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Author Topic: New Member, I am having ACI in mid October, Help!  (Read 28493 times)

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Offline Youthist

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New Member, I am having ACI in mid October, Help!
« on: September 06, 2010, 10:27:31 AM »
Hi All,

I am new here, and I am glad i found this forum and this particular section related to my operation - It is great to find others that have been through / gone through this operation, which I had never heard of until about 4 weeks ago...!

Background: Bad Football injury in mid 90s, which I didn't think about for years, that has never caused a problem until earlier this year (early May) , when trying to run (I usually run about 25k per week and football once a week) I was getting sharp medial pain. One MRI later and I it was explained that that I had a lesion on my inner knee, and I would have to quit running and football....not a good situation. Then after an arthroscopy to remove the loose body the Surgeon started talking about ACI, which is the route I am taking. Andrew Unwin did the first one, and removed the loose body, and I have now been passed onto John Skinner at Spire Bushey.

Mr Skinner harvested on Thursday last week, and now I am waiting until Mid-October for the main ACI operation. From reading on here, and other places on the net, I am started to realise how difficult the early stages after the operation are going to be from a physio and rehab standpoint (not to mention from a getting some sleep standpoint!). I have got one month off work (desk based) after the operation just to focus on the the physio side of things in that first month - do people feel this is going to be of value?

One question I do have, is a lot of people are mentioning "CPM" on here, what is this? I have not had this explained to me, I know I am going to be on crutches for 3 to 4 weeks non weight bearing. Mr Skinner has said after the op that my knee is in good shape, and feels I will be "fairly active" within one year of the operation. My goal is to get back to running and football ASAP....

Any comments or thoughts from anyone who has any advice or opinion please feel free to reply! (also let me know about CPM plz!).

Cheers all, and I am happy to have found somewhere where others have been through all of this!

cheers
tony



Offline Rennschnecke

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Re: New Member, I am having ACI in mid October, Help!
« Reply #1 on: September 06, 2010, 11:46:03 AM »
Hi Tony

CPM is a continuous passive motion machine.  You basically strap your leg in it and it will bend it for you.  The benefits are it keeps the knee 'lubricated' without undue stress.  In your case, it keeps it moving without weightbearing.

The first 4 weeks I was basically in the CPM or doing home exercises.  My physio didn't think they could do much with me during the early stages.  If you can get a full 6 weeks off it would be very good, but others have gone back at 2 or 3 weeks although part-time.

Talk to your surgeon about time off work and adjustments you need to make.  These tend to be ability to elevate and ice the knee as well as parking close to the building and seating downstairs.  However, people have tended to have quite varying rehab protocols depending on their defect so your surgeon is the best person to answer your questions.

Good luck in October.  Hope all goes well!
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: New Member, I am having ACI in mid October, Help!
« Reply #2 on: September 06, 2010, 12:13:35 PM »
Hi Tony

First the good news, Spire Bushey/ RNOH Stanmore has a fantastic bunch of specialists and they do MACI's most weeks. Your defect on the inside femoral chondyl also has highest success rate (Patella MACI's worst). The bad news is that rehab takes a long time and you can pretty much forget about running/ sport for a year. If you overdo it and bugger up the graft they might be able to start over, or they might not which means early knee replacement and end to all sports, so be careful!

I'm two weeks into MACI at Stanmore under Prof Briggs, first four weeks are nwb, then two weeks partial weight bearing. You need to have your leg elevated all day so being off work for first month is necessary, six weeks would be better, maybe work from home. Its not too painful (not as bad as I thought it would be, and less painful then knee was before operation) but also need to do physio exercises at least four times a day icing the leg a couple of times a day is also recommended (not that conducive to getting work done).

I don't think that cpm's are needed for MACI rehab, growing cartilage on matrix seems to remove the need. I haven't seen any other recent MACI patient refer to them but they were used early on. 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 Youthist

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Re: New Member, I am having ACI in mid October, Help!
« Reply #3 on: September 06, 2010, 12:54:54 PM »
Hi guys,

Thanks to both of you for your insight and comments.   re work, I can work from home and so I think after 4 weeks I will be back trying to work from the home office, I have the full setup, and in fact  usually work 2 days per week from home even before this all started in May. Its great that the prospects are good KartBoy based on the location of my lesion. I definitely will not be rushing back into running or football, I plan on just non-impact sports until the time is right. I will take that over not being able to do any running  again, which was the first initial diagnosis.

Also Andew, I am liking the "It's not as painful as I thought it was going to be" stuff - keep that coming :-) 
Is your leg in a cast / splint? Do you have to wear it at nights to sleep, or can you take it off?  Also how many nights were you kept in after the op?

Cheers guys
tony

Offline KartBoy

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Re: New Member, I am having ACI in mid October, Help!
« Reply #4 on: September 06, 2010, 09:41:46 PM »
Tony

I wear a hinged brace, its on all the time even at night but during the day I tend to open the latches to let the leg get some air, i'm just careful to not move too much. I had to sleep on my back for the first week as I couldn't turn on my side in the brace but I can do this now (carefully) and put a pillow between leg and brace for comfort, I can only lie on my right side (MACI was on right knee).

I was in two nights after the operation which is normal. They just want to make sure that pain/ medication is all sorted and that you can get around on crutches ok. Here is my post-op diary http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=52704 post to the thread if it flags up any other questions.

All the best, Andrew
« Last Edit: September 06, 2010, 09:44:57 PM by KartBoy »
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: New Member, I am having ACI in mid October, Help!
« Reply #5 on: September 06, 2010, 10:10:55 PM »
In hospital for two nights for MACI (kissing lesions patellofemoral joint), brace to be worn all the time including overnight for 6 weeks, CPM for 8 weeks.  I was full weightbearing though as it was the PFJ.

Surprisingly little pain for first 8 weeks, it was very well controlled by meds, but severe intermittent pain began from week 9 onwards.  Have arthrofibrosis and still being reviewed with plan for treatment.

Please note, my protocol differed from that given to others with kissing lesions so there is some variability with what you will experience compared with others who may seem to be in similar positions.  The only thing I'd stress now with hindsight is ice your knee religiously and elevate as much as possible.  Getting the inflammation and swelling out of the knee will help reduce the risk of excessive adhesion formation.  Otherwise you should follow your OS's instructions quite strictly, although the frustrating thing I found was that I had questions once I was working through the programme.

All the best!
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: New Member, I am having ACI in mid October, Help!
« Reply #6 on: September 07, 2010, 11:01:12 AM »
I think keeping the compression stocking on is a really good idea, I did this to keep leg warm but after discussing with physio she said it was recommended for first few weeks (maybe not so much for Patello femoral because your weight bearing). Make sure you get an extra set while your in the hospital, they can be hand washed though.

You must keep the leg elevated, as much as possible and physio told me ice twice daily for 10 minutes, even with stocking on my leg goes dark red after only a few minutes on my feet and makes it ache much worse.
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 Cricket

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Re: New Member, I am having ACI in mid October, Help!
« Reply #7 on: September 08, 2010, 02:25:14 AM »
It seems like you are interested in other people's experiences so I you might want to read the online diary I kept through my ACI surgery. I really appreciated other people's diaries (listed in my links on the blog) and wanted to offer something back. I did a bit of research on all the things I talked about with my doctor and covered that info too, so that might help.

I am about 5 months out now and at the nervous stage where I am worried about over-doing it. I still check back here now and then for a bump in confidence.

Good luck!

http://allisonsaci.blogspot.com/
Jan 2009 - OCD diagnosis in femoral articular cartilage of R. knee
Mar 2009 - Microfracture
Sept 2009 - Arthroscopy and cartilage harvest
March 24th 2010 - ACI part 2

http://allisonsaci.blogspot.com/

Offline KartBoy

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Re: New Member, I am having ACI in mid October, Help!
« Reply #8 on: September 08, 2010, 11:41:44 AM »
Hi Alison

I had a look through your blog, including the pictures! You had a much larger defect than mine but it will be interesting to follow your progress as I'm only just into third week. Its good to read that your off pain killers, I look forward to that.

Tony, don't be spooked by Alison's blog. It may be too early for you to read it, as it maybe too much information for you to take in right now. It's taking a while to sink in for me at +2.3 weeks that the recovery stretches so far out, just need to get through each day and not overdo it, and not expect too much, too soon. The first milestone for me was staples out at two weeks, next is partial weight bearing in another 10 days with physio review next Monday.

Andrew
« Last Edit: September 08, 2010, 11:47:03 AM by KartBoy »
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 Cricket

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Re: New Member, I am having ACI in mid October, Help!
« Reply #9 on: September 08, 2010, 09:40:13 PM »
I am definitely a more information is better kind of girl. :)

Try out the tags on the side. The checklist and research posts will likely be helpful. If you get braver, then read the lessons learned.

My rehab has been complicated by the fact that I have been hurt for a long time and had corresponding muscle atrophy, worse than someone who wwas fairly active prior to the ACI. So it is probably taking me a little longer to get it back.

I will say this: I am already glad I had it.
Jan 2009 - OCD diagnosis in femoral articular cartilage of R. knee
Mar 2009 - Microfracture
Sept 2009 - Arthroscopy and cartilage harvest
March 24th 2010 - ACI part 2

http://allisonsaci.blogspot.com/

Offline thornburg

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Re: New Member, I am having ACI in mid October, Help!
« Reply #10 on: September 21, 2010, 04:26:31 PM »
Hi Tony -

I am about 9 months post ACI on my left knee patella, surgery date was 12/2/09!   One bit of warning as you seem anxious to get back to your running/football, be patient.  I also was a runner and "martial arts" (Krav Maga) and went back to Krav way to soon and did additional damage to medial side of knee now.  I went back to my activity according to protocol when the doctor advise it was ok, the knee was just not ready for that type of activity due to lack of quad strength.  Shoot I am still trying to find my quad!  ;-)  Now I am working thru 6 weeks of recovery post a recent scope (about 2 weeks ago) to assess the damage and remove some debris.

The CPM machine is boring but needed, it will aid in getting your range of motion back!  I had it for 4 weeks and was "living" in the machine per say for about 8-10 hours a day.  Does not hurt, but I would say uncomfortable as the machine pushes the knee and the degrees of bend get higher.

Sleeping, I was in a brace that prohibited bending for 6 weeks.  After the pain decreased over time, I learned to sleep on my side with it.

Since I was told never to run again, I have turned to biking now.  Its my "new" sport to replace running. Not sure of your long term goals or doctors orders, but might keep in the back of your mind, running might not be an option.

I took 6 weeks off work and then worked from home also.  It really depends on your progress and pain on how quickly to return.  I was ready after the 6 week break!

Seems like others on the board have shared most of the same info I can speak too.  Patience is the biggest thing I wanted to share.

Good Luck and keep us posted on your recovery,
thornburg


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Re: New Member, I am having ACI in mid October, Help!
« Reply #11 on: October 02, 2010, 05:01:29 PM »
I'm having a patella aci/amz in early November, so I also am trying to plan and figure out what to expect.  Return to work is one of my biggest concerns right now.  I know I can probably get a full 6 off, but only 4 paid at 100% after that it drops to 50%, so I'm leaning to taking 4 weeks and then trying to figure out a work from home plan.

Even though it's my left knee, how have those of you that have had this managed driving afterwards.  If I'm in a brace locked in full extension, I'm trying to figure out how I'll fit in my car? I guess I'll figure it out afterwards.... Any suggestions anyone?

Offline Rennschnecke

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Re: New Member, I am having ACI in mid October, Help!
« Reply #12 on: October 03, 2010, 02:06:44 AM »
If you're planning on driving soon after an op you need to check with your insurance what they will accept.  My insurance normally says that it's up to the doctor to say when it is possible.  So then, I check it out with the surgeon.

Some OSs operate a policy of embargoing any driving until 6 weeks post-op (that's what I had for my ACLr).  More recently, my OS said that I could drive after 2 weeks once my knee could bend at least 90 degrees and it was comfortable.  Others may get different instructions (e.g. once you're off narcotics but that would have meant no driving for me for the last 3 or 4 years).

I can't really comment on how to adjust to driving with a brace as I didn't do it.  I had a manual (stick shift) gear box so couldn't drive for ages anyway because of potentially stressing the grafted areas.  I'm now in an automatic, but probably won't drive again until the swelling in my knee resolves a bit more.

Good luck with your planning.  Sounds as if you're going to be well set up thinking of all these issues in advance.
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 Melissa S

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Re: New Member, I am having ACI in mid October, Help!
« Reply #13 on: October 04, 2010, 02:35:56 AM »
I'm having a patella aci/amz in early November, so I also am trying to plan and figure out what to expect. Return to work is one of my biggest concerns right now. I know I can probably get a full 6 off, but only 4 paid at 100% after that it drops to 50%, so I'm leaning to taking 4 weeks and then trying to figure out a work from home plan.

Even though it's my left knee, how have those of you that have had this managed driving afterwards. If I'm in a brace locked in full extension, I'm trying to figure out how I'll fit in my car? I guess I'll figure it out afterwards.... Any suggestions anyone?

I was wondering the same thing Courtney.  I don't understand how I will even get in our vehicles to ride with that brace locked in full extension.  They have always told me with my past surgeries that when I was off pain pills and I could bend to 90 deg. that I could drive.  I think I will go crazy if I can't drive for 6 weeks.  Not to mention we don't exactly live close to my doc office so it will be a hassle for my family to get me there all the time.
Injury with knee hitting concrete 7/07, partially torn ACL, and cartilage damage
Scope and debridement 2/08
2nd scope 1/10 with carticel biopsy
Carticel implant surgery on 11/8/10

Offline Rennschnecke

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Re: New Member, I am having ACI in mid October, Help!
« Reply #14 on: October 04, 2010, 04:28:02 PM »
Oh doh!  Just to get into the car, I usually ride in the back.  Once the door is open, I usually drop/throw my crutches into the well between the front and rear seats, then I lower myself onto the seat sometimes using the back of the front seat for support.  I then slide along the seat so that my leg gets in as well.

There isn't much room for other passengers (only one in the front).  It is a bit awkward, but it means you can ice, elevate and generally be pampered and chaufferred in the back.  The seat belt is a bit awkward and this may be helped by a seatbelt restraint, but I don't have one so can't speak from experience.
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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