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Author Topic: aj's Trochlea ACI and AMZ 12/1/09  (Read 15404 times)

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Offline Rennschnecke

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #30 on: January 26, 2010, 10:17:19 PM »
Congratulations, AJ!  I think it gets better once you get over 100 degrees.  Hope it keeps on improving. :)
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 #31 on: February 10, 2010, 08:17:55 PM »
10 Weeks -

I am at 10 weeks and doing well.  The knee is still swollen and very stiff especially after sitting or standing for longer periods.  I am walking better, but still have a limp at times...usually when i get up from sitting or for the first 30min or so in the morning.  I am now able to get to 115 on my own and my PT was able to get me close to 125, so I seem to still be progressing with my range.  As stiff as it is, I always think I'm not making progress, but every few days at PT, I seem to make small gains.  I am doing a few new things at PT, more stamina type of exercises, in addition to the old stuff.  I'm riding the bike 15-30min per day with no resistance.  I usually break it up over two or three times per day at 10 or 15min each. That's about it...again, nothing too exciting.   I will probably update again in a couple of weeks.

The one question I've been wondering is; how long until the graft matures enough where I don't feel the sharp pain (similar to the pre-op feeling)?  I know it's premature to think I'll be pain free at this point, and I really don't have much pain overall.  However, I still get a sharp pain at times when the patella rides over the graft area (only)when the motion involves engaging my quads.  The only time i really feel this is when I do a leg extension...ex. when I dangle the leg of a chair or bed and then extend (basically a kicking motion)...I don't feel it when I'm not engaging my muscles or when riding the bike.  I would also like to note that I couldn't do a leg extension when hanging it off the side of the bed 4wks ago (too much pain and no strength).  I can't imagine what it will be like the first time I attempt to load the knee, whether it's stairs, lunging, getting up from a chair, etc.   I know the graft is still very soft and is probably nothing to worry about, but I would like to hear your thoughts just to compare. Thanks!
« Last Edit: February 10, 2010, 08:21:12 PM by ajschnelk »

Offline Rennschnecke

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #32 on: February 11, 2010, 12:54:39 AM »
Hi AJ

I don't want to alarm you but beset as I am with all sorts of complications I haven't had the pain you describe.  But then I was banned from doing any open chain work for 6 months and that includes the leg extensions you've described.  If you are hurting I'd suggest stopping those and keep to quad contractions and straight leg raises for now.  If you're in any doubt about anything you might try going back to your OS to check as well.

Take care!
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 #33 on: February 11, 2010, 03:37:05 AM »
thanks Renn...Yeah, I am (at least I think I am) prepared to deal with all sorts of stuff yet.  I realize i have a long way to go.  As far as the pain goes, I'm not doing actual open chain excercises...it's just something I'll try once in a while when stretching or when doing the other stuff.  My OS said it would be a few months before I would be able to do it comfortably, mainly because of the amz, but I guess I didn't know what that meant exactly.  Oh well, I'm not worried...it's just funny how some say they didn't attempt steps for the first four to six months while others are doing them a few months out.  is the graft really ready to load with stairs at 3 months?  I am just past the two month mark and I can't imagine trying stairs right now and/or within the next month. 
« Last Edit: February 11, 2010, 03:48:39 AM by ajschnelk »

Offline thevoice

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #34 on: February 11, 2010, 05:48:09 PM »
I am 9 weeks post op for a defect on the MFC - When I walk its quite smooth then I get this sharp horrible pain from defect area - much like someone is sticking a knife into bone in my leg - really makes me jump when that happens - I have to stop for a second then I take another step and its ok again for about 10 paces then boom! it happens again.

Not nice at all.

Offline Rennschnecke

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #35 on: February 12, 2010, 01:01:44 AM »
AJ

I understand what you mean about the big variability in when people seem to start doing things.  However, when I thought about it there is probably a lot of variability in size and location.  A trochlear defect could be anywhere in the trochlea – dead centre, medial or lateral aspects.  Add proximal and distal etc and any other combinations there's a huge variation possible.  Add to that, relative size and weight of the person, their own propensity for growing cartilage in vivo, pre-surgery strength and on and on and on ...

I got the impression that many of the 'failed' ACI ops were due to doing too much too soon and there were few stories of failures from going slowly.  As a result I decided I would be happy to err on the side of being too slow.  As nature would have it, it is now enforced going slow from the complications but I have a season ticket for the hospital and it's valid for 2 years from the implantation so I have that window to get back to something like normal (though I'm sure I can renew it ;)).  I know that the reality of dealing with a situation can be quite different from what you think beforehand.  The last 7 months feels like forever!  :( This is despite that fact that I knew it was at least a 12 month rehab.  I thought 'That's OK', I'd already spent 4 years doing rehab, so what's another year?  But gradually doing 4 years by extending the rehab a little at a time seems quite different from facing a 1 year sentence (realistically it is a 3 year sentence).

But back to steps etc.  I'm not actively trying these yet for reasons other than cartilage implant op.  However, I've found that my body is tackling very shallow steps normally without me even thinking.  I've found the same thing with crutches – I sometimes forget about using them because my knee is so good (doesn't last though :().  Talking with various PTs this seems to be the ideal way to go and because I've had a lot of set-backs pain-wise I've now opted to just be patient.  (Something to do with being thoroughly told off by my PT on Wednesday for overstressing my knee too frequently by carrying stuff and nagged into submission to avoid it whenever possible!)  What I'm trying to say is that you'll know when you're ready to try steps and you'll also know if you're not.  Also, recovery isn't linear so you can't predict how you'll feel next week even.

It sounds like you're doing great though, so just carry on.

Take care of yourself!
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 #36 on: February 12, 2010, 02:19:05 AM »
Thanks for the feedback, Renn.  I emailed my doctor's PA with a few questions and will go from there.  Like you I had been rehabbing my knee for 4+yrs after the mfx, so like you, i figured what's another year or two.  ;)  Although, now I don't quite feel the same way since there are so many unkowns...is everything healing, is the graft taking, is it maturing, etc.  I will continue with things and keep my head up! ;D Thanks again.  ;) 

Offline Rennschnecke

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #37 on: February 12, 2010, 11:24:47 PM »
I understand, AJ.  ;)  It may (or may not) help to know that my cartilage was doing great at 14 weeks despite everything.  I know because they had a peak when they did the debridement.  It was apparently excellent and excellently integrated far beyond their expectations.  I've also been told that you KNOW when the graft hasn't taken; small signs and symptoms are common but not indicative of failure.  Also, ACI is often better at maturing and integrating than MACI, which is what I've had.

I hope the PA reassures 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 ajschnelk

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #38 on: February 13, 2010, 05:24:42 AM »
I was told today that typically it's around the 3month mark when the graft is no longer painful, however, they also stressed that it's not uncommon for it to take much longer for some.
« Last Edit: February 13, 2010, 05:26:47 AM by ajschnelk »

Offline ajschnelk

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #39 on: February 23, 2010, 10:02:44 PM »
12 weeks

It's hard to believe that I'm at the 12wk mark.  I am walking much better and have almost regained my normal gait, but the leg remains very weak.  Things are still pretty stiff each morning and after sitting for long periods, but that is to be expected at 12wks.  The swelling is still there but tends to vary depending on my activity level.  I am continuing with PT two days a week and continue with the same stuff at home during the off days.  I recently purchased an upright bike and have been using that 20-30min each day (no resistance), and that seems to really be helping things.  I also use a TENS/STEM unit daily.  I have a ways before I can start riding with resistance, but it still feels nice to be able to jump on a bike regularly without much hesitation.  The toughest thing I'm dealing with right now is getting my quads back into shape.  I need to discover some creative ways to work them harder than what I have been because they are nonexistent and SLRs are OLD NEWS --this is probably the hardest part of rehab. I am considering trying an elliptical, but have read conflicting info on them at this stage.  I am going to contact my OS office for their opinion, but anyone here have any info on when they were able to use an elliptical machine?  If it's typically allowed now, at what settings?   I am sure it must be used on the lowest setting with no resistance similar to that of a bike. 

I got to 130 today at PT, so I think my worries of not getting full ROM are almost over.  I am ~8 degrees of matching my other leg ;D

Overall, I seem to have less and less pain (achiness) by the week.  I am not doing any open chain excercises, but I still get a sharp pain at times when I do any open chain movement...extending the leg straight from a hard bend (like when sitting at 90-100degrees) position.  For example when I'm sitting at work, i sometimes sit for long periods with my legs underneath the chair (leg is bent at 90+ or further) and then I'll extend the leg to stretch and I'll get some tenderness/sharp type  pain coming from the graft area.   It'a almost like the knee cap is locked down in the Tgroove and due to the lack of muscle strength, it stays there during the motion which then really puts pressure on the graft.   I'm hoping as I build my quads in combination with the graft maturing this sensation eventually goes away.

That's about it...I will post another udpate in a couple of weeks.   Best of luck to everyone that's currently recovering as well! ;)     
« Last Edit: February 25, 2010, 03:05:48 PM by ajschnelk »

Offline Rennschnecke

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #40 on: February 23, 2010, 10:49:03 PM »
That's fantastic news! :D :D :D

Can't say about elliptical.  I had the general protocol from my OS but he amended it because of the size and location of the grafts.  If I were you I'd contact the OS just to be certain that it's safe to use otherwise you may worry at every twinge etc. (or maybe you would anyway!)

I know SLRs may seem rather boring, but adding weight above the knee or a resistance band may add some variety.  Maybe adapt it to use a gym ball as well to also work the core?  As you're going to PT I'm sure they can advise.  My PT is great at suggesting exercises that look simple and low load, but when I've tried some weights machines I'm surprised at the strength I have.

Oh, and for the desk problem you could consider using a roller skate base or mini skate board to keep the knee moving whilst working.  That may help with the stiffness.

Keep us posted! :)
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 ACE UK

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #41 on: February 28, 2010, 10:54:38 PM »
ajschnelk,

Thanks for all your updates. They will prove useful for me in the future.
Good luck with your recovery.


ta


ACE UK  :P

Offline ajschnelk

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #42 on: March 31, 2010, 09:45:34 PM »
4 Months

Things are continuing to progress. I had my 3rd follow-up visit this weeks and my OS is very happy with where I am.  He was really surpised at how little crepitus i had during movement and thought the swelling and knee overall looked great.  He mentioned that given where I am, he feels that I have a very good chance at making a full recovery and being able to get back to all activities.  I am not going to get overly excited because I still have a long road ahead, but it was still good to hear.  ;D I have very little pain just normal stifness and soreness in the a.m. and when I'm on my feet for any long periods.  I still have some sensitivity/pain under and around the patella when doing open chain movement, but it does seem to be improving.  My OS is not concerned about at all and given how good i was prior to surgery thinks it will take a full 8-12months before I really see any benefits of the surgery.  He said that I'm the type of patient that will require the graft to really harden before feeling better.  I asked about the TTO hardware (two screws) and he doesn't think i'll need to have them removed, but we won't know for sure until I am able to do more.  They are not an issue right now, but part me would just like to have them removed if they aren't serving a purpose...time will tell. 

He wants me to continue PT for another 4wks and then recommended that I go with a one-on-one personal trainer and get into a heavy cross training program.  I haven't looked into yet and I don't know how helpful it would be.  He's aware that I want to get back to recreational level sports and that I was very active prior, so this might be the reason.  Have many here gone on with a personal trainer after PT?  If so, I'd really like to hear your experience and if it seemed very helpful with your recovery. 

My Range is at an easy 135...it's not my presurgey range, but I'm within 5-10 degrees of it.  I am hoping once the swelling completely subsides I'll be able to get there. 

The new issue and what's more bothersome is my "good" knee.  It has been swelling on me and the worse part of all is that both my ACI OS and my local OS don't have a clear answer.  I had it scoped a couple months before my ACI and other than a very small meniscal tear (which they took care of), the joint looked perfect.  I have had two MRIs as well and they are not showing anything.  the latest MRI was a very detailed MRI that showed everything (i'm aware that MRIs don't always pickup articular defects) and my OS says he's about 99% sure there aren't any (articular defects) issues based on the images. >:(  I am going to give it a couple months and if I have to, i am going to request a scope to get a better look.

Overall things are progressing well with the ACI.  As far as rehab goes I plan to continue with the boring isometric type stuff and add some resistance to the excercise bike and begin some light loading (stairs, mini squats 0-30degrees etc.).  I guess the rehab doesn't begin to get aggressive until around the 8month mark.  I know people are all over the place as to when they attempt stairs and I was told that I could try lightly at 10wks, but I have yet to try...it seems that most begin around the 3-4month mark with trochlea defects.  I will update how it goes as i plan to take my time advancing to stairs and resistance biking. 

Best of luck to everyone that is currently in the midst of ACI Rehab.  ;)
« Last Edit: March 31, 2010, 09:51:14 PM by ajschnelk »

Offline Rennschnecke

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #43 on: March 31, 2010, 11:20:39 PM »
That's great news, AJ!  Keep it up!

While I'm not the best example of a successful and uneventful rehab I have found that I've started doing small steps with my MACI'd leg automatically without even thinking.  I also came across details of how someone with AF tackled it.  They started with a book around 1 inch thick and did step ups first.  If it was uncomfortable they went to 1/2 inch.  They did sets of step up for around a week or so comfortably before increasing the step by 1/2 inch a time.  As they had to avoid aggravating the knee because of AF they went very slowly, so you may be able to progress more quickly.  I guess you can try step downs on the same basis and alongside step ups maybe separated by a week or two.

If you try this, let me know how you get on.

Have a happy Easter! :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 ajschnelk

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Re: aj's Trochlea ACI and AMZ 12/1/09
« Reply #44 on: June 14, 2010, 08:24:40 PM »
6.5 Months

Well, things are continuing to progress, albeit, very slowly.  I have increased the biking to 20-30 minutes with very low resistance daily.  I have also been using the elliptical for another 20min (daily) with very little resistance.  I continue to focus on stretching and getting my ROM back, but have realized of late that I really need to focus on the strengthening.  My ROM is probably within just a few degrees of the other knee, but I still have some slight swelling and stiffness on a daily basis, so I believe once that goes away, I will have full ROM.  I am still doing the basic isometric stuff and have started doing some light closed chain strengthening 0-30 degrees during the past few weeks.  I have been given the okay to go to 45degrees, so that will be my next step once I feel comfortable with it.  I have been very conservative with the closed chain stuff and feel it's time I ramp this up to help with quad strength and control.   I am doing stairs both up and down without too much issue, but I still tend to favor the aci knee when going up -- No real pain involved with stairs.

My quad is very weak and to the point where it's pretty much nonexistent.  The leg will give out occasionally due to the lack of quad strength when I'm fairly active (e.g., yard work).  I continue to have some pain when loading the knee beyond 30 degrees WB (accidently) and when doing open chain activities, but it seems to improve a little month by month.  I believe lack of muscle control and strength is the biggest reason for most of the pain, along with the graft not being fully hardened and more than likely scar tissue.   Like I mentioned above, I haven't been pushing the strength piece too hard but intend to during the next few months now that I am past the 6month mark.  Not much else to report on...I see my OS at the end of July for a follow-up visit and to have my other knee checked out (I won't go there now) >:(

I will post an update after my next OS visit. ;) 
« Last Edit: June 14, 2010, 08:33:34 PM by ajschnelk »















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