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Author Topic: ACI 7 weeks ago takes turn for worse  (Read 11338 times)

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Offline Dennis BadKnee

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Re: ACI 7 weeks ago takes turn for worse
« Reply #30 on: November 04, 2010, 12:27:50 AM »
That was about my 3rd 7 mile hike. I say 'about', because I went on a few less structured hikes in mountains that might have been about this or more, and one 3 day kayak trip where I walked a bunch. I can walk 5 miles every other day, perhaps every day, and not have any pain or swelling, but I can feel I did something and it is time to stop - no tiredness, but some other awareness about the knee.

On the 7 miles, the knee swells just a little and feels ever so slightly sore at night. The next day it is back to normal. I think it is good to give the ACI the message that we plan to do such things. But I don't think it would be good to do more at this point.

I do probe every now and then to see if my limits are increasing - especially when I feel very confident and complacent. Those 7 miles are now about it, I think.

Oh, BTW - when I two-man carry the kayak, with my end being 30+ pounds, it feels (for days) like someone hit my kneecap lightly with a rubber mallet. Can't be good. Yet, I can lift weights and carry 70 pounds for a few feet at the gym, no ill affect.  I think this makes a good case for my friends bringing in my firewood this winter.

Keep up the good work and stick with it. This is not something where we can let down the guard or get complacent.

Dennis

Offline mlashmar

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Re: ACI 7 weeks ago takes turn for worse
« Reply #31 on: November 08, 2010, 11:20:37 AM »
Feeling a little down over the last few days  :(

I guess it must be par for the course with MACI to feel like this at times, the odd bad week here and there.  In fact, that's how this thread started when on weeks I was convinced things had gone badly wrong (in fact, it was just my reaction to breaking down the adhesions in my knee, thankfully).  So, why am I feeling down, especially as I have been walking without crutches for a couple of weeks now?

My knee seems to be playing up, I think.  It might be fine, but I just don't feel confident in saying that and I feel utterly deflated at the minute and Friday's physio session (where I can chat it through with the physio) can't come soon enough. 

Symptoms wise:
- the knee seems to be acting up a bit, the days of discomfort, pain and swelling have returned, especially by the end of the day and with a vengeance. 
- specifically, I'm getting pain at the patella tendon and to the side of the knee
- when cycling, I get a clunking type sensation in the knee (I can feel this when placing my hand over my knee), but interestingly, I can feel that on my other knee too! 

It all seemed to start when I was doing some wall slide exercises, difficult to describe the feeling, but it was like the knee got stuck as I was moving through the exercise, it was painful and a bit of a shock.  Perhaps it was just part and parcel of rehab, these things happen, but I wonder if I have done some damage.

Roll on Friday......
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 #32 on: November 08, 2010, 11:51:33 AM »
Mike,

I'm sure you'll discuss your symptoms with your PT, but I'd guess that the increase in symptoms are a guide to that fact that you're currently stressing your knee to the limit.  It may be worthwhile just cutting back a little in the forces you put your knee under, whilst maintaining motion and mobiity.

The clunking may also be due to deconditioning of the muscles at the moment.  Once you can get back to strengthening then this should decrease.

I don't know what type of wall slides you're doing, but if they are painful could you go through the same motion without stress the joint in the same way?

My understanding is that if the graft fails you definitely know suggests it's very painful.

Hope you pick up through the day!  :)
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 #33 on: November 09, 2010, 04:17:01 PM »
Cheers Renn

Scaling back exercises now, but still giving me hassle after by mid-afternoon.  PT can't come quickly enough, guess I'm going through a low period at the moment (seems to go in cycles, but thought I'd finished them!).  Rubbish.
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 #34 on: November 09, 2010, 05:56:50 PM »
Hang in there mate - I am sure things are fine.  I had a bad patch two weeks ago, and it passed (which you really helped with, iirc). Remember how patient we all have to be to get where we want to get to.  Like my physio says all the time to me - this operation is  not about 5 minutes, or 5 months, its all about 5 years. 

Offline mlashmar

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Re: ACI 7 weeks ago takes turn for worse
« Reply #35 on: November 16, 2010, 08:03:28 AM »
Cheers You

Well, I went to the physio on Friday and offloaded.  Physio still seems positive and did some basic checks and thinks things are OK.  Pleased with my progress and has added stepping up and down from a step to the routine, which I have progressed with really well since.

Nagging doubts still persist as does the clunking in my knee (to be fair, it is present in my good knee too, so who knows).  Walking is getting a little more fluid now and I am getting less conscious of it.  I am still 'aware' of my knee the whole time and it still gets swollen and sore by the end of the day (had a few days where I thought that was subsiding, but not convinced yet).

If anything, the knee seems to stiffen during the night and I have to 'get it going' again in the morning!  Still not sleeping on my front (preferred), but am able to sleep on my side for some time (gets uncomfortable after a while).

Noticed some lumps underneath the scarring on my knee, give me sharp pain sometimes when doing ROM exercises.  Physio thought they could be residual stitch material, seems odd after 3 months, but I guess the surgeon will tell me.

My exercise regime is:
- wall slides
- sit to stand
- step up and down using bad knee
- cycling (now up to 8 minutes per session, low to moderate resistance)
- single leg squats (less than 90 degree bend, prob about 60 degrees) and using chair for balance
- leg bend exercises to full ROM

Next off to visit surgeon on 22 Nov and start my new job on 1 December, so fingers crossed for both of those!
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 #36 on: November 16, 2010, 01:36:57 PM »
Hi Mike

I'm really surprised to hear that you are doing wall slides, sit to stand, steps and 1 leg squats.  For me those exercises were banned for at least 3 months.  Clearly, our constraints are dictated by our defect sizes and locations.

If I were you, I'd refer back to the info provided by Karen Hambly and at http://www.cartilage-repair.co.uk/ and also check with the surgeon that they are happy for the exercises to be done.  As Dennis has said, so PTs can do more harm than good because of not knowing what they don't know.  However, you are the one who has to live with the consequences.

The lumps under your scarring are probably adhesions.  They do tend to hurt with ROM because they are being stretched and don't have the same elasticity as your normal tissue.  Has your physio advised you about massaging these?
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 #37 on: November 16, 2010, 05:49:30 PM »
Hi Renn

I'll double check, but they appear to be included in the Stanmore protocol.  I am walking around unaided now, and the protocol seeks to build up quads through a variety of exercises from relatively early (week 6) and a milestone for week 12 is to be able to dynamically stabilise the knee during single leg stand/squat.

I'll check out the lumps with the surgeon when I see him, not too convinced by the explanation, but the physio isn't sure as does not have detailed op notes (as to how wound was closed).  Sounds like adhesions is more likely, thankfully they are quite small. 
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 #38 on: November 23, 2010, 08:04:16 AM »
Saw the consultant yesterday (Mr Carrington) for my 3 month check up, so thought I'd add another update.

This last weekend I went away for the weekend, the first little holiday this year.  Stayed in a nice little village and decided to have a walk around the town.  Quite apprehensive about it (the walking) at first, but gave it a go.  Probably walked about 1.5 miles in all, with some steep inclines included, various stops on the way to see how things were progressing.  It went really well, in fact, I actually felt really good afterwards.  I rested my knee before we went out for dinner that night, but probably didn't need to, felt great!!!   :D ;D :D ;D

I went to London for the outpatient visit as I mentioned above.  Initially I worked in our London office for the morning, taking the overground train (1.5 hours) and underground when in London.  Travelling was fine and I am now able to bend my knee for relatively long periods comfortably.  I spent the morning in the London office without my usual leg rest, seemed to go OK (kept moving my knee to keep comfortable but otherwise OK).  Then I headed out for the appointment, I decided to walk from the office to the appointment, about 1 mile.  A slow walk and my knee puffed up afterwards a little, but it seemed to go OK.

My consultant was happy with the progress, range of movement had significantly improved (probably back to pre-operative range and has been for a good 3 weeks or more).  Need to work on quads, which is in hand.  Interestingly, he said that it is common for people to be disappointed with progress at 3 months, as the cartilage and quads have not fully developed at that stage, at 6 months, all being well, I should be feeling really good about it all.  I mentioned the clunking in my knee, he said not to worry about that, this should improve as the muscles develop, which in turn will allow me better control of the patella and how it tracks in the knee joint (i.e. poor control of the patella at present meaning it is bumping around in the knee a little).

So overall, a positive appointment, still some nagging doubts about it all, but perhaps that is an overhang from my failed microfracture and the fact that the MACI hasn't proven itself to be effective yet, so time will tell.  Off to do some exercises today and to sign up at a gym so I can do some more exercises!
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 #39 on: November 23, 2010, 10:37:07 AM »
Hi Mike

Fantastic news!  It sounds like you're doing really well and getting back into life again (although with constraints).

I hope this carries one for you.  Remember not to overdo things at this stage you won't get any feedback on the stresses on the cartilage.  But there's plenty of advice from those who have gone before you.

Take care!
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 #40 on: November 25, 2010, 04:58:37 PM »
Cheers Renn, sage advice

How are you getting on?  Things improving?
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 #41 on: November 25, 2010, 06:05:20 PM »
Things are slower than I'd like, but that seems to be the case with everyone.

I'm at that stage where I can walk without crutches, but not for very far and I get discomfort behind the knee.  I'd like to work out how to increase my walking range without having the kick back pain I've had in the past.

I have almost full ROM, which tightens up overnight.  Still warm and swelling increases through the day.  Still doing three long home PT sessions a day, so it's life-consuming.  It feels like that same old stuff each day. :(

My pain is mostly under control although it does act up with activity.  Can bike at zero resistance comfortably but rower is quite demanding.

Pain meds were adjusted at my meeting in pain clinic on Tuesday so I'm now on slow release tramadol which may make it easier for me to come off the tramadol.  I'll then be in a position to reduce my fentanyl dosage but I've been told to expect to do this over 6 months, so no hurry.

I guess I'm not bad but like most people here struggle to see any difference from day to day.  Feeling sluggish as well.  Just want to wave a magic wand to get better.  8)

Good to hear your news. ;)

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 #42 on: November 26, 2010, 11:47:22 AM »
Renn

Sounds like you are making progress though, so hopefully things continue to progress.  I know what you mean about the rate of progress, it is difficult to see the difference day to day.  Maybe worth keeping a diary of progress (when you first up resistance on bike etc) which may help inform you of the progress you are making.  Many of your symptoms are identical to mine a month or so ago, so don't lose heart, keep being positive and carry on with the hard work.  It does feel like that in the last month things have picked up more quickly and hopefully as I head to 6 months that trend will continue, so hopefully you'll be the same once ROM is fully established and you start building those quads.

Have you tried lowering the bike a slot at a time, I found that helped get my leg going and make the leg feel smoother through ROM and generally.  Still stiffens in the morning, almost needs some exercise to get going, but I gather it will be like that for a few months still.
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 #43 on: November 27, 2010, 12:15:01 AM »
Hi Mike

I keep a mind-blowingly tedious diary of everything I do and all the meds I take as well as a day-by-day diary of pain, heat and swelling with some indicator of ROM.  Sadly my pedometer is highly inaccurate mainly because I walk too slow for the set-up.  This recording helps me to work out whether or not I can increase the level of any particular activity, e.g. ankle weights, number of reps etc.  It provides a good intellectual level of feedback, but emotions seem to weigh more and that isn't necessarily tied to logic.

I probably won't be lowering the bike.  I have usually used the static bike with a high seat anyway.  It puts less stress on my patellofemoral joint, which is where I have my defects, it enables me to work on power output better and it allows my leg to go to almost full extension which simulates what I would be trying to do in competition although after all this time a return to competition is very low on my priorities.  I've found that I can do endless bike on zero resistance, the problems arise when I start to go to higher resistances.  On reflection, that may be due to trying to do my normal interval workout of fast and slow rpm.  I've now decided to forget the power work and just focus on the strength component until I can walk better.

I don't know if I'm stiff in the mornings or not it doesn't feel like how I imagined stiffness would feel.  I constantly feel as if the back of my leg has strapping on it, but the physio said I was not visibly swollen behind the knee.  Maybe it is just tight soft tissue despite my stretches.

You sound really cheerful at the moment after a few stutters in the first few months.  I hope that you feel the path is a bit smoother from now on, but I imagine you will still feel some things are tricky at times.  Don't forget that people here will be happy to help support you through all this.

Take care!
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 #44 on: December 17, 2010, 06:22:44 PM »
Well, tomorrow marks the 4 month post operation milestone, so I thought it was time to post an update!

I started my new job on 1 December, which for me was the first time I had properly gone back to work (I was previously on gardening leave, which suited my rehabilitation).  I was initially quite nervous about starting work because I still had a severe limp at times and keeping my knee comfortable would be an issue. 

The week before I started my new job, I joined a local gym and started on the X-Trainer, Exercise Bike (albeit I have one at home which I had been using) and the leg press and hamstring curl, all under advice of my consultant and physio.

So, as to how it is going, a bit of a mixed bag really.  I still walk with a noticeable limp, although at times (particularly in the morning) it is not very noticeable.  I still get quite uncomfortable most days at work (despite a good leg rest I managed to wrestle away from my former employer).  I quite often get clunky sensations in my knee (I'm sorry this is a rubbish description), it tends to happen when my knee goes through flexion/extension and both my physio and consultant explained it as most likely being the muscles around the knee not being strong enough to guide the patella correctly.  My thoughts (for what they are worth) are that neither has been able to confirm the explanation, so if I'm still worried next time I visit the consultant (at 6 months) I will push for an MRI scan (it's on the NHS, so I guess there is a reluctance to scan me - if anyone has managed to get a scan on the NHS after having an ACI, please let me know the factors that led to you obtaining one).

I am religiously going to the gym every morning before work, doing a combination of cardio and weights as directed. Certainly my strength is improving and my new colleagues have noticed the difference in my gait in the three weeks I've been at work, so it is certainly paying off.  I'm not doing my physio at home, which is a shame, but after the day is out, I tend to want to rest.  Walking down stairs is still a struggle (generally one step), but I am keen to improve on this.

Anyway, I have waffled on a bit, hope you are all getting on well in ACI land, Season Greetings!
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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