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Author Topic: aj's Trochlea ACI and AMZ 12/1/09  (Read 15403 times)

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Offline Room 101

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #15 on: January 04, 2010, 06:44:15 PM »
Keep up the good work AJS!!  It's great to hear all is well do far!

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: aj's Trochlea ACI and AMZ 12/1/09
« Reply #16 on: January 13, 2010, 07:20:05 PM »
-6wks-

WoW, I can't believe I am at 6wks already...

I had my 6wk follow-up with my OS on monday and was given the green light to ditch the brace and move away from the crutches. I also gave up the CPM machine during the visit. It's been two days since my apt. and I am now walking(limping) crutch free. I plan to use one crutch at times depending on how the weather is, but it's nice not having to rely on them every time I need to move. I still have pain when bending the leg as I am still pretty swollen, but no real pain otherwise. My ROM is what I need to focus on going forward...I have been stuck at 90 for the past week and since giving up the CPM, I almost feel like I have lost a littl bit of range. And when I do bend to 90, it's not an easy process...it takes some time to get there. I'm hoping adding new excercises during the next couple weeks will help increase my ROM.

I can definitely see how the next few months will be long as there isn't much I can do other than the same old boring PT stuff. I do plan to hit the gym on a regular basis doing other stuff outside of my knee, so I am hoping this might help. It will be nice once I get my ROM back and I'm able to walk normally.

That's it for now. ;)
« Last Edit: January 13, 2010, 09:03:40 PM by ajschnelk »

Offline Room 101

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #17 on: January 13, 2010, 10:40:13 PM »
Congrats on the success so far!  That's great news.  I think it's quite normal to lose a bit of ROM once the CPM goes away.  I know I did, but then you start doing more and it comes back quickly.  Great to hear you're doing so well!

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: aj's Trochlea ACI and AMZ 12/1/09
« Reply #18 on: January 14, 2010, 04:02:30 AM »
thanks, room101.  The ROM is really the only that's really bothering me right now.  I am hoping that the walking in addition to the other excercises will help things during the next couple weeks.

Offline thornburg

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #19 on: January 14, 2010, 03:02:01 PM »
Congrats on the 6 week mark!

keep up the work, the ROM does come along.  I am about 130 now .. PT really helped with that aspect.  I do heal slides whenever I can!

Glad to hear your doing well!   Keep us posted on your progress!

Take care 

- thornburg

Offline Room 101

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #20 on: January 14, 2010, 08:27:07 PM »
Hi, AJS.  I was slow with ROM also.  I was told as long as I had full extension that's what mattered.  II was getting a little worried because I didn't reach 125 for a long time.  My OS & therapist both said not to worry and it would come back.  I honestly think it came back to full and I didn't even realize it.  I was just suddenly walking normally down the stairs.  Walking will for certain help you out. 

Take care, and enjoy losing the CPM, brace & crutches!  Those are such good days  :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 Rennschnecke

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #21 on: January 15, 2010, 01:59:03 AM »
Hi AJ

I got stuck at 90 and had debridement to remove scar tissue.  Needless to say I've done lots of research on that stuff now.  Just keep bending the leg passively as much as possible and do patella mobilisations incessantly to maintain and develop mobility.  If you want any ideas of things to do just let me know.

Otherwise, try to avoid overdoing things and irritating the knee keep the pain and swelling under control to reduce the risk of scar tissue formation.  If you maintain mobility and don't form more tissue you'll get the ROM back.  I think the window of opportunity is around 34 months to get to around 100 to 120 after which it may be a slower return to full ROM.  Once you are over 115 degrees I think the chances of it getting 'fibrotic' are slim.

Good luck!
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: aj's Trochlea ACI and AMZ 12/1/09
« Reply #22 on: January 15, 2010, 02:56:17 AM »
Thanks, Renn... I plan to ice much more than I have been and will try to bend it consistently when at work.  It seems like the swelling is what's really limiting me, but I really don't know.  I sure hope I don't have to have anything further done (like a scope).

Offline Room 101

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #23 on: January 15, 2010, 06:16:50 PM »
Hey, AJS, I was limited to 90 degrees for around 12 weeks and then it was hard to get back.  I was definitely limited by swelling for a long time, but it's just me protecting me... it went away with PT and patience.  I can tell you I didn't have the range anywhere close to the time I ditched crutches.  Riding the bike helped me a ton also as did walking.

Keep working at it, and hopefully you'll see improvement when the swelling begins to subside.

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: aj's Trochlea ACI and AMZ 12/1/09
« Reply #24 on: January 15, 2010, 06:55:01 PM »
Hey, AJS, I was limited to 90 degrees for around 12 weeks and then it was hard to get back. I was definitely limited by swelling for a long time, but it's just me protecting me... it went away with PT and patience. I can tell you I didn't have the range anywhere close to the time I ditched crutches. Riding the bike helped me a ton also as did walking.

Keep working at it, and hopefully you'll see improvement when the swelling begins to subside.

Room 101

Thanks for the encouragement. My OS was not concern on Monday, so I guess I shouldn't be...I still have a lot of swelling and lateral muscle pain due to the amz, so I am sure this is affecting my range as well. I'll keep at it and hope that it comes around in the next few weeks. I will say, my range from 0-90 feels 100 times better since I started WB and walking 5days ago.
« Last Edit: January 15, 2010, 07:03:19 PM by ajschnelk »

Offline Room 101

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #25 on: January 15, 2010, 11:48:29 PM »
That is outstanding!  Did you ask him for the scrip in patience  ;D
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: aj's Trochlea ACI and AMZ 12/1/09
« Reply #26 on: January 16, 2010, 02:37:02 AM »
 Hi AJ

Glad to hear that WB is helping! I think that moving around is supposed to help pump fluid out. As ever, the trick is to get the balance between that and irritating the knee so that it swells.

BTW Don't worry if you find you need to use crutches to minimise swelling (as well as pain). I was still using crutches a lot around the home at 6 months p/o. Granted it was probably due to having a debridement (and maybe also due to being on crutches pre-op because of excruciating pain so I'm just about getting back there) but then I found I'd just evolved to moving around without them more and more without even thinking. No pain, no limp etc. The PT has reinforced the fact that this is the best way and I've been told that if I limp I've come off crutches too early. I know it's terribly inconvenient to use crutches can be difficult even to get a cup of coffee and I hope you don't get to experience it.

Have a nice weekend with your feet up and lots of ice!!!

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 Recovering Runner

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Re: ajschnelk's Trochlea ACI and AMZ 12/1/09
« Reply #27 on: January 17, 2010, 05:25:50 PM »

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.



I guess I'll go ahead and crash the AMZ party. I'm on postop day 4 after amz (more anteriorization than true anteromedialization of the tibial tubercle) and DeNovo NT implant along my patella, no trochlear damage. Dr Cole did my procedure as well. It really helped to hear your description of the leg pain because I am having identical symptoms. The other postsurgical pain is really minor at this point, the game ready keeps the swelling down nicely, and the CPM works well. I was told to go 0-30 degrees the first two weeks, progressing to up to 45 degrees as tolerated.

The only real pain I'm having is an excruciating tearing sort of pain along the anteromedial portion of my leg just below the knee. It is entirely within the soft tissues rather than the bone. It occurs when I lower my leg from horizontal to vertical, and is excruciating, but transient. It disappears after the leg has been vertical (I have been upright) for a minute or two. I have found that the pain can be avoided if I lower the leg slowly. Of course, I don't do anything more than ask my wife to lower it slowly. I can't actually lower it myself yet. I was happy to read that someone else had the same symptoms, and that your pain was gone by day 12 postop.

Thanks for posting, and I hope your recovery goes well.

 

Offline ajschnelk

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #28 on: January 18, 2010, 01:21:56 AM »
runner-

I'm not familiar with the Denovo NT implant, but it sounds like your pain is coming from the amz hardware.  I had some pain in the area, but most of the worst pain for me was on the lateral side from all of the pulling and tearing during surgery.  Yes, you'll notice a huge improvement after around 10days. I was pretty much confined to my room for the first 10days due to the pain when standing. Hang in there...I'm not sure why, but the first 7-10 days flew by for me.
« Last Edit: January 18, 2010, 01:27:40 AM by ajschnelk »

Offline ajschnelk

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #29 on: January 26, 2010, 08:14:45 PM »
8 weeks

I am 8 weeks today and I guess things are progressing as they should... and that basically means i'm progressing slowly. :(  Last friday at PT, I was able to get to 105 degrees flexation...it was not an easy 105 as it was quite painful.  We broke through some scar tissue(at least I hope it was) when stretching and it ended up being pretty sore for a couple days.   I was a little worried at first thinking maybe I did something related to the graft, but I think it's very unlikely since I was NWB when we were pushing my range.  My patella mobility has improved since that day when manipulating it, so I'm pretty sure it was scar tissue.   The swelling has gone down some, but it still feels pretty full and tight.  I am walking better with less of a limp, but I am still very cautious as the leg is very weak and is very stiff in the morning and after sitting for long periods.  That's about it...nothing too exciting exept for finally breaking 100 degrees! ;)