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Author Topic: Soccer player- ACI & Meniscal transplant diary and the road to recovery  (Read 15717 times)

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Offline tremy1977

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Thanks Rennschnecke. I haven't contact them, only because i thought at first it will take a bit to settle and with me going in now on the 1st march im not sure it would make any difference ?? what do you think ?.. I was told about it being taken from a non wight bearing but for some mad reason i juat can't walk without it locking. The OS did say he debrided a growth that was on the from on my knee so maybe its got something to do with that ??

I had the same thought about the 3 weeks for stage 1 to 2, not sure if thats just how this OS works or if im being accelerated through. I think you maybe right though about the locking, it could just be a natural progression thats lead me to have the ACI ?

Thanks for the advice, keep it coming, i'll need it after next week !!

Paul

Offline Rennschnecke

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Paul

It may not make any difference to contact them, but you may get some peace of mind for the next 5 or 6 days.  It's possible that you'd get to see a physio even if just for some taping or advice on how to manage it – especially if the locking also gives pain.

I thought the standard growth time for chondrocytes was 4 to 6 weeks, but it may depend on how big the defect is that needs to be covered.

Good luck for Monday.  I see my GP then so will be thinking of 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 Lottiefox

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Hey Paul

Been thinking about how things have gone for you this week  - hope you're doing OK and let us know how you are when you feel up to it.  :)

All the best!

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 cfranc

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Hey just stepping in....I'm over in the US and just had an ACI and TTO on my left knee Feb 3rd.  Just trying to compare and see how others are doing before/after.

After my biopsy scope to harvest my cells, it took a good 4+ weeks for the swelling to go down but once it did things were back to 'normal'. 

I am now almost 5 weeks out from the actual aci surgery and at 95 ROM.  Ideally they want you to have 90 at 3 weeks but I had an immense amount of swelling and it has been slow to go down.  I am going to PT 3xs a week and on the cpm 8 hrs a day.  I also add in a good 2-3 hrs of leg dangling, knee cap manipulation and other stretches. 

I've had 4 prior surgeries prior to this - 2 scopes, 2 VMOs and an ealier TTO (don't ask...let's just say not all docs are created equally).  This has by far required the most amount of work on my part...so prepare yourself...no napping after this surgery.

For those headed in I have a few recommendations: 
1) see if you can get a device called 'gameready' it's an icing system that far exceeds any other out there.
2) find a nice comfortable flat place to hang out where you can hang out on your cpm (a fully extended futon works great..plus you don't have to feel like you're stuck in bed all day)
3) get yourself a table or night stand next to where you'll be hanging out to put all those things you may need within reach
4) think of every possible item you may want/need while hanging around and have it conveniently located near your cpm area (books, computer, ipod, tv, snacks)
5) if you can get someone to help pack you some easy meals daily and put in a cooler next to you all the better

And my last advice take one day at a time....it's too overwhelming to think farther out than that.  Assume you will get back to your normal activities and just focus on as much pt as possible to get you to that goal.

I live for waterskiing and couldn't imagine my life without hiking.  With any luck I will be spending the fall of 2011 trekking in Nepal.  According to my doctor he's had patients recover and do ironman triathalons! So if that's possible...I think all of our goals albeit on a lesser scale are possible as well :)
Jan 1991 Lateral release
Nov 1997 VMO/Lateral release
April 1998 scope to remove bone chips
Feb 2002 VMO/TTO
Oct 2009 Biopsy for ACI
Feb 3, 2010 ACI/TTO

Offline tremy1977

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Re: Soccer player- ACI and meniscs replacement diary- 1 week post op.
« Reply #19 on: March 11, 2010, 11:25:48 PM »
Hi everyone.

I'm just over a week post op now. I ended up staying in hospital(Oswestry) for 5 days. This was mainly due to pain management and the fact i had a femoral block in to numb the leg from any pain. This was so good !!  apart from being uncomfotable the pain was barable with the block in. Although they didnt let me out until i had full feeling back in the leg and i was able to cope with the pain on the meds they where giving me.

Anyway's things aren't to bad. I'm still suffering the dull ache after surgery and the night times seem to be the worst. The swelling is still there but i have to admit its not as bad as i'd feared before the the op. The key i'm finding, is to keep on top of it with the medication.

After reading so much about the rehab on here, i'd done my homework on the CPM machine and the PWB for the first 8 weeks. i'd read lots of rehab notes from different hospitals just to give me a heads up. So after coming out of surgery and waking up in full flexed knee brace from my ankle to my thigh was a little shock. Briefly i had my left knee, tibia plateau ACI and a lateral Actifit meniscal graft. I was expecting to be on the CPM straight after the op per the OS in my pre op appointment, Apparently though as the ACTIFIT graft was quite rough the OS was worried that it might rip the flap covering the ACI. So the plan is now to wear the brace for 10 days solid till its all settled. However he's also told me to FWB while im in the cast as much as i can, apparently results are now showing that this now helps to nurish the new cartlilage while working the joint also from stiffening up. All a bit mad as i've not heard of anything like this while reading lots of other post regarding ACI rehab, even in the PT notes i've been given it was telling me to PWB.
I did ask the OS and PT lots questions regarding the CPM and the FWB post op just to reassure myself. Because my defect is on the tibia and i've also had the meniscal replacement the rehab had to be adjusted to suit.
I've been weight bearing with the crutches as much as i can and i have to say it feels great but it does pain me alot once i've settle down so i'm not over doing it, i'm also worried i might do myself more harm then good !! My PT starts next week once i can start to get ROM out of the brace so hopefully i'll be more positive after speaking to them.
The plan is to reach 35 degrees only for 3 weeks and then 90 degrees there after till the 6th week.

I've already started the knee cap manipulation and the leg raises but its still painful just doing those.

Be great to hear from anyone who's had a simliar type op and how there rehab has gone.

Would also like to say how brilliant Oswestry hospital was and how much of a fantastic job there doing there for orthapedic patients. If like me your having your op there then all i can say is, your having it done in the best place.

i'll keep updating my post as the weeks go by.

cheers
Paul







briefly i had the ACI plateau on the Tibia and a lateral Actifit meniscal graft.


Offline Rennschnecke

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Hi Paul

I wouldn't worry so much about your protocol being different from what others have had.  I haven't had your exact procedure (my grafts were on the patella and trochlea) but I was in a fixed brace for 1 week before CPM (ended up being two weeks because I managed to crash my machine) and was fwb when in the brace.  I felt great, but I hadn't had the meniscal op nor a tibial graft.

I think the fact that they are adjusting treatment in the light of new findings is quite reassuring that they are trying to give you the best chance of recovering from this.

Good luck with the pain management.
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 cfranc

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Hey Paul

Ditto on not worrying about the fact your PT protocal is a bit different.  Protocol for my surgeon indicates FWB if no osteotomy and only touch down WB with osteotomy. 

My OS was also very non-committal on what to expect after surgery...general answer was depends on the person.  For the same surgery, 1 person actually had the procedure as an outpatient and went home afterwards, while I was in the hospital for 2 nights. 

I would just say that whatever they tell you you can do ...take advantage.  Being just over 5 weeks out myself, I would say whatever they tell you to do for ROM work it as hard as possible. 

My OS' goal was to have me at 90 3 wks post op and 110 6 wks post op.  I was only low to mid 80s 3 wks out and am now struggling in the low 90s at close to 6 wks.  And being stuck at 90 for over a week is increasing my chances of having to have a scope to clear out scar tissue.

By the way, I am soooo jealous you are FWB...ahh to use my leg again :) 

Jan 1991 Lateral release
Nov 1997 VMO/Lateral release
April 1998 scope to remove bone chips
Feb 2002 VMO/TTO
Oct 2009 Biopsy for ACI
Feb 3, 2010 ACI/TTO

Offline tremy1977

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Thanks for the advice.

I've taken my leg out of the knee brace while i'm about the house per the OS instruction's. The pain has increased a little but im sure thats due to me moving it alot more. I start PT on Thursday so i'll keep every posted on what type of line there taking as it does seem to been different for everyone.

The FWB is great but i'm still walking with the crutches..... Not looking forward to my knee being bent from the PT this week !!. My concern is that i had my surgery done is a serperate hospital to the the one im havingmy  PT in as i live to far away to travel.

When i had my PT consultation last week the PT had never heard on ACI surgery ;-0 !!! Luckly i have the guide notes of my rehab from the PT at Oswestry, i've passed them on, so im hoping they go off that !! fingers crossed.

Not sure i could face another scope like you may be having cfranc !! how come you may be having it that ?? is the scar tissue really bad after your op then ?

Paul

Offline thevoice

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Re: Soccer player- ACI & Meniscal transplant diary and the road to recovery
« Reply #23 on: March 15, 2010, 12:09:15 PM »
I found the same thing in that my local physio hadnt come across this op before - they normally just read off the paper that you give them with the guidelines on - main issue i found is if you get a wired pain or expirence something thats off the norm so to speak they cant draw on expirence to say "ah yes I hads someone with the same thing after this op and it cleared up/improved thats perfectly normal blah blah"

Offline cfranc

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Re: Soccer player- ACI & Meniscal transplant diary and the road to recovery
« Reply #24 on: March 15, 2010, 05:00:02 PM »
Hey Paul..

I can email over the PT protocol my OS' office uses. You can also look it up on-line:  http://www.cartilagerepaircenter.org/

Look up rehab and then go to the ACI section. It may be somewhat different than yours but will help give your PT a better idea of what they can/can not do. 

From other acquaintances having this surgery, as well as, the lousy in-home PT service I had the first few weeks, most PT will try to have you doing more than you should if you're not careful.

My ROM has been stuck in the low 90s for over a week now.  My OS indicated that if I couldn't get back my ROM fairly quickly the chance of scar tissue setting in and needing a scope to clear it out would be high.  So do what you can as quick as you can.  But as indicated by my OS, it is much prefered to have a scope to clear out the scar tissue than push it too much and damage the work from surgery.

I am about to email my OS now...my next appt is not until April 1st...maybe he has some other ideas to get back my ROM or worst case hopefully we can schedule the scope asap....I need to walk I am going nuts!!
Jan 1991 Lateral release
Nov 1997 VMO/Lateral release
April 1998 scope to remove bone chips
Feb 2002 VMO/TTO
Oct 2009 Biopsy for ACI
Feb 3, 2010 ACI/TTO

Offline Dennis BadKnee

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Re: Soccer player- ACI & Meniscal transplant diary and the road to recovery
« Reply #25 on: March 16, 2010, 06:35:17 PM »
Paul,

The rehab protocols on Dr. Minas’ website (http://www.cartilagerepaircenter.org/) are general in nature.  He gave me a different protocol with an ‘(8)’ in the header, which tells me they have many different protocols with the same titles.   As cfranc offered, I too am willing to send you mine via email.  But I think the protocol should be specific to the nature of your ACTIFIT rubbing on the ACI membrane, etc.

I too had a PT who had not heard of ACI.  Prior to surgery I interviewed PTs, then selected the one who I knew would work.  My PT read the literature and spoke with Dr. Minas’ (my surgeon’s) RN Tim Bryant, so I felt comfortable he would try his best. 

Despite all good intentions, I remain in angst over whether I am doing enough, too much or doing it right or wrong.  Because my knee feels good and seem to be doing well, my PT would like to see me get more aggressive, which suites my personality.  However, from reading the literature and speaking with Dr. Minas, I know over-aggressive rehab is a cause for ACI graft failure – DR. MINAS EMPHASIZED THIS!  So what is one to do!  Hopefully I will get some answers on 31 March when I go for my 6-month follow-up.

Be diligent with your rehab.
Dennis

Offline tremy1977

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Re: Soccer player- ACI & Meniscal transplant diary and the road to recovery
« Reply #26 on: March 16, 2010, 10:31:25 PM »
Cheer's. If you don't mind emailing me your PT that would be great. The ACI PT at Oswestry and the OS Prof Richardson said exactly your words about the ACTIFIT meniscus rubbing the ACI graft and tearing it.  When i went for my first PT appointemnt last week i knew more than her due to the nature of the operation. i'll know more on thursday though now im out of the brace.

With regards to your rehab, i think you've answerd your own question. you need to listen to your OS who has the knowledge of previous patients and experience of the ACI proceedure., your PT is learning as he goes so i'd be listening to DR Minas !! On the other hand though Dennis, everything does seem to be pointing to more activity is good for nurishing the cartilage. Just take your time before rushing back to your running or anything that involing the twisting and pivoting.
Personally i'd carrying on doing what your doing as that seems to be healing your knee, another 6 months will be nothing compared to getting a set back injuring yourself again.

My email is [email protected]

Cheers
Paul

Offline Dennis BadKnee

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Re: Soccer player- ACI & Meniscal transplant diary and the road to recovery
« Reply #27 on: March 17, 2010, 12:39:27 AM »
Paul,
I emailed the PT protocols.  Thanks for the words of encouragement.  I do feel good about my knee’s progress.  I never had any setbacks in my first 6 months, although I had some uncertain periods about what to do or not to do, especially how much to do it (10 minutes or 3 hours).

You may have already found this link to Karen Hambly’s (Google search shows more of her works) course, part 4:

http://www.kneeguru.co.uk/KNEEnotes/node/740

Karen’s highlights to me are:

1) As the tissue adaptability chart indicates, cartilage takes a very long time to heal (e.g., my ACI graft is 20% healed at 26 weeks). 

2) Cyclical compressive forces are good (in fact, necessary).   

3) Shear forces are bad and to be avoided.

These concepts related to ACI apply throughout our rehabs.  I think our other tissues such as muscles heal quickly, and if everything else is going well, it feels as if we can do a lot more than is advisable ACI-wise.  Articular cartilage has no nerves.  The ACI would suffer even if we do not feel it.  But on the other hand, compressive forces tell the ACI how to grow and motion keeps the joint nourished and free moving.  This is a tough balancing act - not too much, not too little.  But, oh, by they way, no one tells you anything quantitative (it’s not on the PT protocols) and your brain is not a good judge.  So what do you do?  It is like walking a tightrope blindfolded.

My thoughts are that the already high success rate of ACI surgery would be even higher if it weren’t for failures due to improper rehab or behavior.  You are way ahead by doing the research.

Also, here is a study of ACI in soccer players you might find applicable – soccer players' ACI show high success!

http://www.ncbi.nlm.nih.gov/pubmed/16093535

Dennis

Offline Rennschnecke

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Re: Soccer player- ACI & Meniscal transplant diary and the road to recovery
« Reply #28 on: March 18, 2010, 01:00:09 AM »
Hi Paul

Re. PT – Ditto what's been about PTs being overly aggressive at times.  Do you think it would be useful to strike up a relationship with the key PT at Oswestry (visiting them when you're seeing the surgeon) and use them as the lead and the local PT for hands-on stuff? I found that my NHS PT was very aggressive compared with my private PT who has experience with ACI patients.  The NHS PT just went through the usual knee rehab stuff and referred me to hydrotherapy but that unfortunately set off all my subsequent pain and got me back onto crutches.  In the end they discharged me because they couldn't think what to do despite the fact I couldn't walk without crutches.

As you've got the meniscal implant your constraints will differ from many others.  I've just been told that large areas also take longer to settle down (consolation from my OS because of my continuing problems).

From some of the reports from those who have had successful outcomes from ACI I think they just did countless SLRs, cycled, rowed and generally mobilised for a year.  Really boring stuff!  But then, I haven't heard of people failing from going too slowly!  (I'm just trying to reassure myself that still doing all the boring stuff because I can't do any more isn't actually a disadvantage  :()
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 Dennis BadKnee

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Re: Soccer player- ACI & Meniscal transplant diary and the road to recovery
« Reply #29 on: March 18, 2010, 09:05:34 PM »
I agree with Rennschnecke as to how to handle the first year after ACI.  There is a crisis in PT after our surgeon’s are done!  We need to do research and fend for ourselves.  There is no reason to have PT set anyone back, at least not to the scale where it is happening to most people.  I pretty much feel I am better off on my own, using the PT as a consultant, but making actual decisions myself, refusing some PT.  I was very pleased with the surgeon, Dr. Minas and all the hospital staff EXCEPT for the PT both in hospital and guidance afterwards from the hospital.

The first day out of surgery, Dr. Minas’ fellow (Dr. Carlos Gonzalez) was in charge (I had never met him) of my hospital stay.  He had the PT staff put me on unlimited ROM, as tolerated, on the CPM.  I had read the literature provided prior to my surgery warning not get into the range of 40-70 degrees due to this being highest forces on the patella/trochlea.  Having had ACI in the trochlea, I complained to the PT who replied that it is on his orders, but I held my ground.  Later, Dr. Gonzalez stopped into my room and asked what ROM I was using.  I replied 0-60 but they at one time had me at 90 (without pain) before I stopped them.  He said to limit it to the 0-60 (still in the danger range).  What about the excursion into 90???  He said, that’s ok, don’t worry.  Now I was alarmed. 

The following day, the PT had me on crutches and kept trying to get me to put 40-pounds Partial Weight Bearing (PWB) on my leg.  We argued, I refused.   The PT returned with a written protocol saying ‘40 pounds.’  I still refused because the header of the protocol did not mention all my procedures.  So they wrote the additional surgical procedures onto the header with a pen.  I was not convinced and still refused.  That night at 4am, the resident doctor had awakened me for a checkup.  The doc said, “We heard what you did.”  What did I do?  He said it was good I had been my own patient advocate, saying I may have ripped out the TTO lugs had I put 40 pounds on my leg. 

So the following day, they returned with another protocol saying Touch Down Weight Bearing (TDWB) only, ‘like stepping on egg shells’.  However, the written protocol also stated Quad Sets as well as exercise bike cycling (prohibited on the other, TTO protocol).  When I questioned this, they took a pen and struck those, saying oh yeah, don’t do those.  Also, they told me other things not to do, but never gave me a timeframe when I could do them.  So I came home and refrained from some things that I later learned (at the 6 week checkup) I should have been doing (e.g., working for full leg extension, but somehow without engaging the Quad).  I believe no harm was done, but it is fortunate I had been so insistent on what I thought I knew to be right.  This should not have happened and I should not have had to know better than the hospital PT staff that work with people having such surgeries on a regular basis. 

None of this should have happened.  I know ACI is relatively new and that everyone’s body reacts differently, but what bothers me is that there should be more and better guidance.  There is a silver lining in all this.  I read that out of all ACI, there is an 80+% success rate (based on pain reduction – which is another peeve of mine – pain is irrelevant to some extent if I can achieve physical goals without deterioration).  The good thing is that (I believe) the success would be much higher if it weren’t for over-aggressive or inappropriate PT, which is probably the cause for most failures.  In other words, become knowledgeable and avoid the pitfalls, tipping the odds in your favor.

Now I am working with a local PT who has never had ACI experience.  He is very diligent on learning.  However, he is seeing my muscles heal and my pain level being very low, and my walking gait as normal – thus is beginning to treat me as any other knee patient.  He would like to start me hopping on a trampoline and doing other aggressive moves.  What I think I know is that the ACI is that it is still very vulnerable, so I refuse.  Although aggressive physical activity suits my personality, I will abide by my research and what I believe to be good for me.  This is frustrating.  In my mind, I am increasing activity linearly and slowly, doing the things posted above.

Here is something else; has anyone one else come across this?  I was given a handout after I left the hospital that states “Anti-inflammatory agents (ibuprofen, aspirin, Aleve, Naprosyn, Vioxx, Celebrex, etc.) are not allowed for at least 6-9 months because of their adverse effect on cartilage growth.”  While I was in the hospital I had been given large doses of intravenous anti-inflammatory agents.   I have not asked the surgeon about this, but it is on my mind. I just don’t want to alienate the staff by acting like I am a know it all.  But based on what happened with PT, I fear the worse.

Best wishes to you Paul. 
Keep us posted.
Dennis















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