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Author Topic: My proposed extensive MACI - Feb 3rd 2010  (Read 16968 times)

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Offline Rennschnecke

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Re: My proposed extensive MACI
« Reply #30 on: February 06, 2010, 09:09:14 AM »
Hi 7of9

To get in and out of bed you may find it a lot easier if you support it with the other leg.  Just slip the good leg under the bad one and use that as the main lever to get up/down and across.

Hope that helps
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 goobervision

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Re: My proposed extensive MACI
« Reply #31 on: February 07, 2010, 09:45:58 AM »
7of9,

I can't say that I struggled with the up/down in/out of bed, but I was in a brace for the first 6 weeks.  No bend for the first few weeks, I could feel the strain around the joint, but nothing major.  You are definately in the period of taking it easy, RICE and very gentle exercising.  I found that I have off pains when I start doing anything new, they normally pass in a couple of days (or a week) and are very unerving.  I remember when I first got on the static bike there was a wierd cramp like sensation in my quads almost every 5 mins, but not cramp. 

I have been on one crutch this week with limited time off the crutch, and have managed a 2 1/2 mile walk with the crutch and about 1/2 mile without.  Pain and swelling is back though so painkillers, anti-inflams and RICE.  My wall squats are slowly progressing to 45 degree real squats, going to get my Wii Balance Board out to make sure that I am not favoring my well muscled right leg.   My rehab says that I am on a treadmill in a week and a half, walking. So of to the gym then for some walking, cycling and upper body weights, hopefully I can start with some very light leg weights to get used to them and the nice part of sauna etc to relax.

Oh, and I have my hands back!  Thank God for that, I found that to be the worst part of the whole deal.  Starting to pickup some work from home, boredom is killing me.


Offline SevenofNine

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Re: My proposed extensive MACI
« Reply #32 on: February 08, 2010, 04:40:08 AM »
Day 6 post op

Well I think I've got the angle right now for the hook under, up and across :) :) when I get it wrong i certainly know about it hahha thanks Rennschnecke, a great tip.

I do RICE as often as I can but living alone means I have to get stuff for myself so yes I'm on the move a lot - may be partly that I keep forgetting some of the stuff and have to have a re-run.hahah My OS has instructed weight as tolerated through the brace whilst crutching so I'm getting plenty of that. I've also had to think up ways of doing things like I had a visitor peg out the washing for me but got it in again using a bag, as opposed to the clothes basket, whilst crutching. I've also made a couple of trips to my postbox - I live in a group of townhouses so the post boxes are located at the driveway entry - bit of a hike but I just took it slowly one step at a time.

I go back to OS day after tomorrow, then next step is staple removal (26) I've changed the dressing and just had to count them! Can anyone share their pain experience when staples were removed.... something to look forward to. Though the wound looks very clean, but I had to dab a bit of diluted tea tree oil, just to be sure :-)

Cheers,

7of9
May 22 2013 RK LR & medial capsular plication, debridement, meniscus repair
Feb 3 2010 LK MACI
Nov 4 2009 LK scope - meniscus repair, debridement,      biopsy for MACI

Offline Rennschnecke

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Re: My proposed extensive MACI
« Reply #33 on: February 08, 2010, 11:00:13 AM »
You sound really active 7of9 – bet you're getting a good workout on top!  ;)

Didn't have staples, so can't say what removal was like, but I'm sure it'll be sharp and sweet at the same time (a bit like sweet and sour  8)).

Hope it carries on being positive 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 SevenofNine

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Re: My proposed extensive MACI
« Reply #34 on: February 12, 2010, 02:11:03 AM »
Day 10 post op

I saw the OS on day 8 and the whole exercise exhausted me, getting there-waiting 1.5 hours & getting home, in total about 3 hours. I don't know why they bother making appointments for patients; it couldn't be a longer wait if everyone just showed up when they felt like it. I know they're busy people but hello aren't we all! - that's my rant for the day hahah feel better now.

The OS is happy with how the op went, my progress, the clean wound and has ordered me to change to a ROM brace from three weeks. I'll be happy with this as my current full extension brace has a bad case of slippage, very annoying - surely I couldn't be losing muscle mass that quickly hahah.

The OS was not concerned at all about me damaging the LFC graft as he said it's position is protected - made me wonder how it got damaged in the first place, but thought better than to say so. His main concern is with protecting the trochlear graft & said the risk is the movement of the patella shearing it. If anyone has suggestions of what to absolutely avoid to prevent the shearing that would be great. He's going slow on the rehab protocol of increasing ROM for this reason.

Getting more used to the crutching and managing the odd step over, carrying bottled water underarm, backpack stashed, all good. Finished pain meds a few days ago - happy with that.

Rennschnecke, you have a warped sense of humour; nice ;) staple removal as 'sweet & sour' hahah. My staples are scheduled for removal on day 13 - I'm not even thinking about being superstitious & it isn't a Friday! Could you explain closed / open chain strengthing to me? I just want to be clear, much appreciated.

Cheers,
7of9
May 22 2013 RK LR & medial capsular plication, debridement, meniscus repair
Feb 3 2010 LK MACI
Nov 4 2009 LK scope - meniscus repair, debridement,      biopsy for MACI

Offline Rennschnecke

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Re: My proposed extensive MACI
« Reply #35 on: February 12, 2010, 11:43:16 PM »
Hi 7of9

Yeah, it seems to be a global phenomenon that OS staff think that patients are on a pilgrimage to their gods! ;D  On the other hand, I don't mind delays too much as I think I'd rather have a doctor who is prepared to spend time with their patients rather than just process them through the system.  And it's impossible to predict how much attention any one patient will need. :-[

Shearing forces occur between the patella and trochlea when you bend and straighten the knee.  The forces increase as you increase the angle of the bend, the amount of weight carried and also whether you are going up/down steps or slopes.  You can minimise the shear forces by limiting bend on walking to less than 30 degrees, going up/down steps one at a time (as you probably have done with a straight leg) and approaching slopes in a similar way.  In other words, avoid loading the knee joint when bent.

Open and closed chain refer essentially to whether there is any support at the foot level.  So technically walking is open chain.  Cycling is closed chain.  Open chain exercises put more stress on the knee joint as there is no stabilisation of the joint beyond muscular strength.  I'm not a physiologist though, so maybe someone else could explain it better.  If you want any further explanation I'll do my best! ;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 Lottiefox

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Re: My proposed extensive MACI
« Reply #36 on: February 13, 2010, 10:09:54 AM »
Hi 7of9

Good to hear that things are progressing smoothly at the moment. Great news about finishing the pain meds.

Keep us posted and I hope things carry on in the same positive way!

Lottie  :D
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline SevenofNine

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Re: My proposed extensive MACI
« Reply #37 on: February 14, 2010, 05:19:20 AM »
Hi Lottiefox, nice to hear from you & thanks for your support.

Rennschnecke, thanks for your 'avoid-shearing' tips - I have to say I avoid stairs/steps like the plague & will continue to do so to give my grafts time to embed. Your explanation of closed/open chain was good - that means SLRs are open; my protocol is closed chain until post six weeks so a while off for them. I haven't been to PT yet but will start three weeks post; I feel I'm doing enough just looking after me and weightbearing as tolerated right now and don't think the PT could really add any value at this stage.

I have my staples removed tomorrow Day 13 :-\ & have an appointment to get my ROM brace fitted on Day 15 - all good.

My visitors are becoming well trained arriving with a cappuccino for me & helping with the chores I can't manage yet - like taking my rubbish tub down to the skip, folding sheets, returning my library books; they're just little treasures & they keep coming back hahah.
Enjoy your Valentines day everyone,
7of9
May 22 2013 RK LR & medial capsular plication, debridement, meniscus repair
Feb 3 2010 LK MACI
Nov 4 2009 LK scope - meniscus repair, debridement,      biopsy for MACI

Offline Rennschnecke

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Re: My proposed extensive MACI
« Reply #38 on: February 14, 2010, 08:15:55 PM »
Hi 7of9

Glad to hear your friends are all very well trained.  Sounds like you're coping really well and having regular visitors must be great for breaking up the boredom! ;)

I guess SLRs are open chain, although I'm not sure they're put into that class.  I did do some SLRs in a brace early on to keep the quads working.  They were prescribed by a PT so no problems.  Probably not a good idea to do without a brace as you need to be sure your quads are strong enough.  I know that there were no udesirable shearing forces because the cartilage at 3 months was 'excellent'.

My lead PT didn't want to see me until at least 6 weeks post as she said I couldn't do much until I'm out of the brace, so three weeks doesn't sound bad.

Hope the staple extraction goes quickly and painlessly  :).

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 Lottiefox

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Re: My proposed extensive MACI
« Reply #39 on: February 16, 2010, 08:46:11 AM »
Hey 7of9

By my reckoning you should be staple free now?! Hope it went smoothly. What well trained visitors; if I go for my surgery I shall ensure they all arrive with copious capuccino, some nice chocolate tiffin cake from Costa coffe down the road, loads of trashy magazines and do all my ironing, bathroom cleaning etc (husband will be great at looking after me I'm sure but he doesn't really think ironing needs doing or that toilets ever need cleaning!! ;D)

Good luck with the progress this week and the ROM brace. All sounding positive.

I have my T2 mapping scan and CT scans this Thursday to establish what exactly I need (how big and deep are my patella defects) and whether I'll need any alignment procedures as well. Then I guess I'm going to have to make a decision (that will require coffee and cake!)

Keep us posted,

All the best from a slightly warmer but damp UK,

Lottie  :) 8)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline SevenofNine

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Re: My proposed extensive MACI
« Reply #40 on: February 19, 2010, 02:55:14 AM »
Day 17 post op

Yes I'm staple-free! I only yelped with about 4 of them, so not bad out of 26. I now have little holes on each side of my scar that are starting to heal - not the best look & will improve with time & a little bio-oil, the wonder oil, hahah.

I have now been fitted with my ROM brace & what a cumbersome article it is, though does stay in place much better than the full extension brace - I'm set at 30degrees this week but don't feel I'm actually using that range when crutching as I've become used to the full extension. Something for me to work on. I can't wear this ROM brace through the nite - I tried the first nite, lasted a couple of hours & decided it just has too much hardware to be comfortable so I now switch to the full extension brace a bedtime. No problems there, it's lovely to have choices :)

I've been reading quite a bit - for this I can sit outside in the beautiful weather; have also been playing internet scrabble to while away the hours. I can easily do this while icing so that works. I should start formal physio next week so really need to be able to get in my car & drive - it's an auto & my left leg is the 'bad' one so it's just a matter of getting in & set. Others experiences with their first drive & what flexion was required would be helpful ???
Cheers,

7of9
May 22 2013 RK LR & medial capsular plication, debridement, meniscus repair
Feb 3 2010 LK MACI
Nov 4 2009 LK scope - meniscus repair, debridement,      biopsy for MACI

Offline Rennschnecke

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Re: My proposed extensive MACI
« Reply #41 on: February 20, 2010, 01:31:26 AM »
Glad to hear that the staple removal went well for you, 7of9!  Also sounds like you're having a good time in the sunshine.

I can't tell you much about driving early as I had to get an automatic later.  Have you checked with your OS that it's OK to drive?  Insurance companies usually want them to clear you.

In terms of things to think about, you need to be able to bend your knee enough to get into and out of the car.  This may include moving the seat well back.  Then you need to be able to put your leg inside comfortably.  I'm guessing that angles may vary according to how long your legs are and the size of the car.  Maybe you could do a test run beforehand.

The ROM brace sounds like fun. Sorry it's not more comfortable.  Hope it's bearing up in the summer weather (is it still summer?).
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 SevenofNine

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Re: My proposed extensive MACI
« Reply #42 on: February 21, 2010, 12:09:31 AM »
Day 19 Post Op - will have to change to reporting in weeks soon :D

Rennschnecke, yes I'll give the car a 'dry run' prior to making my PT appointment. My OS has advised that I can drive as soon as I'm comfortable (define comfortable you might say - there are degrees) & I've checked with my insurance company who confirm I am covered as along as the OS gives me the green light. So it's up to me now  ;)

The ROM brace is a 'summer edition' hahah, so the brace fitter advised me; it has gaps in the foam between the straps as opposed to being completely closed. A good thing as it's 32 degrees C today & yes summer officially ends at the end of Feb but it'll still be hot through March. Can't complain as I love the heat so am not looking forward to winter.

Lottiefox, how do you go with your scans & prognosis - have you made a decision yet? I'm interested in how your going & how you're managing in the meantime, mobility wise. I agree that cake helps - nothing like a freshly made lamington 8).

I'm enjoying the winter Olympics - that 'skeleton' is something else ;D

Cheers,
7of9
May 22 2013 RK LR & medial capsular plication, debridement, meniscus repair
Feb 3 2010 LK MACI
Nov 4 2009 LK scope - meniscus repair, debridement,      biopsy for MACI

Offline Lottiefox

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Re: My proposed extensive MACI
« Reply #43 on: February 21, 2010, 10:51:05 AM »
Hi 7of9

Glad to hear things are going well and you'll be back behind the wheel soon. That skeleton is awesome, we're celebrating our Women's Gold medal with Amy Williams, you go girl!!!  ;D  Also loving the boarding half pipe and the BIG ski jump - those guys are mad! The camera angles they were showing on the jump as they launch off were just stunning!

The scans are all done, full MRI and T2 maps and CT scan of the patella tracking. I see the OS on the 1st March for his recommendations and then it will be decision time. In the meantime I'm doing OK, I'm able to mobilise fully and have full ROM etc. I just struggle with stairs a LOT and anything like jogging or fast walking is not posible, nor is pivoting on the leg or long walks. Pain is generally controlled by a couple of tablets a day apart from the sharp stabs if I hit an angle wrong. I still train at the gym 4-5 times a week and can bike, cross train, work upper body and core a lot. I am also having acupuncture, do lots of stretches and foam rolling, e-stim, ice, supplements..etc etc. Yawn! I'm pretty lucky really as my defects are not insignificant. However I am a million miles away from how active I was this time last year and that frustrates me. But, the defects won't go away and something like ACI or Cartifill might save the joint for a good few years....

What is a lamington?  :D  I'm a chocolate tiffin girl or a big millionaire's shortbread...yum  8)

Enjoy the rest of the summer, we've got snow here again this morning..... :'(

Lottie  :)
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline SevenofNine

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Re: My proposed extensive MACI
« Reply #44 on: March 02, 2010, 03:48:22 AM »
4 weeks Post OP - I can't believe it's been four weeks already; how time flies when you're having fun ;D

Well I went for a test drive a couple of days ago & it caned (read that as very painful) getting into the car and getting out again. Once inside, all good :D So knowing I could drive I went for my first PT today & now have lots of new options, exercise wise. My ROM is only at 40 degrees :( sounds a bit pathetic I know! still, can only improve, so that's what I'll be working on. Physio was happy with my quad strength - all that WB as tolerated must have done something hahah. I now have the green light to do my exercises without the brace - the physio seems to think my ROM will come on in leaps & bounds now hahah I'll just keep working it as I'm happy to go slow & steady. The more ROM I achieve the easier the car access will become 8)

Lottiefox, it's past the 1st March - first day of autumn here - how did you to with your appointment & have you comhmitted yourself to this journey?? A lamington is an Aussie cake, dipped in chocolate, then rolled in coconut - I think you would love it hahah very popular here!

Must go & do some more exercises...

7of9
May 22 2013 RK LR & medial capsular plication, debridement, meniscus repair
Feb 3 2010 LK MACI
Nov 4 2009 LK scope - meniscus repair, debridement,      biopsy for MACI