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Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #15 on: October 17, 2010, 08:01:11 PM »
I find the need to ramble.  Sorry.

Rennschnecke Your comments are always so positive.  I appreciate your encouragement.  It means a lot to me.

AJ, you always have common sense that supports what I read in technical papers.  I just do not think that the nature of the ACI ever become fully hyaline, just hyaline-like, whatever that means.  I hope you are right about the longevity.  I fear my meniscus transplant may be the biggest limit in the lifespan of this whole thing.

Mike (mlashmar) – I read your thread.  Your experiences are common in the early rehab phase.  But be careful with that PT.   I came close to being harmed.  There is another soccer player in UK (Paul - tremy1977) who had been posting and asking good questions about rehab, then suddenly he stopped posting (I hope he is well).  Many people responded (to Paul) with good ideas.  You might want to read this last page. 

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=50526.15

Here is a study by Dr. Minas for you soccer players “Articular cartilage repair in soccer players with autologous chondrocyte transplantation: functional outcome and return to competition.”

http://www.ncbi.nlm.nih.gov/pubmed/16093535

Mark (markld) – You raise a good point.  Everybody responds differently; and those reading this board need to realize this fact.  On the other hand, perhaps I am not doing as well as I think. My regimen is not as easy for me as you seem to think.  Sorry if I mislead you.   I’ll elaborate on the difficulty aspects.
 
I worry constantly and do not do anything with my life except rehab (full time job).  I had planned for most of my life to retire early, and then do a major through hike/backpack, such as the Pacific Crest Trail before returning to the workforce in a career chage.  I also thought I could skydive and run forever, at ever decreasing rates.  Having made it to that early retirement I find myself extremely distressed due to my knee situation, unable to fulfill that lifelong dream.  So, for now, I am using my time doing full time knee restoration.  When I went to Dr. Minas, I feared he might say “too old, too far gone”.  Instead he noted I am in good shape and stated what is in his paper, “Repair of large chondral defects of the knee with autologous chondrocyte implantation in patients 45 years or older”.

http://www.ncbi.nlm.nih.gov/pubmed/18725654

While on the subject of studies, this scares me, “Increased failure rate of autologous chondrocyte implantation after previous treatment with marrow stimulation techniques”.  I had previous mircrofracture.

http://www.ncbi.nlm.nih.gov/pubmed/19261905

At the previous visit 6 Oct, even Dr. Minas said I am doing much more exercise than anyone; no problem with what I am doing.   Perhaps if I elaborate, you will understand better (and reach a conclusion that I am not doing quite as well as I lead you to believe – sorry if that is the case).  If I had to attribute my ‘success’ to something, I would boil it down to 3 things,

1.    Do everything you should (this requires research – see the link I referred to Mike above), and do it very gently (never one single step being higher force, shear, or ROM than allowable – NOT ONE TIME).  If possible this includes many hours a day – a full time job.  But never ever keep going when you feel the pain increasing.  As part of this, I stretch (I even stop walking at times to stretch).  Either the 30 second break or the stretching seems to rejuvenate me.   I began walking short distances and added the distance of one telephone pole every other day.  I made the mistake of setting this as a goal, and occasionally kept going to meet the goal even when I felt just a little pain.  But when I got home, I discovered what was a little pain persisted for a week.  This, I always keep in mind even today.

2.   Don’t do anything that is bad (avoidance) – lifting, walking too fast, deep squats, etc.  e.g., If I am carrying heavy groceries up the stairway, I only climb stairs with my good leg straight, never bend it even though I could.  Otherwise I climb normally.

3.   ICE & Compression – I wore a compression sock for 6 months, and now I wear a cloth compression sleeve (from a sporting good store).   I also ice every chance I get, probably 20 hours a day.   Dr. Minas said I do not need the ice or compression when I had my 6 month visit.  I asked if the ice is harmful.  He said no, just unnecessary.  I disagree.  Dr. Minas said I must watch for pain and/or swelling.  Ice keeps down the pain and swelling.   If so, and it is not bad, why not do it.  (I would welcome some comments from others if the icing, in particular, might be harmful – since I do it so much – my skin remains red all the time).  I discovered ice during my 2005 microfracture, and continued it into and beyond ACI surgery.  I have two AirCast Cryocuffs with AutoChill from hat-trick-sports.com.  I also see them on ebay. Game Ready is a better system, but ten times as expensive.  I fill them with ice and even use them in bed.  When I do too much exercise, the heat of my knee melts two coolers of ice per night.   When I am doing the right amount, only one cooler melts per night.  After my 2005 microfracture, but prior to my ACI surgery, I would go out west (Moab, UT) for 25 days of consecutive all-day mountain bike trail riding.  At night, in my tent and sleeping bag, I rigged a wire to the car battery and had the Cryocuff going all night long – even when temperatures dropped to freezing.  The icing made possible those long rides with my deteriorated knee. I would be very interested if anyone else has similar experiences with icing.

4.   (Ok, I said three, but this might be important) – I watch my diet more than ever and pay attention to information in Udo Erasmus’s book “Fats that Heal, Fats that Kill”.

All,
This seems weird, but I am being challenged for not being good enough (from those unfamiliar with ACI).  It is a never ending problem.  I think this is because I walk normally as far as meets the eye.  Here are some examples.

At my gym there is a personal trainer who watches the area.  After finishing a 1-hour retro-walk at 15 degree slope (slow slow 2mph), she saw me getting off and asked if she could give me some advice.  Sure, why not.  She qualified herself as having a Master’s Degree in Kinesiology and having coached a men’s football team.  She said she tells all the players what she is telling me, ‘get rid of the knee brace, you don’t need it, it is a mental crutch.’  I tried to explain my surgery, but it fell on deaf ears.  She sees me walking normally.  Now here I am arguing with her.  Now she no longer speaks to me.  Oh well.

During my lengthy rehab period, I received much appreciated assistance from a very good friend (engineer co-worker) who is almost 20 years older than me (he is in his mid-70s), sedentary, but otherwise in good health.  He himself had gone through major procedures including prostate cancer and colon resectioning.    He is insistent that he remembers me as that tough guy who always climbs mountains, skydives ahead of the crowd etc – and now here I am babying my knee beyond all logic.  He insists that 2 months post-op (and especially one year!) one is as good as one will get.  I printed all the guidance, protocols etc to give him.  We are now into a time of the year (my friend and I usually only get together a few times a year) when he and I would normally go do outdoor things.  Before ACI surgery, I normally would hold back (so as to not push him), thus carrying a bulk of the weight (without making him feel weak).  Now he is beside himself, almost not speaking to me, because I don’t want to harm myself and, until recently avoided scheduling an outing.  He is a person who would not walk 5 miles unless his car broke down or he has some reason.  He knows I can walk normally for more than 5 miles now already, so he just cannot fathom what is going on in my brain to not want to drag logs over boulder fields, etc.  Sooooo, we have scheduled a two day outing this Thurs-Fri.  I am afraid.  What to do.  I should just say no. I have a plan to stop at the times that would harm me, but I know how tough it is for me to say no.   We will be in terrain I have not yet ventured.  We will be there before daylight and after dark.   I have succeeded so far by simply not putting myself into such positions except rarely (such as during a recent 4-day ocean kayak trip with my cousin – I came home hurting, but unharmed).

Yesterday I explored displacing rehab stuff with functional stuff, in this case walk less and then blow leaves in my yard.  I walked 4 miles in lieu of 6 (planned).  Then I simply carried a light weight leaf blower, standing stationary most of the time).  Last night my knee hurt all night.  I know I did no damage, but it is despairing to do so little and have it affect me so much.   Normally I would not think it appropriate or necessary to report such minutia, but perhaps it is necessary to show how I am struggling as well.  Nobody should get the impression I am breezing through this.

Again I ask, what can we expect when?  (disclaimer – everybody is different, surgeries different, yea, yea) i.e., in three years if all goes well, will we be at a high activity level.  Or will we conclude that after all this effort, pain and sweat, why risk it; then go on to live as if we had the restrictions of a replacement knee.  If the later, they why are we bothering?

If anyone lives nearby, we could meet and go for a short walk (limited by the least – nobody should push it).  I live near Chambersburg, PA, but would drive to Shenandoah National Park (not far from DC, Baltimore, Philadelphia).  I’ve been meaning to go there and walk the more or less level Appalachian Trail (just rolling hills mostly on top of the ridge).  I would stop if it feels bad and you should always do the same.  And yes, I always have ice in the car for my knee before and after.  I never leave home without it.

Regards,
Dennis

Offline Rennschnecke

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Re: ACI - 1yr post op
« Reply #16 on: October 17, 2010, 11:15:16 PM »
Dennis

I think you are doing very well and I would love to be in your position.  I'm now approaching 16 months post-op but have had the common complication of arthrofibrosis.  I've spent the best part of 2 years on 1 or 2 crutches and the last year has been spent trying to control severe pain following scar tissue removal (MUA with scope).  I have been on continuous narcotics in the form of Duragesic patches since April this year.

Owing to the series of complications I've not got back to walking yet.  I've had yet another op (arthrolysis comprising anterior interval release and lateral release) and am once more back to the early stages of rehab.  This time my physio seems to be more on the ball and I've been doing reasonably well, but the prognosis is poor.  Complete pain relief is deemed unlikely and my OS is recommending a PFJR if my problems continue on to the 2 year mark.  The really stupid thing is my MACI seems to have taken so that the bone is all covered.  However, I've been unable to do much of the physio required to help it mature and proliferate so it seems a bit patchy.  It's unclear whether or not resumption of the physio programme later will enable me to catch up.  So, pretty unknown territory and I haven't found any other posting which covers a similar situation.

I think that AJ has highlighted how limited the information is that is available to us.  The longevity of the cartilage is unknown and techniques are developing all the time which makes the outcomes better.  Essentially, no-one can answer your question.  But if you want to read a bit more try to find the following article.
'Midterm to Long-Term Longitudinal Outcome of Autologous Chondrocyte Implantation in the Knee Joint : A Multilevel Analysis', Abhijit M. Bhosale, Jan Herman Kuiper, W. Eustace B. Johnson, Paul E. Harrison and James B. Richardson, Am J Sports Med 2009 37: 131S.

You are still at a very early stage of recovering from ACI.  I think you need to give yourself 3 to 4 years to see where you are and what you feel you can do.  Unfortunately, many people simply don't understand ACI.  They mostly think that the worst op you can have is an ACL replacement.  The idea that your op is like 10 times more complicated and needs the appropriate length of time to develop is a tricky thing for them to grasp.  It is a shame that your friends don't realise that and I appreciate it is isolating.

I was a professional ski coach, but I've been unable to work for nearly 2 years now.  Before I'd work and then hobble off the slopes to skulk in the bar rather than ski with friends afterwards.  I've seen hardly any of my friends since my troubles began – they're all busy with their active lives and as I live on a very steep hill, getting out is a challenge.  When the OS says I should reduce my expectations to just social skiing then I'm pretty sure he doesn't understand what social skiing is for me – most of my skiing pals are either ex-racers or coaches or instructors.  However, I decided to go for the MACI because my OS said it provided a chance that I might return to running and I know that if I can run I can ski.

But returning to your point – I believe that your cartilage will enable you to get back to impact work.  I believe that you will be able to get back to being active mostly in the way you'd like to be based on your current report now.  Have you read JulianUK's postings?  He has got to a higher level of activity than he was pre-op.  Granted he probably wasn't at your level, but the key point to note is that it took him nearly 4 years to achieve this.  Why go through ACI?  I think it is because it can allow you to return to a higher level of activity than a knee replacement.  I know someone who had a knee replacement then began to play soccer because his knee no longer hurt.  He needs a revision after 5 years instead of 10.  As someone in his 50s he faces a bleak future because the number of revisions is limited and by the time he is in his 70s he may not have the option of a prosthetic knee to maintain activity.  But technology is improving all the time.

I don't know what you can do about your friends.  It's somewhat insensitive behaviour on their part, and whilst it can be tempting to  :P to them, you probably don't want to do this.  I don't know whether you feel able to sit down with them and let them know that there is a lot of uncertainty about what you can do because you're part of the pioneering group for the procedure.  Let them know that you're still a tough guy because you've jumped into this op without knowing whether it will restore you to full activity or how long the benefits will last.  Try to let them know that it is highly demanding psychologically to restrict your activities for the medium to long term as the impact of activity can be delayed and despite looking normal on the outside, it isn't normal inside your knee.  That's why you always need to consider the loading on your knee and the shear forces at play and need to work up to some tasks in a controlled manner.

Sorry, I'm rambling now.  Didn't mean to go on for so long!

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 rbahr

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Re: ACI - 1yr post op
« Reply #17 on: October 18, 2010, 02:23:26 AM »
Hi all,

I am sitting here with ice on my knee - Thanks for the guidence, Dennis - just spent the day pushing things - which I will likely regret tomorrow - but hopefully not a week from now...

Rennschnecke: I neglected to mention in my earlier post that one of my recent complications with my surgery was arthrofibrosis. I had fine extension, but limited flexion (85 degrees). I had 2 scopes to deal with this, the second restored me to ~125 degrees, which at this point is not as good as what I started with, but a lot better than 85 deg... Point is that there is always hope and a possibility that things will sort out.

Dennis: thanks again for the thoughtful dialogue - in fact I would like to thank everyone here...

Ray
« Last Edit: October 18, 2010, 03:20:31 AM by rbahr »

Offline Rennschnecke

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Re: ACI - 1yr post op
« Reply #18 on: October 20, 2010, 12:54:22 AM »
Hi Ray

Thanks for letting me know that you're keeping me company in the arthrofibrosis boat.  I do agree with you that there is always hope and a possibility that things will sort out, but sometimes there are so many obstacles in the way that working your way through/round them is difficult.

My story is a bit different from yours.  I had flexion problems at 8 weeks post-op and then had a release at 14 weeks, but I had further adhesion problems which led to infrapatellar contracture with patella baja and moderate to severe pain which lasted for months.  I had pretty good flexion (around 135 degrees), but a slight extension deficit and pain on walking.  It took nearly 12 months before my OS agreed to go back in to do the necessary releases as he'd been given that idea that I might have CRPS.  I'd seen 4 pain consultants who all agreed that I did not have CRPS and needed surgery.  So, I've had a lot frustration this past year.

Unfortunately, the delays may well mean that I am unlikely to have any further ops unless they involve a knee replacement.  At least, my OS states that at the 2 year post-op mark the only decision to be taken is whether I opt for a joint replacement.  I'm really bummed by this as it seems the grafts have taken so I don't understand why a knee replacement would be appropriate.

As my knee is still significantly swollen at 5 weeks post-op I'm worried about returning to the pre-op state again.  I've followed all the advice available on managing rehab post-AF surgery but the swelling is taking it's own sweet time to dissipate.  The latest clinic notes were not exactly new to me, but had some additional items that I've been processing, e.g. that I may never get complete pain relief and that a line will be drawn at the 2 year mark.  Trying to get my head around that at the moment.

Hope things are improving for you!

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 rbahr

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Re: ACI - 1yr post op
« Reply #19 on: October 20, 2010, 01:34:13 AM »
Hi Rennschnecke et al,

I absolutely do not want to derail Dennis' thread, but there is a point he has made a number of times that I completely agree with and I need to reiterate. The FIRST rule in successful rehab and/or early treatment is to know as much as your Doc - so read, study, talk, read some more, talk more... The SECOND rule is to be a loudmouth know-it-all with any of the medical profession who are 'helping' you.. Insist on those things that you know and don't back down - demand proof, demand action... If your Doc will not help - find another doc. The sad fact is that a LOT (not all) of these people know less than you, but will never show it. This is true to the point that they will mess you up, damage things and in general ruin all the good work your Doc did. The THIRD rule is find the medical people you trust and like and listen to them...

I will take the AF discussion off line...

Thanks

Ray

Offline mlashmar

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Re: ACI - 1yr post op
« Reply #20 on: October 28, 2010, 07:41:10 PM »
Dennis - I pretty much read your post in two ways. 

The first was that, your ACI had gone well but you were lacking confidence in it (e.g. were unable to take the brace off).  I sympathise with that, it can almost feel like the MACI is a ticking time bomb, at some point it will fail and in the meantime, you are walking on broken glass.  I'm still not as progressed as you are, but I certainly can relate to a lot of what you say. 

A somewhat sobering point for me was when I increased my ROM and quad exercises at week 6, in line with the protocol.  All of a sudden my knee got very swollen and sore, I was convinced it had failed.  In reality I had been overly cautious, the reaction was normal (a breakdown of adhesions).  So, why am I bringing it up and what did I learn?  In that one week the feelings I had been having for a number of years intensified, at 33 years old most of the things I love to do were over (and things I hoped to do, such as carry a child I may have in the future), the fight I had against the insurance co was a waste and I was no longer a full man (does that make sense?).  Of course I was wrong, things were going OK, on track, although I had to be careful not to 'mother' my knee, I really needed to push on with my physio, albeit cautiously, and try to make the most of the chance I've been given be rebalancing my knee and my life, the former should not completely dominate the latter (the brace is now hidden away in a cupboard).  Of course, all of this is really easy to type, but much harder to put into practice (it's be a complete lie to say I don't struggle with it), but I wonder if you have the right support from your physio/OS to push you on a little more and, most importantly, help you to feel a little more confident about your knee?

I also read your post a second way, the pain and heat you still suffer with give you cause for concern, they reinforce your doubts.  I think Renn has made some very good points here, it may take you a bit longer to get to where you want to.  I'd be interested to hear what your OS is telling you in terms of progress against expectation and your symptoms at this stage compared to other successful patients.  Would an MRI give you the hard factual evidence to convince you that things were going well, were on track etc?  Beyond that, I guess it is doing as you have been, a little step at a time, but keep pushing yourself on a little bit at a time, frustratingly slow, but I hope that you can map out the dream trail sometime in the future.

In reality, I think it is probably a combination of the two above (but guess you will know in your own mind).  Keep plugging away and thanks for the advice above, I'll have a little look (my guess is that soccer got the worst of your friend above, it is a nightmare for knees!).

Renn - sad to hear of your plight.  I think just about everyone on here benefits from your positive input, definitely made me smile and perk me up over time.  Keep pushing on, take each day as it comes and I hope it all goes well for you at the two year mark, what ever the outcome at that point may be.  I'll be keeping my fingers crossed for you and will be sending my positive energies to you (if indeed that is possible - I'll try anyway).

Renn -
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 - 1yr post op
« Reply #21 on: November 01, 2010, 01:32:02 AM »
Mike,
Great comments. 

1.    How long will it last, how delicate will it be (ie, what can I do)?  What do I need to do to take care of it?  This is my main concern at this point.  In my surgery, there are two worrisome components, the ACI and the transplanted meniscus.  Going into surgery, I had thought the ACI would be the most limiting.  Now I believe it may be the meniscus.  My friend Ray, who posted above, sent me private mail with links showing that transplanted menisci continue to undergo a breakdown into a less stable chondrocyte matrix.  Some suggest an "activity risk management” program being important to long term success.  I also need to determine if there will be any restrictions due to ACI.  As AJ stated, “… outside of your meniscus issues, i don't see why you couldn't become fully active again.”  Time will tell.

2.   Physio/PT – I don’t trust them!!  And many people on this board have had knees ruined by them.  At 13 months post-op, I continue to do well.  Mark provided good feedback when he stated that he found it un-believable that I am doing this well (I had listed my many activities), especially at my age of 57 with the extent of my surgery.  So, being that I am doing unbelievably well, it is not a lack of confidence in my knee, but more an obsession with item 1, above, that is on my mind constantly (and I believe it should be).  I have concluded that the PT folks are unable to determine what to do or how much, so I pretty much feel on my own with generalize guidance from the OS.  If you look at some of the postings, many failures had been due to overly aggressive (or just plain dumb) PT.   Fortunately I am beyond needing help of a physio.  Besides, if I had listened to the physios (physical therapists here in the US) even in the hospital, they would have destroyed my knee.  I trust myself more than them. 

3.   What is my OS saying and what does the MRI show?  - My OS says I am “doing better than anyone.”  You are observant about my need for an MRI to sooth my mind (but I refer back to item 1 – the knee, academically speaking, seems like glass).  Dr. Minas said he knows I will not be satisfied unless he does another MRI at 2 years PO (he did one 6 months and 1 year), so he scheduled one.  Also I think he is curious as to why am I doing so well (which is just fine with me).  He said these MRIs now show it as indistinguishable from a native meniscus.  Although I had not known to ask him last month, I do plan to ask (in one year) if he can see the MRI intensity changes due to changing density of the deteriorating meniscus.  He answers questions if I pull him, but does not push data to me.  He said I will be able to backpack, but not run or skydive.   But …. I learned that transplanted menisci last only 4-7 years!!!  WHAT ABOUT THIS???!!!  So, I am back to item 1.  I need to develop an "activity risk management” program while looking into mitigation research for this meniscus degeneration process (Fortunately for you, this does not apply to the ACI).

4.   NOT A FULL MAN! – I know what you mean. We all have things in life we feel define us.  I now call myself the 5% man.  What do I mean?  If I logged my time spent doing what I love, I am down to 5% (pretty much only short hiking – immediately pre-op and PO).  My main activity had been distance running (30-50 miles per week) – but now cannot do – will never do.  I used to skydive all summer – no longer do – will never do.  I used to backpack a month a year – no longer do – but supposedly may someday (yeah!) – until the meniscus deteriorates (sad!).   My friends all go out and run together almost every day (I never run with them now and never will).  I used to bike most of the year and used to go out west for a month of all day mountain bike riding – but no longer – should get some of this back – until the meniscus fails – and probably not allowable at the intensity of my friends or that my body would otherwise allow.  Frustrating!

Renn,

Hang in there.  Hopefully the ROM will improve and pain will decrease.  Are you icing?   You are not long after the last surgery.  Please don’t think I am pushing, but why are you averse to a knee replacement?   As a parallel course to my healing and working with the gift my OS has given, I am researching replacement knees.  Why?  Because if (or when) my knee fails, I do not want to be pushed into the wrong hardware.  I want to have things lined up ahead of time.  It is your life and you need to insist on the care and outcome you require.

When is your 2-year mark PO for the ACI?

From my limited research, I see there are projected 30-year knees, some more for some 'limited' athletic use, and more importantly, knees designed for maintainability where they do not need to chisel metal from bone and start over again, but simply go in and replace the worn parts (presumably the spacer that replaces the meniscus).  Walking is the next day, full healing is 6-weeks or so with 6 months to the final outcome.  If I were to talk to an OS (different from the ACI ones), I would stress that I plan to run, backpack and skydive.  I know they do not want to certify these activities, but I am reading of people who are doing it.  As I said, this is very early research on my part, but knowing what I know now that I will rehab for 3 years and then wear out the meniscus in another 4, I may have chosen differently.   We ACI people are hell-bent on living life to the fullest and avoiding TKR as if these are mutually independent.  Now I am no longer sure about all this. I would be interested in your thoughts.

Mostly, I want to see the time when you are healed, running and skiing again!  No fun watching friends go outside while we sit inside.  But at least we have each other.  I do appreciate the company even as I do not wish the knee afflictions on anyone.


Ray,

Thanks for all the leads, and thanks for summarizing the rules of engagement with the medical establishment above!   I think Mike used these rules when he fought (successfully as his own advocate) for 8 months for his ACI when everyone wanted to push TKR.   You can never relax.

All,

If you have any research leads to anything related, post them please.

Regards,
Dennis
Knees define us!

Offline Rennschnecke

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Re: ACI - 1yr post op
« Reply #22 on: November 01, 2010, 09:50:11 AM »
Hi Dennis

Try looking at this article if you haven't already done so.
'Importance of Sports in Cartilage Regeneration After Autologous Chondrocyte Implantation: A Prospective Study With a 3-Year Follow-up', Peter Cornelius Kreuz, Matthias Steinwachs, Christoph Erggelet, Andreas Lahm, Stefanie Krause, Christian Ossendorf, Dirk Meier, Nadir Ghanem and Markus Uhl
Am. J. Sports Med. 2007, 35, 1261.

I know that a knee replacement is not the end of all activity, but I suffer from arthrofibrosis and a knee replacement can lead to arthrofibrosis.  As my problems are due to AF, a knee replacement may not lead to any resolution of the problems.  I believe that I need to find a way to conquer AF first before considering a knee replacement of any sort. 

In short, I don't believe a TKR/PKR would be the solution.  Articular cartilage cover is complete (i.e. clinically good outcome), but patient functionality outcome poor owing to the complications.

My two years for ACI is up in June 2011, but I also know it can take around 2 to 3 years to recover from AF surgery even if all goes well (NB large variability in timescales and outcomes) – so that means September 2013. Uggh!

I keep plodding on and need to undertake intensive PT until the tissues stabilise (maybe in another 6 to 8 weeks).  Still hoping to walk by 2011.  8)

It sounds to me that you are doing well physically and coping well overall, Dennis.  Other postings indicate that you are still at an early stage in recovery and there will come a time when you will be able to forget your knee for day to day activities.

 :)
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 skifanatic

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Re: ACI - 1yr post op
« Reply #23 on: November 03, 2010, 04:54:35 PM »
Hey Dennis - I'm on my way for ACI Phase II on Monday.  I'm impressed with your recovery (given the extent of your damage) and your regimen .  Question - When did you resume outdoor (street) biking??  I see at six months you reported that you had not.

FWIW - I have every intent on eventually resuming full activity with one exception...running.  Several years of overdoing it on the treadmill and on the street is likely what caused my defect.  Quit running back in May and I don't look back.  I was able to psychologically replace running by becoming a cycling junkie.  It has filled the gap quite nicely.

Offline Melissa S

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Re: ACI - 1yr post op
« Reply #24 on: November 03, 2010, 07:55:22 PM »
Hey Skifanatic.  Looks like we are going under the knife the same day.  I am also have phase II on this Monday the 8th.  Good luck to you.  Are you in the States or UK?

Melissa
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 Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #25 on: November 04, 2010, 12:14:02 AM »
Quote
Try looking at this article if you haven't already done so.
'Importance of Sports in Cartilage Regeneration After Autologous Chondrocyte Implantation: A Prospective Study With a 3-Year Follow-up', Peter Cornelius Kreuz, Matthias Steinwachs, Christoph Erggelet, Andreas Lahm, Stefanie Krause, Christian Ossendorf, Dirk Meier, Nadir Ghanem and Markus Uhl
Am. J. Sports Med. 2007, 35, 1261.

Renn,
Thanks very much.  This is a very inspiring article.  Loved what they said.  Send more!

Hello Skifanatic,
Well, I hate to say but I still have not gone outside biking except once.  You would think biking would be easier than most else.  Here is my lame excuse.  I tried it after being approved at 6 months, but the one short  (SHORT!!!) 7  mile only slightly hilly (not possible to avoid from my house) made my knee hurt a bit and swell - minor.  I kept the cadence right and very low gears (low speed).  I decided to not push it by riding since I can walk.

So, I now keep riding the boring indoor trainer – more controlled.  I was also afraid of some minor accident being more major due to the sensitivity of the knee.  At this point I am certain I could go outside and will take your message as a stimulus to do so and report back.  Check in a couple weeks.

On the indoor trainer I am riding about an hour to 1.5 hours at a relatively minor effort, but should be enough to ride outdoors slowly.  I have no negative effects from this.   My mindset has been rehab, and rehab only without risk. 
I am hoping to get back to all day rides again in a few years.  Check dsj60 bike rides at 3.5 years PO log here:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=36406.75

I wish the best to you and Melissa.  But I am glad to say I have the surgery behind me.

Dennis

Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #26 on: November 04, 2010, 04:34:44 PM »
Melissa and skifanatic,

Thinking about your upcoming surgeries Monday, I would recommend, if you have not already done so, to nail down what to expect post op immediately and in the few weeks following.  You probably did this, but it never hurts to be certain. 

For your procedure exactly, what will they expect to do during recovery and rehab in the first days and weeks.  In my case, this is where they had been lacking – but it all turned out well.  You should try to be as knowledgeable as you can in order to be your own advocate.  There are going to be ‘don’t do’ as well as ‘must do’ things.  It is better to know beforehand than to be surprised.  In my case they had pre-op literature that I received 2 weeks post op – not much use except in hindsight.

Keep thinking of all the great activities you will get to do once you new knees are fully healed!  Keep us posted on your progress.

Dennis

Offline skifanatic

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Re: ACI - 1yr post op
« Reply #27 on: November 04, 2010, 05:17:09 PM »
Thanks for the info Dennis and good luck with that street riding!  Hopefully you find it more pleasurable now.  Certainly, after the phase 1 scope biopsy and spruce-up, I was suprisingly disabled for about a week and then rushed down to my local rail-trail and made excellent progress without those hills.

Hey Melissa - I'm here in the states. Best of luck to you on Monday!  I look forward to hearing about your progress.

At this point, I've received a high level recovery overview in the mail from the folks at Genzyme.  There is a poster of sort that provides the details of four recovery phases.  Each phase is described in weeks until the last phase which is described in months.  Accompanying the poster is a nice book for documenting personal progress and goals.  I will definitely use this.

So, weeks 0-6 appear to have a very high suckage factor as this phase is titled "Protection" and it includes a lot of pain management with 8-12 hours per day in the CPM.  It does mention introducing stationary biking during this phase as ROM permits.  Unfortunately, my stationary bike is recumbant.  Is this an issue?  I guess I'll find out soon enough, eh?



Offline Rennschnecke

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Re: ACI - 1yr post op
« Reply #28 on: November 05, 2010, 01:49:11 AM »
Recumbent bikes are usually easier than uprights to turnover, but you need at least 100 degrees of flexion to do this comfortably.  When your OS clears you for the bike you can develop ROM by just rocking to and fro, but you need to also protect from being overly aggressive and pushing through adhesions too hard.

Main thing will be to reduce swelling pain and maintain and develop as much mobility as possible without aggravating the other symptoms.

Good luck with the whole journey.  There's plenty of hints here on how to ride through the boring patches.  ;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 Melissa S

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Re: ACI - 1yr post op
« Reply #29 on: November 05, 2010, 04:26:09 PM »
Melissa and skifanatic,

Thinking about your upcoming surgeries Monday, I would recommend, if you have not already done so, to nail down what to expect post op immediately and in the few weeks following.  You probably did this, but it never hurts to be certain. 

For your procedure exactly, what will they expect to do during recovery and rehab in the first days and weeks.  In my case, this is where they had been lacking – but it all turned out well.  You should try to be as knowledgeable as you can in order to be your own advocate.  There are going to be ‘don’t do’ as well as ‘must do’ things.  It is better to know beforehand than to be surprised.  In my case they had pre-op literature that I received 2 weeks post op – not much use except in hindsight.

Keep thinking of all the great activities you will get to do once you new knees are fully healed!  Keep us posted on your progress.

Dennis


Dennis:
Thanks for you suggestions.  I met with my doctor and therapist yesterday and went through all the questions I have had and I think I am mentally and physically ready to do this.  I would be lying if I said I wasn't still anxious but I am going into this with a positive mindset that it will work and my knee will stop holding me back with day to day activities.

Skifanatic:
Where do you live and who is doing your surgery?  It is funny there are a bunch of people on here that are having their surgeries within 2-3 weeks of each other.

Melissa
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















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