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Author Topic: ACI - 1yr post op  (Read 21948 times)

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Offline Rennschnecke

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Re: ACI & Meniscus implant - info re. meniscus implants
« Reply #45 on: March 06, 2011, 01:31:17 AM »
Hi Dennis

Just read this article which you may have read already, but if not, may be of interest to indicate which types of activities might be more stressful on your reconstructed knee.
http://www.orthosupersite.com/view.aspx?rID=65575

Currently working thro my backlog of article and also reading up on knee replacements.

Doubt that PKR/TKR would be suitable for me just now.  I have almost full ROM and so most movements, but still need to avoid stress and high forces.  Slowly getting stronger, but still overstepped the mark on Wednesday so paying for it just now. :'(

Ray is right, there's always hope until some experts confirm you're at the end of the line.  However, there are many OSs out there who are keen to develop biological solutions to knee problems so the options are developing all the time.

Hope you're growing in confidence about your own situation Dennis!
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 Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #46 on: June 08, 2011, 03:13:33 AM »
Hello all.  It is now 20 months post-op.  I thought it might be good to report that I am still doing well.  I’ve been walking in mountains with a light (15 pound) pack and am now mountain biking outdoors a couple hours per ride, a couple days a week, in addition to the other things I had been doing, which I listed earlier in this thread. 

My main worries remain that this procedure will leave me so vulnerable that it will fail as soon as I attempt to do most things I would normally do.  When I go back to Dr. Minas this September for the 2 year follow up, I intend to ask about this.  I don't really expect clear answers because I don't think anyone knows.   On the positive side, I am able to do a lot more now than immediately before surgery, albeit things done very gently for fear of causing failure.

Until that visit with Dr. Minas, I will gently continue to increase my intensity and duration while refraining from what I believe might be catastrophic (jumping, heavy lifting, twisting with weight, etc).

I wish the best to everyone with knee problems.  Bad knees sure can wreck life plans.

Dennis

Offline cliffoa

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Re: ACI - 1yr post op
« Reply #47 on: June 10, 2011, 11:42:50 AM »
Hi Dennis,
Hang on in there dude. I think most of us on here know how a bad knee can turn life upside down. I'm 8 months out from my own meniscal transplant, and have similar concerns. I cycle most days for an hour or two, and can walk up to a couple of miles, but I still get redness, heat and inflammation every day, and the knee feels nowhere near strong or stable enough to do all those things you mention (jumping, running, heavy lifting, twisting etc). Any sudden or heavy movement, the knee lets you know about  it. Even simple everyday tasks like standing on your bad leg to put on your trousers (pants), you have to think twice. It's a real drag, but what can you do. On bad days you think, why me, and you just want to be normal. But then you just get on with it, or you'd go crazy. I'm not as far into rehab as you, but even now I don't feel the cartilage transplant is gonna make that much difference.  Like you I'm hanging on to my own biological knee for as long as I can, in the hope that new and better procedures are just around the corner, or when the day finally comes when I need to have a PKR or TKR, they're next generation and allow you do to most things you want in life. 

Just that some days, the dark days, nursing your knee through every minute of your life, every activity, every movement, constantly icing and taking anti-inflammatories, you think, jesus, wouldn't it just be better to chop the damn thing off and get a replacement put on?  I guess when that day arrives, I'll know I'vve got to the end of the road and get a replacement.  I'm hoping to get another 5 to 10 years out of my knee before I get to that point, I just hope those years aren't as crappy and debilitating as they are right now. Otherwise, that's 10 years of your life you can't get back, and maybe a PKR/TKR earlier would have been the better option. It's all about quality of life I guess. But the situation we're in, we have to put our faith in the surgeons, and hope that these transplants will finally settle down and give us back some quality time.  I share your frustration bro.  Good luck with your continued rehab, I wish you well.  Sorry for rambling, I'm at work and just wanted to bang this out quick on my computer, then get back to work.
Best.
Archie
1974 ACL rupture, medial meniscus tear. Partial menisectomy.
1974-1999 No ACL - 25 years.
2000 ACL graft.
2006-07 2 x Damaged articular cartilage = 2 x arthroscopic debridements.
2010 Meniscal allograft from frozen donor graft.
2012 Failed allograft removed.

Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #48 on: June 12, 2011, 09:29:35 PM »
Archie et al,

I appreciate your comments.  They are right on the mark.   Don’t apologize for rambling, your post reads fine. Besides, I happen to be a rambling kind of guy.  Just look at my ramblings.

I read your other posts concerning your procedure.  Hang in there, it does get better.  If I am right, you need to pay particular attention to two things during rehab, 1) don’t overstress your knee even one step (avoid instant failure) and 2) certainly do stress the tissue gently and for prolonged times, as long as it feels correct, so as to teach the tissue its intended role.

An important timeline to keep in mind is posted in Karen Hambly’s excellent course on ACI rehab posted here:

http://www.kneeguru.co.uk/KNEEnotes/node/740

I believe this applies to you also (you did not have ACI, right?  What about the damage you mention?).  Note the notional very long tissue adaptation times for cartilage repair.  I can attest that my rate of improvement appears to be following the right-most curve on the graph.  This makes me feel good in that there is still very much cause for me to expect continued improvement (being at a point 80 weeks, 60%) from a medical standpoint.  Every month that goes by, I realize how much better I am than I had been a month previous.  The rate of improvement is not great, but it is also not showing any signs of slowing down (this makes me very happy). 

What concerns me is not- knowing objectively how much I can expect to be able to do without causing failure.  I tend to do things hard and keep going even when my body objects.  This knee thing does not allow such behavior.  I think failure may occur two ways, 1) by excessively long use and 2) by a single instantaneous jolt that exceeds the knee’s new design limits.  I can avoid item one by paying attention to how things feel.  But item two is more difficult to gauge.  I like endurance sports.  I would like to backpack for a few weeks or longer or do distance biking.  I don’t care how slow I need to go, just that I want to go all day, many miles.  What if I need to step up onto a big rock with a heavy pack – will this rip into my knee.  Must I always step up with the good leg even if the repaired knee is willing to perform the function!

I already can pretty much walk or bike fairly long distances without any increased bad sensations, so I continue to increase distances on both biking and walking, limited more by the time in a day.  And I can walk pretty fast, even uphill - aerobically fast.  But I continuously guard against the single-point failure that I believe would be caused by over-stressing things.  And this is not a matter of confidence in my knee, but rather something (I think) needs to be paid attention for the remainder of my life.  This is going to be hard. 

Harder to deal with is going to be the meniscal degeneration, if any.   Renn posted very good info in her link above that shows promise and helps quantify details.

Well, I think I rambled enough.  It does help to confer with others.

Regards,
Dennis


Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #49 on: February 08, 2012, 12:04:49 AM »
It’s been a while since my last update.  I am still doing well (relatively speaking), and would like to share my thoughts and welcome your comments on this philosophy. 

First, if you are reading this, then I feel sorry for you, because your life will likely never be great again (if you depend on your legs for sports/hobbies).  I’m sorry I need to say it, but you need to face the truth.  Knees dominate daily life and will probably do so for you.  Sorry.

On 22 Sep 2011 I traveled 800 miles for my 2-year post-op MRI and visit with Dr. Minas.  The imaging people said that 17 different images were taken.  During my 5-minute visit with Dr. Minas, he looked at two of those images and (here is everything he said) said, “you are doing very well”.  I should not complain and am very grateful for the wonderful surgery, but I sure would appreciate more information.  I got billed by the hospital for some doctor I never met, presumably the interpreter of the MRI.  Should I request the raw MRI data (I can take courses to learn how to view it) and the interpretation.  I want information.

Ok, here is what I am doing these days.  I still workout 2-3 hours per day, 7 days a week – it is a hobby.  I can walk uphill and downhill as fast as I want with no pain.  I swim and do weights 3 days, and walk at least 4 days (or bike ride, but wintertime I only walk).  Sometimes I walk with a light 10-15 pound pack and eventually hope to soon try a 30-50 pound pack for backpacking.  I’m really not sure why I have not tried more weight yet as the pack never bothers me.  Most walks are around 6 miles, some as much as 12.  For me, a very fast walk is merely 15-16 minute mile pace – not that really fast at all, but I never was fast, when I ran, it was an 8 minute mile.  My knee feels ok, but I am always aware the knee is not like my other knee.  The knee seldom has pain, but ‘sensations’ always let me know the knee is less than the other knee.  I think I will always need to consider this knee a very vulnerable part of my body.  For now I can do a lot as long as I am very careful. If I make a mistake or misstep, permanent damage could be done to my knee.

I never run even a short distance, such as crossing the street.  I am always on a vigil to protect my knee.  Friends are tiring of my protective nature.  I tire of it.  I can outwalk sedentary friends and keep up with the others walking, but not when they run.  My former running and backpacking buddies think I am faking it or over-indulging, wanting me to run or go on hard backpacks.  In November (2011), I did a series of things that set me into a month of regret, but I did recover fully.  Experimentally, I went for day-after-day consecutive fast hikes -  a 6-mile, then 7-mile hike, then a rugged 8 mile hike in Shenandoah National Park, then a very fast, as fast as I could walk, 7-mile walk.  I think it was the very fast walk that did it, I was in pain that evening in bed.  The pain remained for a month.  I thought I may have done permanent damage, but did not.   In my recovery period (month) I cut back to 3-4 mile hikes, slow, 4 days a week.  I do not think it would be good to totally ‘rest’.  Does this prove I am vulnerable, or perhaps the opposite, that the pain doesn’t matter, just go for it?

Now I am again doing longer and longer hikes, limited by the time it takes now that I no longer run.  I would never dream of playing sports, such as baseball (running to base or to catch a ball), soccer, etc.  Skydiving used to be something I enjoyed a lot, but I don’t want to have that rare hard landing ruin my knee.  I sorely miss running, but want to hold on to what I have – pretty much unlimited walking, and hopefully backpacking soon.  But I do not expect to do anything unrestrictedly. 

I feel it prudent to get ready for total failure as I push things.  Why are we avoiding total knee replacements (me included)?  What can I do now that the knee replacement would not allow?  I see they have a projected 30-year knee.

I wish everyone well.  If I can help, feel free to contact me.  If you have any thoughts on what I said, please share.  Anyone living nearby (17265), I would love to meet for a hike if you can.  As I said, knees dominate my life – why not hike and talk knees.

Dennis

Offline Jamey1215

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Re: ACI - 1yr post op
« Reply #50 on: February 09, 2012, 01:07:53 AM »
Hi Dennis,

Any regrets?  I am scheduled for ACI and TTT surgery in a few weeks.  I am very nervous but don't really have many other options, as I have been told by several orthopedics.  I am very active, at least trying to be right now, but spend almost every evening with ice on my knee and some days Ultram is the only thing that gets me through the day.  I would not say I am in a ridiculous amount of pain, but can no longer do the things I once enjoyed doing.  I used to train and run marathons and triatholons.  I also have horses that I ride a few days a week and it is getting more and more difficult to get through my days at the barn, doing what I love.  Anyways, just wanted to see what your thoughts were.  I am committed at this point, but would love to hear your thoughts.

Jamey

Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #51 on: February 09, 2012, 01:08:43 PM »
Jamey,

Regrets?  Not really about this surgery.  What options were there?  I regret my motorcycle crash in 1987 (stupid me), and very much regret going to Dr. David Joyner (1990 surgery) and listening to him when he told me I don’t need an ACL to run 50 miles a week in mountains, skydive and backpack.  This was the dark ages before the internet, and I believed him.

I read your other posts.  Where is your defect and how big?  My situation before ACI was similar to the way you are describing yourself.  I had to do something.  No option gives us the durability of a native original knee.   Technology keeps progressing and perhaps some day…

What does your surgeon suggest you should be able to do after surgery besides being in less pain, and what restrictions do you expect in the long run?

I wish you the best.

Regards,
Dennis

Offline Jamey1215

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Re: ACI - 1yr post op
« Reply #52 on: February 09, 2012, 08:07:30 PM »
Hi Dennis,

Thank you for replying. My defect is 2cmx2cm on my patella. I believe there is a smaller one as well on the patella. The doctor is optimistic that I will be able to return to high impact sports. He said I could be running again at 9 months if all goes well. I am hoping to be riding and showing again by the fall. I don't want to be overly optimistic but I need something positive to look forward to if I am going to get through this. I'm really worried about getting back to work. I have 3 weeks max of paid time off. I can sit at a desk upon my return so that's a positive but I don't have the luxury of staing at home for 4-6 wks like some posts I have read. I had a realignment done on my rt knee about 15 years ago and don't recall it being that awful. Yes it hurt but 3 wks after surgery I was up and around no problem. I even recall going to a new years party and was back in classes for the spring semester. I keep telling myself to stop reading about this, everyone is different but for some reason I can't!!

Offline Dennis BadKnee

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Re: ACI - 1yr post op
« Reply #53 on: February 09, 2012, 10:11:02 PM »
Jamey,

My recommendation is that you read the Carticel literature carefully as well as rehab guidelines from your surgeon, all of which you should have in-hand by now.  Location of the ACI greatly changes the rehab protocol, yours being on a non-weight bearing surface.  But then you will also have the rehab protocols from the TTT to incorporate.

ACI is not like any other surgery, it is not like healing from a broken bone or ligament reconstruction.  ACI most certainly is not at all tolerant of pushing it hard in the early phases (before the tissue matures) - you would squash it, rip it, delaminate it and otherwise destroy the initially delicate tissue.  This runs counter-intuitive to our spirit of pushing our bodies hard and getting increasingly great results.  Physical therapists unfamiliar with ACI have destroyed many knees via overaggressive rehab early, just read this board to see examples.

That said, ask your doctor how to protect and rehab yourself in the various timelines/phases after surgery and I expect you will have the best chance for a healthy active future.  If you want to further prepare, call your Carticel consultant to add to what the doc says.

From what you said, I bet you can go to work as needed (but ask the doc).   You do need to perform all the rehab (perhaps continuous passive motion machine) as required.  And you do need to be careful.  As long as you have good knowledge of what to expect and are willing to follow guidance, it all sounds good.

I am curious as to where you are having it done and what surgeon you are using.

Dennis



Offline Jamey1215

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Re: ACI - 1yr post op
« Reply #54 on: February 10, 2012, 03:51:17 AM »
I live in the Houston area. My surgeon is Patrick McCulloch and the surgery is at Methodist Hospital. Dr McCulloch is the cartilage guru for this area. I actually started off with a different surgeon but after my scope and biopsy I was referred to McCulloch. The surgeon that was originally going to do it felt the realignment that I needed was beyond what he felt comfortable doing. I have a lot of respect for him for referring me on once he realized this was going to be more complicated than he was used to doing. I believe I am having the amz alignment done. They plan to just move my patella up instead of medially or laterally since my defect is on the medial side of the patella and I had some wear on the lateral side. Sorry for babbling....

cdubb

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Re: ACI - 1yr post op
« Reply #55 on: February 20, 2012, 10:35:32 PM »
Jamey...I would be cautious with impact activities too early after surgery. I had a patella ACI with TT to my left knee on 11/3/10 and set aside the fact that I had a patella DeNovo NT with TT to my right knee on 12/13/11...there is no way I could do impact activities now. I had a 20 mm x 20 mm central defect on the left knee. I am very much improved from pre op, but I still struggle with stairs, inclines and arising from a seated position on my left knee. Clearly the right is only 2 months post op, so I'm a far cry from considering impact activities overall. I'm not saying you won't ever be able to run or do impact, but just keep realistic expectations. I don't think I would even be cleared for impact on just the left knee alone until 16-18 months post op... Maybe you'll have a quicker recovery than me though and perhaps your doctor allows more earlier. 

As for the work...it is possible to return at 3 weeks. I took longer, but that's because I could and still get full pay. 2-3 weeks for sedentary job is fine.  I do recovery from surgeries quicker than many also, but this one is a bit more than I'd ever done before. Driving for me took until 4-5 weeks for both right and left, but only because I am 5'11" and just didn't fit in my car until I was unlocked to 60 degrees.
Good luck to you!

Offline OCD in Portland

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Re: ACI - 1yr post op
« Reply #56 on: February 21, 2012, 12:56:07 AM »
Hey cdubb,

Now that you are at 10 weeks post op, how are you doing?  What are you able to do?  Not able to do?  Are you where you expected?  I'm at my 10 week mark on Friday, and while we had slightly different things, I'm curious how yours is going.  Also, we both had our other knees done previously, so wondering how your other leg is holding up.

I was NWB for the first 6 weeks, increasing PWB for the last 4, and finally get to walk without crutches on Friday.  I'm excited because I haven't really been able to do anything yet.  I wasn't even allowed to start PT until week 6.  As of this week I can do the bike with low resistance and swim laps, which is pretty exciting.  I'm surprised that my knee still hurts, especially when I sleep, but I think that's just because my last knee really didn't hurt after the first week post op.  As for my other leg, it has help up on the 10 weeks of crutches so much better than I ever expected.  That has really been the most positive part of all of this, I was really worried i would be over-stressing the first leg after this surgery.

Offline Jamey1215

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Re: ACI - 1yr post op
« Reply #57 on: February 21, 2012, 01:29:56 AM »
Cdubb,

I am not as anxious to return to running as riding.  If I can't run for 9-12 months I won't be too upset.  I was actually shocked the surgeon even said it was a possibility.  I plan to give up long distance running and maybe just do some triathlons hopefully next summer if able.  If not, oh well.  I just hate that I am going to be giving up my independance for a while.  I am good for a few days, but a few months is going to be rough.  Hopefully I will heal quickly like I have in the past.  I have a job where I can sit at a desk if needed so hopefully by 2 wks that will be doable.  I have short term disability but it only pays 60% so I don't want to use it if I don't have to.  I am not really financially prepared to not be collecting my full paycheck.  I think at 2 weeks I will have to go back regardless and just suck it up.  I have a week of vacation I can dip in to also but I would like to save that for an actual vacation if possible!

cdubb

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Re: ACI - 1yr post op
« Reply #58 on: February 22, 2012, 03:29:12 AM »
Hey OCD,
I am 10 weeks today.  I was heel/toe touch for 4 weeks and then allowed to go up a little from there.  At 6 weeks, I was to begin the transition to FWB and off crutches. Since I had good quad control, I was able to just ditch the brace at 6 weeks also.   Within a couple days, I was crutchless and that weekend, I actually did quite a bit out and about shopping at Target, running my son to basketball and a birthday party.  Moving slowly and with a slight limp, but doing pretty well.  Once I got to FWB, it openen up so many more things to do in PT.  It's still pretty boring and only closed chain permitted for patella defects, but I'm doing some single leg balance on flat ground, but I do like to have something to touch for balance when doing single stuff because I don't entirely trust my quad yet.  I amdoing some two legged balance things are on the blue foam mat like thowing a ball at the rebounder, or cord stuff like rows, pull downs, etc.  I like that because it also helps my upper body and the quad actually does get a workout having to stabilize on a dynamic surface.  I'm doing wobble board stuff with 2 legs.   Calf raises and 4 way ankle strength stuff.   A lot of my PT stuff is hip and core focused, so I am doing SLR's of course, planks, crunches, twists.   A lot of isometric quad contractions, NMES still, hamstring curls with a swiss ball or lying prone on a table.  Hmm...I think that's about all I'm doing at PT??  My normal daily activities with geting to/from work, shuttling kids around, going to PT, shopping were fine by about 7-8 weeks out.  I still get sore and at times I have a limp, but on a whole, I think I'm moving around pretty well.  A long ways to go in PT still clearly, but day to day, my life is pretty normal.  I do have some soreness on the anteromedial side of my shin aggravated with hamstring type exercises and my PT says it's pretty normal and likely some pes anserine irritation.  I also have some IT band stuff going on with some snapping of the IT band on the lateral and proximal part of my patella.   Not that I didn't trust my PT, but I did email my docs PA also to make sure it all sounded normal and she did say that is what it sounded like and to roll and stretch the IT band and the pes anserine or hamstring insertion should calm down as the quad returns.  She didn't really seem concerned in the least though, so that's good.  I did ask if I could do the elllipical trainer and was told not yet and to wait until at least 14 weeks and then try, but be cautious.

The other knee is definitely aggravated  having to do a bit more, but has help up okay on a whole.  I think that it certainly could be much worse than it is.  It was never pain free post op, but just much improved.  I am icing both of my knees a lot.  I unfortunately cannot take anti-inflammatory meds on any consistent level for awhile because I took so many last year to keep my right knee in control until I could have surgery that I gave myself NSAID induced gastric erosions, so I don't have that to help keep things calmed down either.  Overall though, it is doing okay.  I think it is slightly regressing because it's hard to work it out too much with the other knee so compromised, but I do all my exercises with both legs at PT.  At least the quad atrophy matches now!! I have two skinny, muscleless thighs now! I'm hoping that as I can do more with the right, both knees will improve a lot. 

You know what's strange...I think I am having more ongoing knee pain at this stage than I recall with my left knee also.  I absolutely am having sleep issues still, which I know I did not have last time.  What happens is that I bend my knee when I sleep and then I go to straighten it and that causes pain that wakes me up and then it aches/throbs and I can't get back to sleep.  I have pain meds left from post op, but they actually make me kind of itchy/agitated and keep me awake. My doctor prescribed Ultram to try, which does help a little, but I try to not take it every night. 

So, that's where I'm at now at 10 weeks.  In summary, my daily life is pretty much normal, but a long ways to go with rehabbing both knees still.

cdubb

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Re: ACI - 1yr post op
« Reply #59 on: February 22, 2012, 03:45:13 AM »
Jamey,
When you mean riding, I am assuming you mean horse?  Only because you also said showing?  If that's the case, I think that will still be a stretch by the fall.  I've only ridden a horse a few times and don't really know what I'm doing, so I'm sure I put more force on the knees than necessary, but I do remember that my knees hurt a lot during and the following day.  We were in Estes Park and did a 2 hour trail ride (made for beginners because there were some younger kids like 8 on the ride and we only galloped at a couple spots).  I did that as an activity because I thought it was a smarter activity for my knees than trying to do a hike in the mountains....I was hurting...and that was before my knees really tanked on me.   Again...not experienced at all in riding a horse, but I was surprised at how much force was going through my knees on the ride, especially during the gallop and when we were going down some of the steeper slopes.  It reminded me of jet skiing and how much I hurt after that.  Since you're experienced though, I'm sure your ability to return to that activity will be different than mine!

Had my short term not paid 100% for up to 6 weeks, I would not have taken the 5 weeks I did.  Last year due to years of service, I only had 4 weeks full pay before droping to 50%, so I returned at 4 weeks.  Based on our benefit structure, I wasn't losing pay, so I didn't rush back.  It'll be rough, but you could probably do it.  If you have the opportunity to work from home, that would be ideal.  I stayed at home my first week this time and for a week and a half my left knee.  So, I wasn't actually commuting and driving to the office until almost 6 weeks.  I know that my docs PA told me that they had one patient who was a Kindergarten teacher who returned at 2 weeks ...that's insane, but she did it!    I can absolutely understand the need to get back if you'll lose part of your salary...especially when the bills start rolling in from surgery... My US Bioservices bill was higher (double actually) than the costs of the DeNovo NT graft material, but both charges are absurd...and even the amount insurance pays is absurd.  We're actually still paying off US Bioservices... Just expect to have some increase in swelling in the knee, foot and ankle when you go back.  It's inevitable no matter when you return. 

Good luck to you!

Dennis...sory for hijacking your thread!















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