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Author Topic: ACI on lateral femoral condyle  (Read 18448 times)

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Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #45 on: September 08, 2010, 06:23:22 PM »
Lee,

Glad you got good news from your appointment.  Waiting is one of the hardest things so good luck with getting your appointment through.

Is your job seasonal in that there are times of the year that are busier than others?  If so, is there any chance of coordinating your time off with the low season?  Just a thought!

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 #46 on: September 09, 2010, 07:19:12 PM »
Rennschnecke,

Thanks, unfortunatley the port is busy all year round, I have spoken to my manager and we are meeting soon to discuss my period of absence, limitations on return to work etc. I have decided to be as up front as possible about everything and try to give as much information as possible about the procedure and rehab, as you know very little is known about ACI as a rule and it's best to give a worse case scenario so as not to let my employer down at all. I'm not too sure how long it takes for the pre-operative blood tests and MRSA test results to come back, but I figured to leave it a week or so and then begin to try and get myself a cancellation. The down side to if I am successful is that it doesn't give my employer as much time to organise cover, but I really am in a hurry to get my knee back to some sort of reasonable level. The OS said that there is currently a 3 month wait for the first stage and then 6 weeks after the main surgery will take place, that would take me into 2011 and it seems daft but I want to start the year with only rehab to be concerned about.
So, lots of phonecalls ahead and pestering the lovely staff at Stanmore...............poor people ;D

Lee

Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #47 on: September 09, 2010, 08:17:49 PM »
Hi Lee,

Don't know what it's like at Stanmore but I know that my surgeon said he could only do so many ops per year (budget limitations) and then there is the Carticel process don't know what their criteria are.  You may find that getting your first procedure moved forward would be difficult because the rest of the schedule is quite fixed, so they have to check that you can get the theatre time and the beds when you need them.  However, I do wish you luck!

Was given a date for my next op of 21 September yesterday but got a call today asking if I could go in on the 14th yes!  Next Tuesday!  But mine is a stand-alone procedure not a two stage one.

Can you do any office/desk work for your employer between months 3 and 6?  That would be best for you if you can get it.

Best wishes  ;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 KartBoy

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Re: ACI on lateral femoral condyle
« Reply #48 on: September 10, 2010, 11:21:21 AM »
Lee, If you follow the same process as me then they need to do a scope which will then be followed by the two MACI procedures. You might be able to speed up the scope by telling the people at Stanmore that your available at very short notice, they are very good and put up with my pestering very well.

Once the scope is done you'll then have a review and be put into the queue for actual MACI which you may not be able to speed up much but again luck might be with you, I bugged them so much over the scope that I was also given a fairly short wait for actual MACI although had a nine week gap between harvesting & implant.

Just talk to them and be very nice, they are good people but its got to be hard talking to sick people day in/ day out. I couldn't do that as a job.
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 #49 on: September 10, 2010, 06:51:28 PM »
Rennschnecke, really pleased to hear your next op has been moved forward, what is it that you are having done?. Whatever it is I hope it is successful and wish you all the best. With regard to work I think it will become a little clearer after the meeting, I will wait to see if they are good enough to pay me for the lengthy recovery, if not then maybe look at other options such as office based work, this would be a last resort in some ways as the head office is some distance away from home and would require staying away from home a week at a time. Will be thinking of you on tuesday :)

Andrew, Thanks for the reply, I hope your recovery is going well. After my initial appointment I am not so sure I need the first of the two scopes as I had microfracture a year ago and recent MRI scans, I am under the impression that they will carry out the scope and as long as there have been no disasters and the knee has not degraded to a point it is unsalvageable they will harvest the cells. OS seems quite upbeat about my chances, although he did stress that final decisions will only be made after the initial scope with regard to both the bone graft and the defect itself. He felt that if the knee had got a lot worse I would be struggling a lot more than I am currently, so fingers crossed. I will try my utmost to bring the surgery forward and will be sure to follow your advice and let them know I am available at very short notice.

Thanks again for the replies have a great weekend!! ;D

Lee

Offline barnee21

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Re: ACI on lateral femoral condyle
« Reply #50 on: September 20, 2010, 04:38:01 PM »
Hi all,

Just a quick update, called the booking centre at stanmore again today and spoke to a wonderfully helpful lady, I have my first stage arthroscopy on the 22nd of october, a lot sooner than I expected and great news all round!!!. Just goes to show a little persistance and gentle badgering can go a long way. It seems to be very close all of a sudden and I have been in contact with my managers with regard to the length of absence, payment etc, fingers crossed they can see their way to helping.

Lee

Offline KartBoy

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Re: ACI on lateral femoral condyle
« Reply #51 on: September 20, 2010, 09:47:33 PM »
Great news Lee, If they are harvesting cartilage on the 22nd then I suggest you get started strengthening the knee and leg muscles as soon and as much as possible, its shocking how quick the quads waste when your nwb even for only a month. I got to put weight on the knee today for the first time at +4 weeks and it is shocking how weak the leg is.
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 #52 on: September 23, 2010, 04:50:21 PM »
Thanks Andrew, will get to work on the quads, although at the appointment with the OS I did ask about strengthening the quads and he said that they are twice the size of his so not to worry. Still I think if I put the work in beforehand it can only help in the long run. After the microfracture surgery last year I lost a lot of muscle and it has taken a long time to regain it!!

Hope everyone is recovering well or at least not in too much pain  ;D

Lee

Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #53 on: September 27, 2010, 08:30:42 PM »
Hi Lee,

Getting yourself into good condition can only help as the better your condition going into the op, the better you are coming out of it. However, I wouldn't obsess about it. It's a long recovery and during the time you cannot do any strengthening work you may find the muscle bulk going down. The god news is that your body has some muscle memory so when you do get back to training, you should find it much more straightforward getting back to fitness than getting there the first time. (At least, I hope this holds even after 2 to 4 years of de-conditioning.)

Apparently, this is the reason why elite athletes can always return to extraordinary levels of fitness even if there is a big gap in activity!

Good luck with the journey.

R
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 tremy1977

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Re: ACI on lateral femoral condyle
« Reply #54 on: October 18, 2010, 09:33:52 PM »
Alright lee, just been reading all your posts and questions.Your situation seems very similar to mine. failed micro frature etc and you have exactly the same size defect on the lateral side of your knee like i did. I had the ACI and a meniscus transplant operation in Oswestry(shropshire) in march this year. Being from Liverpool it was a decent drive. Anyways mate i'm sure after reading everyone's advice you've got, you know know a lot already. I'm 7 mths post op and to be honest i only started running 3 weeks ago on the treadmill but i must say i expected a lot worse after the operation with regards to pain and stuff.I have to say it wasn't that bad. I didn't the have CPM machine on my knee due to the menicus transplant getting done and with you having the bone graft it may be the same ?, they are very careful when after doing the ACI that the patch over the cartidige doesn't rip and sometime the CPM can cause that.I was in hospital for 5 days and for 4 of them i had a femoral block in my leg to numb any pain, soon as that was out then then they where looking to send me home. I had a straight leg brace on for 10 days until phsyio started also but i was pretty much FWB right after the op. Prof richardson that done mine is a big believer in that weight bearing and movement speeds up the healing process. obvioulsy everyone surgeon is different.
the 1st stage they'll take about 12 tubes of blood off you for the cell harvesting and then its normally just a day job or 1 night stay for the first procedure.
I'm also a part of the Active trail which i know a few people in your blog have mentioned. I was picked out randomlly to have the ACI which i was pleased about. My Active trial is through Keele university i've got lots of information on it if you've been offered the chance ?? sorry if i'm behind and you'v.e already sorted all that.
I was a semi pro footballer Lee and since i done my injury and since my operation i havent been able to do a thing sporting wise. Gotta say mate its a long road to recovery and you have to hold yourself back so its a good idea to get the mindset of a long rehab and if your getting it done on the NHS like i did then it'll be 1 day a week at the physio who by the way never seem to know much about these types of operations so i've found alot of the things you need to do are from your doings.

Hope some of that makes sense. if you need any advice or questions on things i'll be made up to help you.
best of luck
Paul

Offline barnee21

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Re: ACI on lateral femoral condyle
« Reply #55 on: October 23, 2010, 12:21:24 PM »
Hi all,

Firstly, thanks Paul I may pick your brains for some info as I progress.

Had the first stage yesterday and all went well, the staff at Stanmore were fantastic, I have never recieved care that comes close to how well I was treated yesterday. All went well, the cells were harvested and I will return in 6 weeks for the 2nd stage. Little bit sore this morning and slightly concerned at the level of swelling from an arthroscopy, the OS that carried out the 1st stage has said that they will use a gel for my surgery and no patch is required. Has anyone else had this type of surgery?.

The defect site had got slightly larger from when I had the failed microfracture its now 2 x 2 cm, but this is still ok for the procedure to go ahead. Really pleased that it is going ahead as there is always a nagging doubt that things have got worse between procedures and nothing can then be done to help.

So, now I look on towards the start of december when the real work begins to getting back my knee.....................

Thanks again to all that have provided me with infomation and encouragement to this point.

Lee

Offline KartBoy

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Re: ACI on lateral femoral condyle
« Reply #56 on: October 27, 2010, 08:26:14 PM »
Lee

I found that the knee was more painful and swollen after the harvest than for previous arthoscopies, I think they clean up the graft site in preparation for stage II, not certain but makes sense. Your defect is similar size to yours and i'm nine weeks out now and very happy with progress. I agree with your comments about stanmore, its in serious need of a bulldozer but the staff were great. I don't know if you have seen my post-op diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=52704 but if you haven't its worth a read although it is my own experience, I hope yours is as good.

Keep us posted!

Regards 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 #57 on: November 04, 2010, 06:40:30 PM »
Hi guys,

Thank-you Andrew, had a good read through your post-op diary, great insight into (hopefully) what I can expect, I fully understand that no two recoveries are the same and there is always a possibility of complications.

Recieved a phonecall from my favorite lady at stanmore Phyliss in bookings to let me know that the harvest went wel and I am booked in for the 3rd December for the second stage ACI, I am still struggling to find any info on the procedure the first OS described where they mix my cells with a kind of gel, place this in the defect after it has been cleaned out, after the surgery I did not speak to the OS and so did not find out if a bone graft will be required, I guess this will be decided on the day of the surgery.

Really pleased that things seem to be moving forward, and can now plan the post-op requirements, I already have a list and am currently seeking out a ice machine and asking all friends for their boxsets and DVDS.

Will keep everyone posted as I progress


Lee

Offline barnee21

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Re: ACI on lateral femoral condyle
« Reply #58 on: November 07, 2010, 08:35:03 PM »
Hello everyone,

I am hoping someone can do me a huge favour and translate the findings from my scope that was performed two weeks ago. I am due for ACI second stage in 4 weeks and just recieved this letter yesterday, I don't think it is too much to be concerned with but would be nice to know!!

Findings - Grade 3, 2 x 2cm lesion laterally on the lateral femoral condyle and 1 x 1cm lesion medially grade 1.
Anterior horn of lateral meniscus - meniscal tear.
MP notch suggesting tear of ACL, ACL stump well fixed on PCL but with some laxity.

Medial compartment - and PFJ intact.
Partial meniscectomy performed.
Cartilage graft taken from lateral edge of trochlea.

Lee

Offline Rennschnecke

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Re: ACI on lateral femoral condyle
« Reply #59 on: November 07, 2010, 09:05:47 PM »
Lee

The report indicates that the cartilage wear is not yet full thickness (which is Grade 4).  The greatest wear appears to be at the femur on the outside portion.  I am not sure whether they will perform an ACI in this instance as you may end up being worse off post-op.  This is because they have to remove the remaining cartilage from the bone (Grade 3 means the cover is thin).  However, the area is quite large so it will be down to your OS to make the call.  But from what you've said you may be having a different procedure done.

It sounds as though you might consider an ACL reconstruction as it is torn although attached to the PCL which helps to stabilize it.

You appear to have the area under the knee cap and the groove in good condition no signs of wear there.

I think your OS has trimmed the meniscus (assume it is the one on the outside of the knee) and taken a graft from the outside portion of the femoral groove for the knee cap.  This may be taken for future use.

It may be worthwhile contacting your surgeon to discuss the second stage.  My understanding is the ACI is not performed unless the defect is already full thickness, which isn't reported.  But so much is going on in this field that the experts are the ones who are really up with the latest practices.

Hope you're recovering well from the scope! 
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.















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