PM »
Hi Thornburg

Here are a few exercises you could check out with your PT (you may already be familiar with them): exercises on a gym ball (e.g. hip raises); exercises on a bosu or cushion or wobble board in line with your protocol (I was doing mini squats 1 and 2 leg); lots of core and glutes work (e.g. backwards walking).

As I said, check these are OK for your with your PT or OS, though it sounds like you're doing really great! :)

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 reepler

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Re: Can I join the A.C.I. party ??
« Reply #37 on: February 23, 2010, 12:07:28 AM »
How are you doing so far with with carticel?  I also see Dr Farr in Indy!  He is one of the best.  He did a carticel implant in my right knee almost 10 years ago.  I was part of the STAR study when he first began doing the carticel implants.  It was a long road to get back on my feet.  It took almost a year before I could function back to normal activities.  I now am having a cartilage allograft done by Dr Farr on my left knee.  I am on a donor waiting list and he says it could be two weeks to 6 months before a donor is found.  They drew fluid off and injected cortisone, now I wait.  He didn't want to do carticel in my left knee because I am now in my mid fourties and obviously if I'm having problems with cartilage in both knees then it's unstable to do carticel.  I'm kinda weirded out with getting donor tissue but I trust Dr. Farr completely.  I went to a ortho in Muncie and they wouldn't even touch my knee so it's back to driving to Indy (about a 2 hour drive) but I think that is the best choice because of Dr. Farr.  The guy knows his knees!  My advise is to follow his directions to the letter, in the long run it will help you heal better.  If my allograft doesn't work then I am looking at  a TKR.  My carticel knee is going strong.  I did have to have one scope for over growth and hardware removal but it was a walk in the park and made the ROM back to where it should be.  Good luck and know it will get better.

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #38 on: February 24, 2010, 07:28:49 PM »
Hey there reepler -

I am doing well so far at the 3 month mark with my carticel implant.   It is amazing how the daily pain I had is gone already, now i have different aches, but different due to over-use of my knee.  It is just not strong yet to keep up with the rest of me!  I was told to be patient, cuz I want to go do so much more activity wise.   I had the surgery on my left knee ... and now the right knee is starting to have the pain and we talked it probably will need the same procedure and when I am ready to proceed, we will go get an MRI.  I am not ready for this process again .. on my good knee!   :-\

I'll keep you posted!


Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #39 on: March 24, 2010, 12:41:09 PM »

All ACI'ers -

5 months post op and starting to hear "grinding" noise again, so much like I remember from pre-op.  anyone out there experience this too?

the grinding occurs when I go almost straight legged from about 15 degrees.   This is making me very very nervous!

A call to the doc is in order just to make me feel less stressed, however thought I would throw this out to the board and see if any others experience this too.

one more thing, at 5 months should I feel great yet?  cuz, frankly, the knee feels ok ... to the degree of questioning my decision and serious pondering before the other knee is scheduled!

willing to hear all thoughts, please share!

take care all!
- thornburg

Offline ajschnelk

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Re: Can I join the A.C.I. party ??
« Reply #40 on: March 25, 2010, 06:01:15 PM »

All ACI'ers -

5 months post op and starting to hear "grinding" noise again, so much like I remember from pre-op.  anyone out there experience this too?

the grinding occurs when I go almost straight legged from about 15 degrees.   This is making me very very nervous!

A call to the doc is in order just to make me feel less stressed, however thought I would throw this out to the board and see if any others experience this too.

one more thing, at 5 months should I feel great yet?  cuz, frankly, the knee feels ok ... to the degree of questioning my decision and serious pondering before the other knee is scheduled!

willing to hear all thoughts, please share!

take care all!
- thornburg


Thornburg:  I hate to break it to you, but we are one week from 4months post.   ;)

Offline thornburg

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Re: Can I join the A.C.I. party ??
« Reply #41 on: March 25, 2010, 07:23:23 PM »
4 months .. gosh, a girl can dream can't she thinking its been 5 months!!   ;D

Offline mr c

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Re: Can I join the A.C.I. party ??
« Reply #42 on: January 17, 2012, 02:12:05 PM »
Hello to all. I'm in law enforcement n been out of work for 3yrs , not even light duty. I've had 4 knee surgeries since 2008: (1) arthoscopic lateral release, (2) 3" incision lateral re-release of both mcl, (3) scope with shaving of knee, (4) aci surgery with 2screws below knee cap in tibia into shin bone ALL because I completely tore my inner mcl ligament (kicked in inner thigh area directly in left knee)n had severe case of osteoporosis all in left knee. Issue is alot of crunching n grinding n sitting or standing to long knee stiffens n locks. Have to easily move knee to shift it out of lock. Up n especially down stairs is a task. Leg pressing feels like I'm getting my strength back but not able to walk swiftly because of stiffness n sharp needle pain. Not able to kneel on it (very sharp pains). I'm just afraid I wont b able to perform my duty after 12yrs n I'm only 36 From running 5miles 3x a week to not even doing steps easily is very discouraging. Anyone with positive information please post your comments















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