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Author Topic: ACI - 1yr post op  (Read 21916 times)

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Offline skifanatic

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Re: ACI - 1yr post op
« Reply #30 on: November 13, 2010, 12:18:55 AM »
Thanks again for all the great advice folks.  I ended up staying at the Faulkner hospital a couple days and currently at home jamming on the CPM machine.  The pharmacy (CVS), being the intelligent folks they are, provided all my scripts except the pain killers.  Nice!  Apparently, they are handled separately and when one arrives seeking their painkillers, one must be explicit...however, one finds that this isn't documented anywhere and one is quite unimpressed with the whole deal.

I have my eyes feasted on that recumbent bike but I suspect it'll be several weeks before i can deal with it. 

Dennis...did you make it out for a ride yet?

Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #31 on: November 14, 2010, 01:28:24 AM »
Skifanatic,

Read all your post-op posts.  Sounds like you are doing well.  Who at Faulkner was your OS, Dr. Gomoll?  Dr. Minas did mine at BWH 75 Francis Street, Boston.

I can relate to the SNAFU on your pain meds.  Prior to surgery, knowing that due to the extent of my surgery I would not be picking up the meds myself, I prearranged with a local pharmacy in Pennsylvania.  Noooo problem, just bring in the script for pain meds.  Even oxycodone? No problem!  Even if I get surgery in Boston?  Yup, nooo problem.  My friend drove for the script, called me, they won’t honor it because Boston is not in a contiguous state.  Eaaagggghhh (perhaps they moved Massachusetts since I spoke to them)!!  I had to have my local doctor re-write the script.  The lesson is that no matter how much one plans, things always get messed up.

BIKING!! – Here is my excuse.  I have decided to not go outside yet.  Here is my thinking.  Days are getting cold anyway and I am doing so very well, I hate to mess up somehow.  Although it appeals to me to bike outdoor, even to push it, I think it is best to have a continuous program of injury free rehab for 2 years – given the large extent of my surgery, perhaps for all ACI surgeries?  I am walking (outdoors) about 5 miles 3x/week, 7 miles 1x/week, treadmill retro walking 1 hour 3x/week @ max incline (2mph), swimming 1 hour 3x/week (same days of the treadmill), and doing a bunch of passive knee stuff.  I am increasing the bike trainer to 1.5 hours with increased resistance about 2-4 times per week.  If it weren’t for the joy of increasing my use of the knee, the trainer would be way too boring.

When I had torn my ACL and then had the menisectomy in 1990, I was told to not run for 6 weeks.  When I was allowed to run, the very first run, the OS did not say how far to run and I did not ask.  So I ran 7 miles, and continued this daily for a week - and my knee got quite sore.  Thinking of that, I look at this surgery as my last chance and don’t want to mess it up.  With the ACI, one goof up, and poof, it is all gone.

Here is something to think about, my NEW attitude: It is not how fast you can get back to the fun stuff, but rather how robustly you can do so even if this requires more time spent in recovery.

Let us know how you do with the recumbent.  The osteotomy changes the ACI protocol, no?

Melissa,

Read your posts as well, including the wild bike ride that began the odyssey. 

You went home the same day?  Wow!

I envy your Ice Man.  I want one.   If you read my posts, you see I am a believer of icing – mitigates pain and swelling – and better, allows increased activity.  I kept asking if I might be harming the ACI growth, but was repeatedly told not.  In fact, I had been lucky enough to not be in much pain.  What little pain I had was better managed with ice than meds, especially after I got home.  I only got two bottles of oxycodone, and have never touched the second, but got it just in case.  It is now almost 14 months PO, and I still continuously do icing.  Call me a wimp, but it works for me.  When I do too much, the icing brings the swelling down quickly. 

They told me there would be 12 months of swelling, but from what others seem to advise and my own experiences, I still have swelling if I stand all day or do anything mildly intense or lengthy (like a 7 mile hike).

Nausea  - I learned that I get extremely nauseated under anesthesia.  When I advised them this prior to surgery, they said they would adjust the chemicals to avoid this.  It worked.  I also cannot stand to throw up and will go to great lengths to avoid it.  Fortunately I did not have to worry.

More on my philosophy of pain meds, I did not want to blunt sensations during rehab that might be warnings of danger.  I do know that many people are not so fortunate and do need the pain meds.  I just read too many instances of screw ups during rehab.

During the past few weeks I did some outdoor hiking in the dark on rocky mountainous terrain (no more than a mile in a day) – a fall sport things which I usually do for many miles, many hours.  At one point I was afraid I may have ruined something because my knee really hurt – and it had not been hurting.  I had not noticed any one thing that caused this, but the pain persisted and the knee swelled, and I worried.  Things are back to normal now, but I attribute the issue to 1)  not icing 2) walking on uneven lose rock 3) not doing the normal higher level of controlled exercises listed above.  Just thought this was worth noting.

I sure hope I can return to the backpacking and endurance walking.  I know I will not be allowed to run.

Dennis

Offline Melissa S

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Re: ACI - 1yr post op
« Reply #32 on: November 14, 2010, 01:58:50 AM »
Dennis
Yes I don't know what I would do without this Ice Man.  I also was worried that the cold might affect cell growth but they have said no.  I have not been able to eat much without feeling sick and getting killer heartburn.  Not sure if it is from the anesthesia still or the pain meds.  I have spaced out the pain meds but I obviously can't go without them.  So it is kind of a catch 22.  I have also been getting some low grade fevers in the evening which doesn't help.  hoping once I get past this first week things will settle down. 
PT has me doing SLR's with help and said she was impressed by how much I was doing on my own.  However, they are pretty painful.  I have just been pushing through the pain but want to make sure that I am not doing something that may hurt my graft.  It is so hard, and I know that is what you are battling with.  It is protect the graft at all costs, right?
Thanks for all your advice.

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 #33 on: November 14, 2010, 02:10:02 AM »
Melissa,

Considering the sickness, are you taking anything like a PPI such as Prilosec?  Oxycodone causes sickness and constipation (if I am right - and it was this way for me).  In addition to Prilosec, then had me on a stool softner.  I normally have no such issues and have had non once I stopped the pain meds.

I know you will do well.  Just keep at it and be careful.  I'll watch your progress.

Dennis

cdubb

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Re: ACI - 1yr post op
« Reply #34 on: November 14, 2010, 02:15:38 AM »
Dennis,
I like reading your postings to see how well you are doing!   It is very encouraging being a fresh ACI patient myself.  I am 5 days ahead of Melissa with a patella ACI as well.  Mine was Nov. 3rd.  I also had the AMZ in addition to it though and even I was discharged same day...actually less than 90 minutes post procedure.  My surgery didn't even start until 2:30 or 3:00 pm ish and I was out the door at 6:24 pm.  I just checked my FB posting while I was sitting in the wheelchair waiting for the valet to get our car to confirm the time.  I recall waking up in recovery about 5:30 pm.  I didn't even have a femoral block or anything.  Knowing it was outpatient did somewhat have me apprehensive ahead of time knowing that other big ACI docs Minas and Gomoll (who I see did yours) keep for 1 or 2 days.  Cole did mine and he does all his outpatient, so I figured if there were recurrent problems, he probably wouldn't continue doing so.   I actually fared just fine and don't see any benefit that I would have had being inpatient.  

I also 2nd the lots of icing comments!!  I credit my lack of swelling to the Gameready! Even though I'm paying $25/day for it, I can't yet bear to give it up....I have lots of bruising from the AMZ...but to be expected when bone is being cut I guess.


Offline Rennschnecke

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Re: ACI - 1yr post op
« Reply #35 on: November 14, 2010, 02:29:15 AM »
Hi Melissa

I'm a bit concerned that you are pushing through pain to do the SLRs.  The pain response can lead to your body just producing more heat and swelling and irritating your knee more than necessary can increase the risk of forming adhesions that can interfere with function.  Sorry, I'm a bit of a fusspot on this point as I've been struggling with adhesions for over a year now.

If you can do ankle pumps and quad sets that's good.  Mobilising the patella is also good but check that your OS is happy with the last activity.

As you clearly need your meds just to keep the pain under control at rest wait a bit until it eases and then have a go at the SLRs again then.  The main thing for now is control pain, heat and swelling and maintain basic mobility.

Everyone wants to protect their ACI graft – after all it's the 'last chance', and the length of rehab is hideous.  Being reborn more than once is just too much!!!
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 #36 on: November 14, 2010, 04:46:55 AM »
Thank you Dennis and Renn,
You don't know how valuable it is to us Newbies to be able do draw on your experiences.  I think i am going to take it easy on the SLR's and use the e-stem unit more to get my quad going. 
I have been taking some Zantac and stool softeners.  The Zantac seems to work pretty good, the latter not too good yet.  Tomorrow my Mom is going to come over and watch some football with me so maybe I will feel like one of the living for a while.
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 skifanatic

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Re: ACI - 1yr post op
« Reply #37 on: November 14, 2010, 05:15:44 PM »
Quote
Sounds like you are doing well.  Who at Faulkner was your OS, Dr. Gomoll?  Dr. Minas did mine at BWH 75 Francis Street, Boston.

Dennis -

Dr. Gomoll was my surgeon.  When I initially contacted the Cartilage Center, they were quoting me March 2011 before I could get an appt to see Dr Minas.  I could literally feel things getting worse in my knee and knew I had a potential time bomb on my hands.  Dr. Gomoll was able to first see me in June 2010.  I researched around a bit and found he has a good track record with these lesions and felt confident with him.

I can understand your holding off on biking.  Although, it's quite interesting that you can endure some rough night hiking!  Are you a die-hard hiker?  For me, that's the end-all, be-all.  To be able to hike again would be sweet success.  In fact, the incident that threw me over the edge was a long day of post-holing (with snowshoes) in deep snow on Mt Washington in May.  I got home and experienced serious pain and swelling.  It was the first time my body alerted me there was a serious problem.

I red lined Mt Wachusett in central Massachusetts last Sunday (the day before my surgery).  Summited three times with no pain or swelling.  One of the resident surgeons commented that she couldn't believe I was off hiking the day before the surgery.  Apparently my defect is quite substantial.

Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #38 on: November 15, 2010, 02:07:11 AM »
Hi cdubb,

Glad you are following my progress.  My biggest fear even at this time is what if after 2-years of rehab stuff I go and make it fail somehow.   I also worry about what limitations I may have and how I will deal with that.  But for now, I think it best to plug away faithfully taking care of the knee.  Besides, all the outdoor walking stuff is pleasurable even if it is very controlled unlike what I am used to doing.

Renn, Melissa,

Renn is right, be careful not to overdo it.  I think Renn made a good catch.  I myself began slowly.  In fact, no one told me to do any weight bearing, and at 7 weeks I was still on the CPM.  That is when the Genzyme (USBIOSERVICES) rep, Josh, told me this is not good.  I thought that was what had been required.  After my confusion settled, I worked into weight bearing and finally up to where I am today. 

skifanatic, and all,

I understand what you mean about activity being all important.  If you get surgical pictures, I encourage you to post them.  Check out my pictures above in this post.  The first picture shows the large defects before the grinding and cutting.   People also could not believe my high output right up to surgery.  But hey, if we don’t do this, (as Gail Sheehy says in her book) “if you don't actively pursue your definition of a meaningful existence, life soon becomes a series of trivial maintenance tasks.”
 
Running distances was my main thing, followed by skydiving, then backpacking, etc.  I have never been roped, but I have backpacked around here (PA) up through New England, down to Shenandoah and the Smokies, as well as Yosemite (I used to live nearby!), Wind Rivers, Grand Canyon, Havasupi, Alaska, etc.  I prefer winter, and frequently used snowshoes.   In 2002 after a Hoh Rain Forest (Olympics) backpack I ran up to the base camp on Mt. Rainier (icing my knee in the snowbank on returning to Langemier).  In the last ten years, I would backpack and then ice my knee standing in glacial runoff before retiring to the tent.   The last couple years, I biked more –  a couple weeks near Mt. Washington area, Plymouth, NH, as well as 2 months in Moab, UT.  I am interested in your mountain stories if you have time.  Keeping thoughts such as these are what keeps me going.  Must make more memories.

I had met Dr. Gomoll during my fight with Blue Cross.  When Dr. Minas told me he did not trust Blue Cross I set up an apt with Dr. Gomoll to try to get him to do my knee.  He agreed with Dr. Minas on exactly what needed to be done, but pleaded with me, saying I put him in an uncomfortable position with Dr. Minas being his boss.  He met with Dr. Minas to encourage Minas to push Blue Cross.  I would have been equally satisfied with Dr. Gomoll as his reputation is superb.  Check out their research papers on the Cart Repair Center pub links.

Another big fear I have is something I am learning - that meniscus transplants (I had this as well) degrade and fail eventually.  Very sad thought!   I want to believe I can be the outlier.  I want this to last a lifetime of high activity (hike in the mountains at 90).  Renn sent a good link to a study showing the ACI part heals better with sports.  I would like to think this also applies somehow to the meniscus, but I know this is not the case. 

Dennis

cdubb

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Re: ACI - 1yr post op
« Reply #39 on: November 15, 2010, 06:49:22 AM »
Dennis,
Your knee is definitely more complex than my knee was due to the meniscal transplant. I am very lucky in that all 4 of my meniscii (not sure if the plural is correct) are pristine, as are the lateral and medial compartments.  That being said, I have substantial, painful patella lesions in both knees (although, hopefully no longer in the left if this ACI patch holds)...hence the AMZ also being done with my left knee.

My surgeon actually trained Dr. Gomoll.  I don't know to the exact extent or for how long, but in discussion about various patella ACI docs with my docs PA, I mentioned his name and she said that Dr. Cole actually trained him.  I've since seen his name on some research publications with Dr. Cole saw that he was at Rush.

And is Josh the only US bioservices rep? He was mine also. 

Also, what do you mean when you say that Dr. Minas did not trust Blue Cross?

cdubb

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Re: ACI - 1yr post op
« Reply #40 on: November 15, 2010, 07:02:05 AM »
Okay, I just went back again and looked at your surgery pics (very cool by the way-I have some too) and your first posting on this thread...your surgery was like 10x's more involved than mine!  I cannot believe the amount of surface that that they put ACI patches on...and then the meniscal transplant and the AMZ to boot!  Sheesh...makes my 20mm x 20 mm patellar lesion with AMZ look like a walk in the park!  Although...gives me even more hope that I'll fare quite well following my rehabilitation since you're doing so well with so much more work done! Sure hope my right holds out a while, so I don't have to do this again anytime soon...although defect sizes are about the same...

Offline slyguy1

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Re: ACI - 1yr post op
« Reply #41 on: November 19, 2010, 02:11:09 PM »
Hi to all,

             It's been awhile since i've had the chance to check out some posts here and just read some of dennis's and Renn's posts. I definitely agree that Dennis has the complications going against him---particularly the meniscus which alot of us out there don't realize how important it is to maintain the stability of the knee not to mention other factors. I had read a summary of Dr. Minas article on ACI failure rate among patients that already had microfracture awhile back and it was not a concern for a lot of people out there. I was concerned and still worried b/c i too have most of my meniscus taken away during my microfraction surgery---unlike people that never had any other procedure my ACI would have a failure rate of 3 times the norm. I think it's great that Dennis has taken his rehab into his own hands and at it full-time. Many out there have full-time jobs standing most of the time which really stresses that knee joint. My OS had mentioned that even walking puts a lot of stress on the joint. So i've been biking it fanatically and to my surprise it can be a good cardio workout if done the right way. As far as icing---i think during the initial stages it is very good but after a year post-op i personally don't think it is a good idea b/c it worsens the degree of arthritis. It may numb the pain in the nerves surrounding the knee but i do believe it affects the bone---especially if it is compromised with the cutting in surgery. Many of us don't realize that it is time that is needed most in healing---yes very frustrating when you used to put your running shoes on and crank out 5 miles. Everyone heals differently also---yes genes play a factor in healing.

        Renn.......i had no idea you were a ski instructer. I hope you can get off that duragesic and be able to do some strengthening exercises. I am with Dennis on PT---i don't trust them --i had better results with the exercises i found right on these posts and b/c of that i am able to ride the bike for 45 minutes now---never a replacement to my running days but i'll take anything that will help ADL.

Offline Rennschnecke

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Re: ACI - 1yr post op
« Reply #42 on: November 19, 2010, 03:46:41 PM »
I think I read somewhere that there have been only around 40,000 ACI ops of various generations performed worldwide.  Given the wide variations in size and location of defects along with health history and activity levels, it would be difficult at this point in time to get reliable statistics for outcome on our procedures.  This is simply because there haven't been enough variations yet.

However, many of the variables are not analysed when assessing successful outcomes.  The key variable that is unknown is how patient satisfaction was assessed.  From postings on this forum, it can be seen that people have a wide variety of parameters for making their own judgements, and sometimes these will change over the duration of recovery.

I think the hardest part of this procedure is the length of time to recovery as fully as we might.  On a day to day basis it seems interminable.  I was interested to read recently how people who are detained indefinitely deteriorate mentally and suffer greatly from depression.  It appears it is not being detained that is the problem but the indefinite nature of it. 

This rehab process can seem indefinite when progress is not easily tangible and we are not free to do as we wish to affect it.  To some extent we may experience a loss of control and feel quite helpless.  I know that this is something I was less prepared for than the hard physical work involved.  Moreover, commitment to a rehab programme can change your lifestyle so much that you no longer feel like you are the same person, especially as it gives you less time for your usual social group.  All these factors can be a considerable source of stress and this forum is one of the places where you no longer feel so alone.

Nevertheless, I am a creature who prefers face-to-face interaction and this has gone to near zero as I put efforts into my rehab.  When I do meet up with friends I end up fretting for missing out on my rehab! ???  My own circumstances are somewhat different from conventional 9 to 5 work, and I sometimes thing it would be good for my mental health to be forced to go out – despite the physical discomfort.  It gives me time away from the knee thing.

Yes, Slyguy – was a ski instructor, and still hoping to return to a position with the sport governing body.  For the time being, I'm hoping my place at University will be reviewed favorably again and I'll be allowed to continue my work from January.

I am progressing better than after my last op, but walking with just one crutch over the last two days has just rebounded so I'm resting today – minimum activity.  I'll be happy to get on the bike.  I could probably do quite a bit on the bike if that were all I needed to do, but full weightbearing when walking is different.  Bike work puts less force through the joint that walking does, but it'll be a good way for doing cardio.  I still haven't worked out a satisfactory way for increasing my walking without overstressing the joint.  Will put my creative juices to trying to work out something once the pain, heat and swelling have dies down again.

Re. PT – I think the benefits depend on who you can get to work with.  For something like ACI, you really need someone in the top percentile who also has extensive experience of working with ACI patients.  Unfortunately, the one or two people I am aware of are not local and are focused on research.  I know of one other great PT who is only accessible once a month because of his contract with the sports bodies (and that was hard won), so not much use for continuing care.  I don't know how it is in the US but in the UK, I find that the really good PTs are rare and very difficult to find and get time with.  At least on this forum there are lots of sensible and knowledgeable people who are bright enough to suss out what works for them.  Their shared expertise is invaluable to support a good recovery.

PS Don't miss running; was never much of a runner and triathlon is something akin to purgatory for me.  ;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.

cdubb

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Re: ACI - 1yr post op
« Reply #43 on: November 19, 2010, 06:41:28 PM »
Renn,
Running is not one of my goals either...hate running...always have!  Probably because it has always hurt to some degree, even back to high school.  I'm just looking to be able to get through my daily activities, which involve parenting a 4 year old, active little boy, pain free.  I'd like to be able to go to the zoo or museums walking for the day pain free and not worry about my knee swelling up on me and causing me grief during and after.  If I can get back to some light recreational tennis (just hitting a ball around with my husband)- that would be icing on the cake! 

Offline Rennschnecke

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Re: ACI - 1yr post op
« Reply #44 on: November 19, 2010, 06:54:53 PM »
Hi cdubb,

Given where you are and how easy your recovery has been so far then given time I'm confident you'll get back to doing what you'd like.

I have an 11 year old and feel like I've really missed out on 5 years of activity with him.  I really hope you feel you can enjoy your time with your little boy as you'd like.  I'm also sure you'll value that time with him all the more after this experience.

For now it's patience (bet you hate that phrase by now!)
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.