Banner - Hide this banner





Author Topic: ACI 7 weeks ago takes turn for worse  (Read 11336 times)

0 Members and 1 Guest are viewing this topic.

Offline mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
ACI 7 weeks ago takes turn for worse
« on: October 05, 2010, 07:32:36 PM »
Hi

I had (M)ACI nearly 7 weeks ago and it seems to have taken a turn for the worse.  :( :( :(

At 6 weeks the brace was removed (for good) and I started on strengthening exercises as directed by physio (wall slides, squats, sit to stand, calf raises and step up in ROM exercises).  All relatively low impact to get going.  No pain was felt during exercise, I found the exercises hard work, but not painful.  My knee gave way on one occasion, but again, no pain was felt at the time.

My knee, although swollen and uncomfortable before was pretty much improving slowly I believe.  It has now become noticeably more swollen, hot and uncomfortable (borderline painful).  Difficult to locate the pain, seems to be general although it could be attributed to the repair site, but also other parts of the knee.  Appearance-wise, it doesn't appear to have changed too much (other than swelling of course).

If you had a similar reaction to starting your strengthening exercises, I'd be interested to hear from you.  Likewise if you recognise these symptoms.  Is this a sign of failure or that I've overdone it and it is typical for the knee to get cross and swollen in this way or is it a case of me over-cooking things a little too far?

Thanks

Mike
Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline ajschnelk

  • Forum Faithful
  • ****
  • Posts: 155
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #1 on: October 05, 2010, 09:50:22 PM »
I am not sure the location of your defect, but it's safe to say that you are doing way too much too early.  I had aci for a trochlea defect and i didn't even think about doing any of those things at 7wks other than the ROM and contraction type excercises.  I don't think i even attemped a partial squat until around 5months.  Where is your defect? 

Offline markld

  • Regular Poster
  • ***
  • Posts: 100
  • Liked: 1
Re: ACI 7 weeks ago takes turn for worse
« Reply #2 on: October 05, 2010, 09:52:04 PM »
Are you insane? You are doing things that one shouldnt do until 6 months post op. I had ACI on both knees and really didnt start strengthening until around 6 months. The graft is still way too soft at 7 weeks to be doing wall slides/squats... etc. You need to slow way down and find a therapist who has some experience in rehabing ACI. The only thing you should be doing at this point is slowly riding a stationary bike.
April 2008 microfracture left knee trochlea
Jan 2009 ACI harvest from right knee
Mar 2009 ACI right knee trochlea
July 2009 Aci left knee
Nov 2009 left knee scope to check graft

Offline mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #3 on: October 05, 2010, 10:02:15 PM »
Hmmm, that's interesting.

I have a 1cm x 2cm full thickness defect on the trickles.

The rehab I am on is as prescribed by the national trial I am part of which indicates beginning strengthening exercises at 6 weeks to 12 weeks. That said, doing what I am doing is clearly too much for the knee, so if I recover, I'll scale down considerably.

The physio was telling me to get rid of the knee brace, start walking with one crutch (and hopefully without a crutch soon) and drastically increase range of movement exercise.

Thanks for your feedback, how are you guys getting on? Frustrating isn't it?
Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #4 on: October 05, 2010, 10:05:08 PM »
Damn iPhone, trochlea not tickles!
Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: ACI 7 weeks ago takes turn for worse
« Reply #5 on: October 06, 2010, 12:24:31 AM »
Hi Mike

Ditto what the others have said.  The only strengthening to be done at this stage is light strengthening comprising quad sets, ham sets, straight leg raises etc.  Some additional exercises that allow you to strengthen other parts of the body without stressing the knee is also recommended.  Bike is good for mobilisation as long as it is at zero resistance.

I find that some physios seem to expect you to follow a protocol like you're a robot.  But your knee is telling you its too much by the increased swelling and discomfort.  If in doubt get in touch with your OS to let them know how your knee is taking this.  In my book it's downright unethical to push anyone to jeopardise the outcome of an op if an alternative is possible.  In other words, the Hippocratic Oath and the Declaration of Helsinki that governs all work and research among human participants restricts activities to those that would not do anymore harm than you might experience normally (i.e. your rehab should not be accelerated without tight monitoring to ensure it is not harmful).

How experienced is your PT with MACI rehab?  I know I had one physio who was way too aggressive, so I ended up ignoring her.  Her approach seemed to consist of loading me up with lots of exercises I might do but without any guidance on suitability.  Luckily I knew more than her she's since proven herself to be excellent at talking to you and citing research but less capable of doing any therapy!

I did have another physio who has ACI experience who was excellent and modified everything according to to tests in clinic and outcomes since the last session.  If there were any questions at any point she would check it out with the OS.  I never had any problems with swelling etc. under her guidance.

Have you looked up the posts of JulianUK?  He's had two successful MACI grafts which have held up for years, so he's probably the Golden Boy from the UK (especially Stanmore) for this procedure.

Hope you can sort things out to get back on track soon!
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 mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #6 on: October 06, 2010, 08:53:24 AM »
Thanks Renn, all of you have been really helpful  ;)

My physio is widely recognised as the best for knees in the area, that said, she hasn't too much experience in MACI. I'll have to wait until Monday for my first post op visit with the surgeon to see whether this is just a nasty reaction that'll settle or the end of the road for this MACI. A little nerve wracking as I'm meant to start a new job on 1 December! Utterly deflated at the minute  :'(

We seem to be pretty good at actually doing the operation in the UK but post op support and rehab is pretty poor!

I'll look up Julian, thanks for the info.
Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: ACI 7 weeks ago takes turn for worse
« Reply #7 on: October 06, 2010, 12:18:04 PM »
Mike

It's probably a bit early to be writing off the MACI op, but if I were you, I'd stop the squats and any activity that increases the shear forces beyond that you'd have with walking - see article by Karen Hambly on PT post-ACI.  As far as I can tell, she is the expert physio in this area.

Where are you based?  I know of some physios out of my area who are familiar with MACI and if they match I can PM you the details.
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 mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #8 on: October 06, 2010, 12:19:55 PM »
Thanks Renn, I'm based in Southampton, Hampshire
Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #9 on: October 06, 2010, 12:22:47 PM »
PS where is the article?
Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: ACI 7 weeks ago takes turn for worse
« Reply #10 on: October 06, 2010, 12:52:52 PM »
You can find all the articles for Karen Hambly within the Information hub just scroll down the page till you find Karen's name.

Sorry, my contacts are not in the Southampton area, so can't help out as I'd hoped.  If I hear of anyone I'll let you know.
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

  • MINIgeek (20-50 posts)
  • **
  • Posts: 32
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #11 on: October 07, 2010, 05:57:58 PM »
Hi Mike,

Sorry to hear about your setback, I am due to have first stage ACI at stanmore on the 22nd oct under Mr Carrington, I am also in Southampton and would be really grateful if you find a decent Physio in the area if you could forward their name on to me, rehab is a huge part of the whole process and getting a physio with knowledge or previous experience of ACI or MACI would be a massive advantage. Hope the knee settles down and you get the correct information on what your limitations are, squats seem a little brutal this soon after the op.

Lee

Offline mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #12 on: October 08, 2010, 08:17:22 AM »
Hi Lee

There's good news and bad news.

Bad news
No one in the area has much if any experience of ACI. The op is comparatively rare still.  I was referred to someone who is widely recognised as the best physio for knees is Southampton.  The referral system for physio is very odd in Southampton, most likely you'll be referred to Moor Green, I'd recommend you resist this and push to get Southampton General.

Good news
Some of the responses on here suggest not doing the strength exercises until 5 months, but that doesn't seem to be protocol here and my physio was following it. The exercises were just a little too much and we should have eased into them a little more slowly, but it is tricky to judge.  Have a look at thinks like Chester Knee Clinic for rehab guides (which seems a little more aggressive than my programme) for an insight and when you do your rehab, your more than welcome to drop me a line, I would however suggest, scale back your exercise programme and build up very very slowly and see how your knee reacts,

Best of luck

Mike


Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: ACI 7 weeks ago takes turn for worse
« Reply #13 on: October 08, 2010, 09:59:15 AM »
oh, and by the way, if you can afford it, well worth investing in an Aircast Cryo Cuff device, I managed to get it (ice bucket and cuff) for about 100 all in and it is an absolute god send!  Fill up the ice and water in the morning and you feel the benefit for pretty much the entire working day.
Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: ACI 7 weeks ago takes turn for worse
« Reply #14 on: October 08, 2010, 12:30:46 PM »
Mike

I've collected a variety of rehab protocols from all over and the ACTIVE protocol is by far the most aggressive and way out of line with all the others, including my OS's.

Karen Hambly has written an article on rehab protocols and gives the earliest time at which exercises may be introduced, but the physio needs to exercise judgement as to whether it is appropriate for a particular person.  The OS should also provide guidance.  I think that true strengthening work is normally restricted until the OS says whatever you can within the limits of pain etc.

If you want to find further protocols you can use Google to search for Dr Minas, Dr Cole, Carticel protocol, the Cartilage Repair Centre and the original Gothenburg protocol.  It takes a bit of time, but there's a lot of info out there.

The guys in the US have a super-duper system which pumps the water regularly.  I think Donjoy UK may be able to supply something like these, but they're not mentioned on their website.  It may be worth investing in to ensure the icing happens as thoroughly as possible.
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.















support