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Author Topic: ACI 7 weeks ago takes turn for worse  (Read 11337 times)

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Offline mlashmar

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Re: ACI 7 weeks ago takes turn for worse
« Reply #15 on: October 10, 2010, 09:07:11 PM »
Well it's off to see Mr Carrington tomorrow at the Royal National Orthopaedic Hospital (he's the consultant / OS). A real sense of trepidation about it all.

The knee has settled down a bit from what it was, but still not great. I have pretty much done nothing for the entire week, very occasional leg bend to 90 degrees and some SLRs.  Still swollen and uncomfortable in as much as it 'doesn't feel right' if you all know why I mean. That said, I don't feel any clunking, grinding and general bad sensations when I hold the palm of my hand over my knee as I bend it, I certainly did before, so maybe not all bad.

Anyways, fingers crossed all is good and whatever happens, I'll post tomorrow and let you know how I get on, and whatever happens, I'll keep you updated.

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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #16 on: October 12, 2010, 08:31:03 AM »
OK, so I had my visit yesterday to the consultant (or OS if you're in The States).  Overall it seems to be pretty good news, if a little confusing.

First off, a physical examination, a little brief but the consultant was adamant and very confident that there were no signs of failure and all was ok (good).

Secondly, he said that he would have wanted me to be much more aggressive with the range of movement exercises. The Royal National Orthopaedic don't use CPM machines (regarded as old fashioned, movement using own muscle power is much preferred). I explained that I'd followed the protocol, sowing thy is up for revision.

Lastly, he explained that my strong reaction to exercise was due to 'adhesions' in the knee as a result of the op and the length of time I have been immobile. This is entirely normal and I should cope with it with ice and pain relief as appropriate. I was not expecting that response, my physio suggested that I calm down exercises if I get that reaction, so will challenge my physio on my next appointment (on Friday) as now I don't know when I'm pushing exercise too far (what is a natural reaction and what is as a result of pushing things too far).

So, overall good I think, I just have to be prepared to have periods of severe pain and swelling. Back to working hard again!
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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #17 on: October 12, 2010, 01:00:06 PM »
Hi Mike

It's good to hear that your surgeon was happy the graft was intact.

If you have adhesions, then you may like to visit the 'Soft Tissue Healing Problems - Arthrofibrosis' section.  The general approach to managing adhesions is to stretch but without getting into pain and swelling.  Those two factors will simply encourage further formation of adhesions and you could then find yourself needing more surgery.

Ask your physio about ultrasound for the adhesions.

As far as being aggressive with range of movement exercises I'd caution against going into pain and swelling, but work to 'massage the limits' using prolonged low load exercises.  Dirk Kokmeyer has written some info on rehab from adhesions which is good useful reading.

Thanks for keeping us updated, and good luck with the continuing rehab.
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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #18 on: October 12, 2010, 05:16:05 PM »
Cheers Renn, thanks for that, really helpful (as ever), I'll look into it.

Hopefully others reading this will benefit and not feel too much doom and gloom when they get pain and swelling.
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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #19 on: October 13, 2010, 10:09:21 AM »
I've been using an exercise for a few days now (I'm now 8 weeks in) and it seems to be a great help in improving joint mobility.  I have been doing the basic range of movement exercises in any case (albeit for a break when my knee for very swollen and sore), but bike seems to have a really good effect.

Settings wise, I have the seat slightly higher than I would normally, so my leg is quite straight at the bottom of the pedalling motion.  That allowed me to bend my knee (just about) at the top of the cycle motion.  I had to get my (long suffering) girl friend to adjust the seating position initially and make sure I could get on and off the bike OK (a little tricky, but you soon pick up a few tricks to allow you to do it safely).  The bike is set on minimal resistance and I started by just doing 1-2 minutes 2-3 times a day, I've upped it to 3 mins now.  I'll keep it on minimal resistance for the time being, I may increase the range of movement slightly by lowering the seat by the smallest amount).

Initially the cycling motion was really awkward, but not painful.  I was cycling in slow motion, perhaps about 20 rpm, but this morning, I improved significantly, perhaps about double. Interestingly, I'm not 'pushing' it, it just kind of happened, my leg just went at the pace my knee felt comfortable. 

The bike is set at minimal resistance and I'll keep it as such until the physio tells me.
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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #20 on: October 15, 2010, 09:25:55 AM »
I had my physio at 0730 this morning and all went really well, my physio was really pleased and it seems the problems I had a week ago were just the breakdown of adhesions and nothing more sinister!  Great stuff!

Physio had told me to pretty much carry on as I am, no real changes to the exercise regime, just carrying in building quads, calf and range of movement exercises.  Small changes are to practice moving leg through a step up motion to help make walking more fluid and to either lower the seat or increase resistance on the bike (only one or the other and only by a small amount).

All seeming to go pretty well at the moment, improvements on a daily basis, just need to ensure the progress is steady (and not get ahead of myself)
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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #21 on: October 18, 2010, 07:47:44 AM »
A touch of tenderness on the patella tendon (tendonitis?) but otherwise all seems to be going ok.

By Wednesday it will be week 9 and the knee is still swollen (albeit much reduced) and stiff. Range of movement is up to 120 degrees, but not a fluid movement yet, cycling seems to be a benefit.  Down to one crutch now, nut certainly need that for walking, although there are times when I feel that I don't.

At night, still most comfortable to lie in my back (I miss lying on my front!). Lying on my side with the scar side down is fine at first bit the gets uncomfortable. Whilst my knee isn't uncomfortable as such, I am aware of it most of the time, I suppose it is on the verge of discomfort.
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 Youthist

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Re: ACI 7 weeks ago takes turn for worse
« Reply #22 on: October 18, 2010, 09:06:05 AM »
I am a permanent lie-on-front sleeper too, always have done, so after two nights I am struggling ! I hope I get used to it  - i see you are still on your back at week 9 - gulp!

How much movement / bend did you have in the first week or two? can you remember?

Offline mlashmar

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Re: ACI 7 weeks ago takes turn for worse
« Reply #23 on: October 18, 2010, 10:28:18 AM »
Not much movement, albeit this was on purpose to protect the graft, the protocol limited movement such that there were no range of movement exercises in the first week and then 0-30 degrees from weeks 1-4.  I'm sure I could have done more, but the priority is protecting the graft, not range of movement in that period.  Moving the knee over the 0-30 degree range wasn't too difficult from memory, it soon became relatively easy, just important not to try and do any more than that.

You will get used to sleeping on your back, or at least enough that you can get to sleep like it.  I kept the brace on at night for the first 4 weeks to keep it all protected.  I still wake up when I go over on my side!  I will deffo post when I first sleep on my front, it will be a momentous 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 Youthist

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Re: ACI 7 weeks ago takes turn for worse
« Reply #24 on: October 18, 2010, 11:10:53 AM »
Good stuff. I am two days post op now, and my brace has been set by Dr Skinner and the physio team at max 45 degrees, and I can just about get there at the moment. He also wants me to put weight on it ("as much as pain will allow") as the compression onto the lesion and patella he said will compact it and encourage growth.

I can now see how every single of these treatments varies based on the location of the trauma, the operation, plus many other factors!

I am going home later today, dreading it a bit to be honest, I am getting used to all this care and attention :-)

Offline mlashmar

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Re: ACI 7 weeks ago takes turn for worse
« Reply #25 on: October 18, 2010, 12:45:26 PM »
haha - yes I bet, try and make sure you have plenty of people coming in to visit you, prob need to get the ice topped up mid-afternoon (depending on when you get up) and have dvds pre-loaded into the player.
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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #26 on: October 28, 2010, 03:29:09 PM »
Seems like ages since I was last on here, but it's been just over a week.  I've now reached 10 weeks post op, so thought I'd write a few lines to update on progress.

I have begun walking without crutches, only a little bit around the house.  Not quite normal fluid steps, particularly after I have rested for a while, but beginning to improve and become more fluid in my walking.  Feels a little like waddling at the moment and still a little stiff through the knee joint as my leg moves through the walking motion.  I'm surprised the motion is not very fluid (still) as my range of movement exercises are taking me well beyond 120 degrees, albeit they are not that fluid either.  It sometimes feels as though parts of my knee get a little stuck in range of movement, but not the repair site.

Pain-wise, the pain I had in my patella tendon no longer seems to be present, or at least no where near as much.  That said, the knee is still a little stiff and swollen and I get the odd pain here and there.  I haven't used the ice or pain killers for a while now (at many times I thought I would take them for ever more!). 

I am doing wall slides, sit to stand, moving my leg through a step up motion, calf raises and exercise bike at the moment.  I use the good leg a little to assist in wall slides and sit to stands.  I've been doing these exercises for nearly 4 weeks now, so have increased the reps but feel like I could do more.

I occasionally hold my hand over my knee cap when I bend my knee, the old crunchy grinding sensation no longer seems to be present, so I hope things are still going well.   :)

I decided to invest in an automatic car, the old one had nearly had enough of me anyway!
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

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Re: ACI 7 weeks ago takes turn for worse
« Reply #27 on: November 01, 2010, 12:20:47 PM »
Whoops

Over did the physio this morning, perhaps a little carried away on the bike, quite sore at the minute and a little warm and swollen.  I wonder when the knee starts to feel normal again, I certainly look forward to the day when I don't think about my knee and just get on with a normal day!  Seems like it will be a little way off for now.....
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 Dennis BadKnee

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Re: ACI 7 weeks ago takes turn for worse
« Reply #28 on: November 02, 2010, 12:54:40 AM »
Mike,

I bet you did not hurt anything at the physio.  I would get a hot knee or slightly painful at your stage.  I feel the painful is something to avoid, but heat can be reduced by icing (at least I was told it is ok).  I still ice regularly.  I have an IR thermometer (industrial) and still see something like a 3 degree C difference from the same spots on my good knee all the time, but higher after a workout. 

I also found that increasing distance/time was more forgiving than increasing intensity.  I still do things at a rather low intensity albeit for a long duration.  Yesterday I went for a 7 mile hike (just under 3 hours).  It is not that I cannot go faster, but it seems to hurt after if I do.  And I do not think pain is good.  At your stage, you just are not sure what is ok and what pain is bad.  Good that the crunch feeling is gone.  Sounds like you've got a smooth knee.

I also shopped for an automatic car, but never did get one.  Now it no longer matters.

Keep us posted.  You seem to be doing well.

Dennis

Offline mlashmar

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Re: ACI 7 weeks ago takes turn for worse
« Reply #29 on: November 02, 2010, 12:12:41 PM »
Wow - 7 mile hike sounds good!  Well done, keep adding little bits at a time.  How does your knee feel after doing the walk?

Incidentally, I read the links you mentioned and saw a lot more of your history, wow, sounds like a really rocky road, so no wonder your confidence in physios and the knee itself has been knocked.  Little by little, I hope you get it back.

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















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