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Author Topic: aj's Trochlea ACI and AMZ 12/1/09  (Read 15402 times)

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Offline ajschnelk

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aj's Trochlea ACI and AMZ 12/1/09
« on: December 05, 2009, 02:52:07 AM »
Hello all,

Everything went as scheduled on Tuesday and while I ended up having the amz, everything went well and I was heading home 3hrs after having surgery.  Believe it or not, the long drive (4hrs) home was fine and I was pain free and comfortable most of the trip.  The aci  and TTO was textbook and the defect actually ended up being smaller than what we thought prior to surgery.  I had my local OS take the biopsy, so Dr. Cole had not been inside my knee previous to the aci surgery.   Everything has been going well and I really don't have a lot to share.  I am currently icing and using the cpm 6hrs a day.  I have not yet started any of the excercises but plan to within the next few days.  I have been able to move about farily well on the crutches and have actually started minmizing my intake of the pain meds.  It's still very sore and I experience sharp pains at times, but as of today the pain is very tolerable. ;)      I have a long road ahead of me and plan to post updates as I proceed with the rehab. 
« Last Edit: December 16, 2009, 04:04:09 AM by ajschnelk »

Offline thornburg

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #1 on: December 05, 2009, 01:57:09 PM »
Wow, quite impressive to decrease the pain meds.  I am still in serious pain and taking them as directed.
I checked in at 12pm EST and left the next morning at 9am ET.  Cant believe you headed home after 3 hours .. amazing!
Gosh, I feel like a whimp! :-\

I did not need the AMZ, my defect was just bigger than expected once he got the knee open.  I see the doc on Monday, when I will see my pictures and such.  Looking forward to that!

I did try my exercises last night, not gonna happen.  I still cannot lift my leg un-assisted.

Take care and I'll drop a line to you soon to see how your doing!

Offline ajschnelk

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #2 on: December 05, 2009, 10:49:33 PM »
thornburg...good deal regarding the AMZ...You probably have a fairly small incision, right?  From what I've gathered, the AMZ can be the most painful part if done during an ACI. My docs told me that most of the pain I'm dealing with and the worst part during the first 7-10 days will be due to the AMZ.  I was hoping going into my procedure that it wouldn't be necessary, but Cole felt that the additional procedure will only help things given what he saw.   I haven't had a ton of pain under the knee, although how bad can it be when i spend most of the day in bed. ;D.  Like you I can only do a couple of the home excercises at the moment...it is pretty much impossible to lift my leg without assistance, which is a very strange feeling.  I skipped a few doses of the meds, but have decided to keep taking them for another day or two. 


BTW, Did you have anything done with the trochlea?  I'm kind of surprised given the size and location of your defect that there was no damage done to the trochela groove.  So you basically had a large isolated defect to the patella and nothing else?

Best of luck and keep me posted with your progress.   ;)
« Last Edit: December 05, 2009, 11:02:14 PM by ajschnelk »

Offline thornburg

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #3 on: December 06, 2009, 12:28:50 AM »
Ajschnelk, my incision runs from right above my knee cap down the middle of the knee to the start of my shin. Abt 10 inches, like a zipper. 25-30 staples about. Regarding trochlea, no, my defect was completely bottom part of my knee cap. Yeah, my defect was the patella and nothing else.

Tried a few more PT exercise. Did the "lay on the side and lift" ok, but the inner lift was tougher. Still not going to try the "lay on stomach and hang of end of bed" or "lay on stomach and lift leg." I tried to lift unassisted several times and no luck.

Like you I am just laying around. Daytime TV really sucks! Talk to you later.


Offline Rennschnecke

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #4 on: December 07, 2009, 01:21:47 AM »
Hi there

Did you both have nerve blocks in the leg?  If so, it may take a while to wear off and could be the reason why it's so hard to lift your leg.  I know when I had a nerve block (for something else) that I was surprised at the lack of control and strength – not something I'd experienced before even after the implant.

WRT laying on the stomach and letting the leg hang down – I think that's worth doing as it helps maintain full extension.  May help minimise limping later.  But it's all time and it can be difficult to fit everything in.
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: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #5 on: December 07, 2009, 01:42:07 AM »
angie talking - yes, I had a nerve block on my leg.  i am hoping that is a reason why no quad strength to lift leg!
I see doc tomrrow, update then!

Offline Room 101

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #6 on: December 07, 2009, 11:22:52 PM »
Hey there!  Happy to see the recent surgeries seemed to go well.  I just passed one year last week.  Reading the posts brings back memories  :P  I am just happy that it has snowed twice here and stuck to the streets briefly, and I am not on crutches!!  The last 2 winters, I was laid up, haha.  Anywho, I had a real hard time lifting my leg after the ACI.  It was a piece of cake after the AMZ ( I had them separately ) - it took me more than 1 month to consistently lift it.  I might have made it one time here or there, but it was not consistent.  I think it was just the muscles shutting down to prevent more trauma under the kneecap.  There are a lot of paople that can do that exercise much sooner, and I was kind of freaking out... but it all came back in time.  I was able to do them standing, so once I could do one, I could do 50, but it just took a long time...

Hope your recoveries keep going smoothly.

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: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #7 on: December 09, 2009, 02:15:34 AM »
One week Update.

I did not have a nerve block, just a general along with some pain meds immediately after.  I am very close to being able to lift my leg, but still not quite there, although I've worked on it very little due to the pain.  I have about a 7-8" incision and it is held together with cosmetic sutures and glue. 

It's hard to believe it's already been one week.  I am still not much different then I was at 4 days post.  I still have horrible pain when I'm upright on the crutches due to the AMZ.  I'm fine when it's propped up and when I'm on the bed or couch, but I haven't been able to move around much due to the unbearable pain when vertical.  I am pretty much stuck to my bed all day every day. 

My doctor is telling me that the amz pain can take up to two weeks before it fades.  I guess it's due to blood pooling (from cutting the bone) and then draining within my leg tissue causing a blood rush and a lot of excess pressure.  It is horrible and feel that if it weren't for it, my pain would be light and I would not be confined to my bed 7 days post.   :(  I'm hoping within the next week things will get better and I"ll start doing the excercises and freely be crutching on a regular basis.

Thornburg:  Have you attempted to dangle your leg off the side of the bed and get it to 90 degreees?  Obviously this would be a passive motion...strictly dangle  it with no msucle involvement.   My OS would like me to start doing this 2-3 times per day and hold for 30sec each. :o


Hope your recovery is still going well.  How did your first follow-up visit go?



« Last Edit: December 09, 2009, 02:30:27 AM by ajschnelk »

Offline thornburg

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #8 on: December 09, 2009, 01:02:17 PM »
ajschnelk:
No, I have not been cleared for that exercise yet.  I was told absolutely no "bending" except in the CPM machine.    I have reached 62 degrees on the CPM, that is uncomfortable.  My short term is goal of 90+ by next Wed when see OS again.  You in one of these machines too?
I still cannot do a straight leg raise either and I am getting very frustrated.  I keep trying, it just wont lift!  I was told when I can do them with no lag, I can come out of my brace at home!  If I cannot do a leg raise by the time I see OS next week, he will send me to PT to get that quad firing.

I must say, I am so very happy I did not need the AMZ based of your comments.  I feel bad for you, it will get better - stay positive!   ;)
Each day for me is better than the one before, however don't want to elude that all is perfect on this end either.

My pain has greatly decreased!  I am down to 1/2 a pain pill post a rough exercise session, that is it!   

First post-op follow up:  he said all looks really good!  I need to hit my exercises more often and harder and get that CPM as high as I can tolerate.
Other than that, all seems to be tracking as expected.  He did say I still have a lot of swelling and should keep ice on it all the time.
Pretty much he said, keep exercising and icying and we will talk next steps when I see him next week.
I got pics from my surgery, need to get them scanned this weekend then I'll send them to you.   Very very interesting to see the defect area!
Did you get pics?

Take care and keep your chin up .. it will get better!   

Offline ajschnelk

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #9 on: December 09, 2009, 08:36:46 PM »
yeah, I have the cpm machine as well.  I've been using it since day two 6-7hrs a day, but I have not yet gone past 35degrees.  Cole's protocol is not to go past 30degrees for the first two weeks, but told me that I could go further if I wanted since the location of my defect will not be affected.  That's interesting that you are allowed to go as far as you're willing.  I don't think I'll be up to 60degrees until around 4wks post.  I cannot do any bending as well, but said it is okay to dangle the leg as long as I don't engage any muscles which means someone needs to hold my foot and let it down for me.  My first post op isn't until 10-15days which will be later next week. 

Offline ajschnelk

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #10 on: December 13, 2009, 10:12:01 PM »
12th day post

Thing are improving...the horrible blood rush pains that i'd get when upright are now gone, so I'm now able to get up and move around pretty well and often.  I have slowly decreased the pain meds and will probably be done with them within the next day or so.  I increased the CPM to 40 degrees today and won't increase it any further until my 1st post op visit which is this friday.  I am now able to do multiple straight leg raises without any problem.  Other than some mild pain when using the cpm things seem to be improving greatly.   ;)

« Last Edit: December 14, 2009, 02:58:58 AM by ajschnelk »

Offline KW

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #11 on: December 13, 2009, 11:02:33 PM »
Sounds like u are doing really well. Keep it up!

Karen
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline thornburg

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #12 on: December 13, 2009, 11:56:43 PM »
good to hear things are better for you and your up and about now, great news!

I am seriously jealous of your straight leg raise, I still cannot do that one exercise.  I am headed to PT this week to electric stim the quad.
I am very frustrated I cant do one yet, no clue why as I can do the other assigned exercised fine!

keep us posted on your 1st post-op meeting!   Good Luck!   (I get my staples out on Wed)

- thornburg

Offline ajschnelk

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #13 on: December 14, 2009, 02:17:25 AM »
will do... I will get my stitches on friday as well.  Don't feel bad about the SLRs...I never really worked at it.  I couldn't do one for the first few days and then all of a sudden i could.  I've done very little in terms of the rehab excercises because of the amz.  I will start doing them on a regular basis this week. 

Offline ajschnelk

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #14 on: January 04, 2010, 02:51:36 PM »
5wks -

Well I will be 5wks post tomorrow and so far things are going as scheduled.  One more week and then I will slowly start to leave the crutches behind and begin weight bearing.  My  quads and other leg muscles are non existent so I am not sure how easy it will be once I start weight bearing.  I have been doing 500 SLRs and 1000 quad contractions per day for the last two weeks, but there is still not much there.:(  I am still using the cpm 6-8hrs per day and will do so for another week. I have kept it at 65 degrees the past two weeks, but plan to bump it up close to 90 during my last week. Since going back to work last week, it is tougher to get the hours in, so I pretty much live in it each evening.

The pain is almost gone except for when i attempt to passively bend it.  I experience some sharp pains from the graft area as I dangle the leg, but I am told this is normal for the first few months due the graft being very soft.  I can get it to 90 (passively), but can't quite get there every time.  I started PT last week, so I am sure once I get a few visits in, my ROM will improve.   I never had to have the stitches removed due them being dissolvable cosmetic sutures, which is obvious given how well my incision looks.  It is already fading as if it was done months ago and not that I really care, but I don't think I have much of a scar once I fully recover. 

I go for my 6wk follow-up vist next week and will post an update if there's anything worth sharing.  ;)
« Last Edit: January 04, 2010, 05:27:02 PM by ajschnelk »















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