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Author Topic: ACI on lateral femoral condyle  (Read 18496 times)

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Offline barnee21

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Re: ACI on lateral femoral condyle
« Reply #15 on: August 16, 2010, 05:47:06 PM »
Hi Tony,

I wonder if you could give me the name of the physio that helped you with your rehab in southampton, Feel that I need to make sure that I can get the rehab spot on to give myself the best chance of recovery and would hate to get there and have my PT say A.C....what?

Thanks

Lee

Offline tundi

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Re: ACI on lateral femoral condyle
« Reply #16 on: August 22, 2010, 09:15:47 PM »
Hi Lee,

   I'm currently seeing Caroline Pepper at Spire Southampton. RNOS have a rehab protocol that is issued after your surgery, the physio team at Spire Bushey were also more than happy to provide  their contact details should my physio havbe any questions about the protocol - I'm sure this would also be true of the physio team at RNOS.

Cheers,

Tony
Apr 10 RK - 2nd Stage MACI
Feb 10 RK scope - biopsy for MACI
Dec 09 RK scope - debridement
Feb 08 RK - plate removal
Feb 07 RK  - 2nd Stage MACI & Distal Femoral Osteotomy
Jan 07 RK - scope - biopsy for MACI
Jul 06 RK scope - debridement & Microfracture
Nov 02 RK scope - debridement

Offline fed up nurse!

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Re: ACI on lateral femoral condyle
« Reply #17 on: August 23, 2010, 06:55:06 PM »
Hi Lee, sorry to hear of all your probs, knees are a nightmare! I have had an ACI at Stanmore ten years ago (I was one of the first on the ACTIVE trial) Unfortunately over the years it has worn away and so after much struggling and hasseling I got re-referred to Stanmore, I am now 3months post surgery. This time I had an MACI of the patella- femoral area, this is now apparently the preferred surgery, the ACTIVE trial has now ended. I was offered this or a partial knee replacement, I am 29 and so the MACI seemed the preferred option. I also had the surgery done under Mr Carrington. I was in hospital for three days and was given a nerve block post surgery, so pain was minimal. I was not in a CPM as you have to be in a straight leg splint for four weeks, after which I was allowed to bend to 40degrees only for another four weeks. I am now at the stage where I am trying to get back full ROM which is a lot harder then I remembered from last time! Pain has been very minimal and so far I am happy, apart from a probable infection, but hopefully that can be easily dealt with.

I hope your appointment goes well, remember to take a book, waiting times for xray can take AGES!!
Good luck xx

Offline barnee21

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Re: ACI on lateral femoral condyle
« Reply #18 on: August 26, 2010, 06:19:49 PM »
Hi fed up nurse,

Thankyou for your reply, I hope that the infection is cleared up as soon as possible and that you're progress carries on as well as it seems to be so far. Did you find Mr Carrington to be informative?, I suppose with having the surgery before you were already well informed, but I would just like to know if all the questions I have buzzing around my head are going to be answered or if i'll get rushed through. I did have an updated MRI back in febuary this year before the farce of trying to get referred, not too sure if i'll require another to get an updated view of the state of the knee. Just out of interest how long did you have to wait between you're initial appointment to getting the surgery?, Sorry for reeling off question after question but its nice to find someone firstly treated by my prospective surgeon and secondly to have been through the mill twice!!!....Ooh just one more was the nerve block offered as an option or is that normal protocal now?, think thats it for now lol.

Thanks

Lee

Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #19 on: August 26, 2010, 11:37:17 PM »
Lee, just jumping in here ...

MRIs will not necessarily be updated – they are costly to take and do not always show up the situation accurately.  As yours was recent (Feb this year?) they probably won't do another, but they may take and Xray.

Nerve blocks are not standard unless you have special medical reasons for requiring a nerve block for pain relief etc.  You can get a spinal as an option, but I've always had to request it.  Seems like surgeons don't like their piece of meat talking back to them in theatre.  However, mine was happy to talk and the anesthetist was taking photos of my knee to show to me.  Didn't think much of the fact that someone was looking at the BBC cricket news during my op though! Ha, ha!

Not too long now till your appointment.  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 barnee21

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Re: ACI on lateral femoral condyle
« Reply #20 on: August 27, 2010, 05:09:47 PM »
Thanks Renschnecke!, Viewing sports during an op is a new one on me ha ha!!. Think the spinal is an option i'd rather not take, put me to sleep and tell me all about it after ha ha. Can't wait for the appointment now it feels like i'm actually moving forward, i'll be sure to let them know that I am free at any time for cancellations.....presuming I get accepted for the surgery. Need this knee to be fixed, it locked whilst I was on top of the crane today which is a new one, this hasn't happened in a while now, scary for a brief moment but after a quick kick out and disgusting crunch I was ok again. Little swollen and more painful this evening than usual. Roll on the 8th sept lets hope Mr Carrington can work some magic..................... ;D

Offline ACE UK

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Re: ACI on lateral femoral condyle
« Reply #21 on: August 28, 2010, 01:06:17 AM »
Lee,

I had an osteotomy as well as MACI so i was given a nerve block. Great for relieving the pain but takes ages to wear off. It therefore took ages for me to pass water - no fun i can tell you! The alternative was a catheter which i was not going to even consider.
I have got a brace and i chased up the hospital before the op to ensure one was going to be provided as they cost over £100. If your op is covered by insurance then make sure they will pay for it. Generally, if it is provided/fitted after the op whilst your still in hospital, then it will be covered. If it is provided as you are leaving hospital or during an outpatients appointment then it is put in the same category as crutches and they wont. i havent been charged for crutches though!

ACE UK  8)

Offline KartBoy

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Re: ACI on lateral femoral condyle
« Reply #22 on: August 28, 2010, 08:01:00 PM »
Hi Lee

I've just had my MACI done at Stanmore (6 days ago) under care of Prof Briggs, your going to the right place but patience will help as MACI are done on a trial basis and only if firstly they really think it will work for you, secondly if your case will tell them things that will eventually help it to become a NICE approved procedure. They have been doing ACI/ MACI's at Stanmore for years but number of patients is still in the hundreds.

Your right to contact central bookings and be prepared to put in the effort and see them at short notice as they really like that, I had to wait months but also shaved months off my wait. I'm not sure about the effect bone graft has on rehab, I'm NWB for six weeks and am strapped in a fixed brace for first week, I may have to wear the brace for entire six weeks of initial nwb, this is up to local physio.

Get a referral from your GP to local physio once you know your getting a MACI (best of luck), this establishes a connection and means that you can give Stanmore their name if/ when you go in for the op so they can send them all the appropriate protocols. I already knew my local physio's because they were involved in my TPF rehab 2 years ago but had a one-off useful session just before the MACI where I got good guidance on exercising the leg as much as possible to strengthen it before they operated.

All the best - Andrew

7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline barnee21

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Re: ACI on lateral femoral condyle
« Reply #23 on: August 29, 2010, 01:12:24 PM »
Hi all,
Thank-you for the responses, ACEUK great information on the nerve block and I will be looking into a brace as soon as I find out that they are willing to do the procedure(fingers crossed!), although I am sure that I read somewhere that in some instances people were in a cast for a while, I guess this is all dependant on the location of the defect. Andrew - I hope that your recovery is going well, I will be sure to get a referral from my GP just as soon as I find out my fate. Just a quick question on the criteria of selection for the MACI procedure, I suppose because I had been referred by my OS in southampton (who can carry out the procedure but not in southampton as the hospital does not have the licence to do the job) I took it as red I would get approved. Now all I can do is keep everything crossed that I am a viable candidate....sorry i'm babbling.....back to the question does anyone know the things they look at to see if you are a good option for the procedure?, I am guessing that they take into consideration age, weight, levels of activity, willingness to commit to rehab, and of course the location and size of defect. If anyone knows of anything that I can do to make myself a better candidate please let me know, I am already strengthening my leg muscles as much as pain will allow, and smoking is now a thing of the past, I have dropped over a stone in weight that was actually gained after the microfracture and my levels of fitness are as good as can be expected.

Thankyou everyone again for you're replies only hope that I can be as helpful to others in the future :)

Lee

Offline KartBoy

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Re: ACI on lateral femoral condyle
« Reply #24 on: August 29, 2010, 04:39:56 PM »
Lee

I have no idea why Prof Briggs thought I was a good candidate I was referred to him from an OS at Guy's & St Thomas' who was responding to my pleas that something must be possible, she knew of his work and didn't think I was a particularily good candidate due to the extent of the damage visible on the MRI. I had to do an extra scope at Stanmore by Prof Briggs before he would agree to go ahead.

I think its very much up to the individual surgeon as to what they have seen/ done before (themselves?) and what they think is possible. I have seen another opinion from consultant OS who thinks I'm a poor candidate who disagrees with the offer of surgery.

I think though that my activities prior to TPF two years ago are big factor, 1st degree brown belt, advanced skier, training for marathon etc and hence very fit. It meant that when I got to see Prof Briggs I was more than desperate, it was MACI or knee replacement. Prof Broggs although made it clear that my desperation had nothing to do with his decision as he wouldn't put me through a painful operation and long rehab unless there was a better than even chance that it would make a significant difference.

Best of luck when you see Mr Carrington
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #25 on: August 29, 2010, 04:51:00 PM »
Other criteria include whether the defect has arisen from trauma or generalised osteoarthritis and whether there are stable margins for the defect to attach to.  I don't think these are things you will be able to influence.  There is a set of criteria which the surgeons work to, but I'm way outside these and my surgeon went ahead based on discussion with international colleagues.

If you're not already doing so, it may be worth taking some glucosamine & chondroitin complex (I take it with MSM: 1500mg/1200mg/250mg) and some omega-3 fish oil (1000mg/day).  They may or may not help.  There is evidence to suggest that the glucosamine complex can ease pain but this occurs only with longer term use, i.e. benefits accrue over 4 to 6 months.  There is a study by folks at Cardiff Uni that indicate that fish oil can inhibit the production of an enzyme that is implicated in the degeneration of articular cartilage.  However, I haven't found many supporting studies and my research is around 2-3 years old.

I'm also taking some hyaluronic acid with no particularly strong foundation for this apart from the fact that one OS suggested it for the Australian athlete who injured her meniscus around 1 month (or less) out from the Olympics.  She took it and with his help competed at Athens and won a bronze medal!!!!

I'm not suggesting that you'll be winning Olympic medals with this cocktail, but if you can afford it and your stomach doesn't object I don't think they will do you any harm!  ;)
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 barnee21

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Re: ACI on lateral femoral condyle
« Reply #26 on: August 29, 2010, 07:07:48 PM »
Thanks Andrew, fingers crossed I am seen as a suitable candidate, keep us all posted on your progress through your rehab.

Rennschnecke, I will try anything to get things back on track, out of interest on the criteria for MACI you suggested that trauma or osteoarthritis could be part of the criteria. Initial diagnosis from my OS in Southampton was osteochrondritis dissecans, but after discussion about an accident at work it is now unclear as to what caused the problem, hope this doesn't complicate matters further!!!

Slight concern today the knee effectively locked up and after freeing it up a great deal of pain and muffled swearing(9 year old daughter close by) I am now in quite an amout of pain, the pain I can deal with, what is playing on my mind is that prior to the microfracture and the removal of the loose body this was happening quite frequently, I hope beyond hope that I do not have more bone/cartilege floating around. I will have to mention this to Mr carrington at the appointment.

Happy bank holidays (lays back on sofa and elevates knee)

Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #27 on: August 29, 2010, 07:15:19 PM »
Lee, just checking whether you're trying elevating leg above heart level to ease pain – much more effective than hip level ...
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 barnee21

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Re: ACI on lateral femoral condyle
« Reply #28 on: August 31, 2010, 05:26:44 PM »
Thanks Rennschnecke, added some extra cushions and helped a lot.

Looking to comple a list of questions for my visit to Stanmore this evening, early finish from work and little one is around a friends for tea.

Any input as to questions that I should be asking that I might well oversee would be much apreciated.

So far I have the following queries: Approximate waiting time for surgery, Will the bone graft complicate or extend rehab?,Pain relief?, How much time will be spent in hospital after surgery. Rehab protocol, will I need to find my own physo with experience of MACI recovery? Estimated time of recovery( I know this is very vague, but I need to tell my employer something) Do I need to source a brace myself prior to surgery?. Also need to discuss my expectations of the surgery and how realistic they are. I have heard quite a lot from people on here regarding Prof. Briggs and Mr skinner but little about Mr Carrington I guess this is a little cheeky but I would like to know his previous experience of this type of Operation.

8 days until the next step, fingers crossed I hear some good news and not a knock back!!!

Lee

Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #29 on: August 31, 2010, 05:54:14 PM »
Lee,

Mr Carrington needs to be suitably licensed to perform the op, but I understand your concerns.  Are you having this done privately or on the NHS?  If it is NHS funded then he is likely to be part of an elite group who has been given a budget to use on this procedure.

As far as questions for the OS are concerned, perhaps rather than talk about recovery, as that term has a multitude of interpretations, you could ask when you might expect to go back to work and what adjustments may have to be made to enable this.  Ask the surgeon if he would be prepared to write any supporting letters required to assist the process.  Consider how you will be getting about, when will you be able to drive (assuming you already drive)?  Also ask about weightbearing constraints and whether you will need a CPM, would you be provided with one or should you sort one out yourself.  One thing I didn't have at the time and with hindsight wish I'd had was an icing machine.  Ask if one will be provided or whether you need to get hold of one – also ask for recommendations.

Can't think of much else at the moment. 

I actually didn't have much formal physio for the first 6 weeks.  I saw a hospital physio who didn't do much apart from give me loads of exercises which filled in all the time off the CPM.  My private physio who is ACI experienced said there wasn't much for she could do for me until after 6 weeks post-MACI so I wouldn't fret too much about the physio for now – you have time to sort this out.

Good luck next week!
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.