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Author Topic: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)  (Read 79733 times)

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cdubb

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My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« on: October 31, 2010, 10:26:05 PM »
I'm probably going to be a bit long winded here, but I thought that it may be helpful to have a bit of a history befor going into my upcoming post op recovery...so bear with me...

I am 31 year old, female, 5’11” and 155 lbs. I am scheduled on November 3, 2010 for a left knee Autologous Chondrocyte Implantation (ACI) to repair a 1.5 cm x 1.5 cm central patellar grade 4 focal chondral defect along with an anteriomedialization of my tibial tubercle (AMZ).  Many of you may also know this as a Fulkerson osteotomy or a TTT.   My right knee will also have a diagnostic arthroscopy with possible ACI biopsy done at the same time. 
 
Here’s a little background information on my knee history to bring you up to speed on how I got to where I am today.  I am a former college softball pitcher and I can recall knee pain essentially dating back to high school; however, I managed okay and didn’t really complain until my Junior year of college to the orthopedic who was treating me for my shoulder at the time.   As I was a pitcher and I was working through shoulder issues, that still remained my focus, but I did do a course of knee pt while rehabbing the shoulder as well.    I managed to complete my 4 years competing and then opted to have the right knee scoped during the summer of 2001.  I had a chondroplasty and lateral release performed.  Unfortunately, I lost my operative report, but from what I can recall, I had chondral flap tear down to bone in the distal medial facet of my patella.  The op note also mentioned some grade 3 and grade 4 chondromalacia, as well as one small condral fissure not down to bone in the lateral joint compartment.  That information is just from my memory, as I lost the op note and photos and since it was over 9 years ago, it probably isn’t too pertinent at this time.  I do recall that my ortho at the time did say that the tear was a surprising finding and that the knee was in worse shape than he thought it would be.  He said that the tear was likely a traumatic tear caused by some sort of direct hit or fall on my knee.  I was a Division I athlete…I’m sure that I fell on my knees or took a ball off the knees numerous times.   While, I continued with knee pain, it was better and certainly able to be managed with anti-inflammatories,  ice as needed and activity modification, etc.   As that knee was worse than the Dr. thought it was going to be, when the left knee began to give me problems,  I opted to get the left knee done in Oct. 2003.  That knee was a straight forward chondroplasty and lateral release with no chondral defects found.   

Since the 2001 and 2003 relative minor procedures and recoveries, I have managed relatively okay (not pain free, but functional) until the past year or so.  I managed to play a little slowpitch softball, the occasional recreational tennis with my husband, etc.  That is until last November, my right knee began to give me problems again, with increasing sharp pains under the kneecap.  I returned to the ortho and underwent a series of 5 Supartz injections into the right knee during December 2009.  I was told that I would “peak” from those in February 2010.  I didn’t particularly get a ton of relief from those; however, still did not intend on returning to the ortho I was treating with because I knew that the alternatives for surgery were all pretty big procedures, which at that point I was not at a point to entertain….

However….I did end up returning in early March 2010….but for the LEFT knee….  I woke up one morning and my left knee was HUGE!  I could walk okay on flat surfaces, but any incline, stairs, squatting, etc. was extremely painful. The only thing different about the prior day is that I had opted to take the stairs down and up 4 flights to go get a drink while at work.  Normally, I avoid stairs and take the elevator, but I thought I figured I wouldn’t be the lame one taking the elevator for 4 flights for once….  I went to the ortho after about 3 days when the swelling had not subsided at all despite ibuprofen, ice some light stationary biking, etc.  He aspirated it and had it cultured.  Cultures were all WNL.  I then happened to have a minor toe surgery in mid March which slowed me up for a bit, but when I started to attempt to increase my activities again, the left knee did not respond well and began to swell and become painful again.  While I’ve dealt with knee pain forever it seems, there was something different about this.  I returned to the ortho, who albeit somewhat begrudgingly, ordered an MRI.   I’m not one to jump to an unnecessary diagnostic test, but for me the results may change my treatment plan and decision, so I felt that it was time to obtain one.   The results came back and showed a focal chondral defect down to the subchondral bone on the lateral facet of my patella with bone marrow edema and some fat pat irregularities and a lateral tilt to my patella.  My doc told me that a different ortho would be able to help me more than he could in repairing the chondral defect in addition to the Fulkerson procedure, so off I went to my current OS.   Ironically, I almost went to this guy to begin with back in November, but since I wasn’t thinking along the surgery lines, I stayed with an ortho right by work to make it more convenient. 

I saw my current OS in mid May for the first time and he felt I may be under rehabbed, so he ordered 8 weeks of pt with a hip and core focus, which I diligently completed.  While I did get stronger, the symptoms in my left (and right) were no better. The left knee was very symptomatic and I was struggling with even walking at time with sharp pains.  Extending the leg even to put my feet up on an ottoman was very painful.  I was struggling to get through my day without several occurrences of the sharp pains in the knee.  This was not a situation that was long term sustainable, so  I returned at the end of July and the decision was made to proceed with a left knee scope with possible microfracture, possible ACI biopsy, possible anteromedialization.   Not knowing what the procedure would be, I requested to stay awake under a spinal for the procedure, which my Dr. obliged and this was completed on August 31, 2010.

The August 31, 2010 surgery was ultimately a pretty anti-climactic day.  Not knowing what to prepare for, I made sure that I had disability set up through work, had things made a little easier at home, etc.  The focal defect ended up being a central patellar defect (vs. lateral that the MRI had shown), so all that was done is a little debridement and an ACI biopsy.  I was told that that area could not be microfractured successfully and that an isolated AMZ only carried about a 50% success rate, but that rate jumped to about 80%+ if the ACI was done in conjunction with the AMZ.  So, I walked out of the hospital, hubby and I went to lunch and I contacted disability and made plans to return to work 2 days after surgery.  Unfortunately, I returned on Thursday and ended up being out again Friday for a minor complication of a spinal headache that sent me back to an anesthesiologist for a spinal blood patch. 

So…after ensuring all the proper insurance authorizations were in place, I am now scheduled for my left knee ACI/AMZ on November 3, 2010.  While my Dr. is doing the left knee, the right knee will be scoped as well. The left knee biopsy didn’t really carry too much of a recovery,  so I figured rather than end up with 2 more procedures if need be, let’s get that part out of the way at the same time.

I am now 3 days away from my left knee ACI/AMZ and right knee diagnostic arthroscopy.  I have made some DME purchases to make my life easier like a raised toilet seat and a shower chair.  Never thought I’d need those at age 31!   Luckily, our house has a guest bedroom on the main level with a bathroom right next to it, so I can camp out down there until I feel ready to maneuver stairs safely.  Post operatively, I’ll be heel touch weightbearing for about 4 weeks, increase between weeks 4-6 and hopefully full weightbearing by 6 weeks and hopefully totally off crutches by 7 weeks. I’ll need to be in a CPM for 6 hours per day. I’m hoping I can swing sleeping in this since it will facilitate an earlier return to work if the hours of the day aren’t used up sitting in that thing.

It’s interesting to me that my right knee has always been the more problematic knee until earlier this year, but now the left has rapidly gone downhill!  I also find it fascinating that a 1.5 cm x 1.5 cm area can cause this much pain/swelling and limitation in activity!  Granted, I did have knee pain prior to this being there, so there are some other mechanical issues with my knee that the AMZ should resolve.   That lateral tilt/maltracking issue is probably why I get a lot of lateral kneecap pain, especially when my foot hits something hard or catches on something.
So…that’s my story.  It’s not nearly as exciting as many of the other stories on here with traumatic knee injuries …just a set of bum knees!   I hope that my recovery also remains uneventful!

3 days and counting……

Any last minute tips/pointers/suggestions are welcomed and anyone please feel free to post on this thread!

Offline Kat_Walk

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #1 on: November 01, 2010, 01:21:26 PM »
And you said your story wasn't exciting!! I reckon its pretty darn interesting, much more so than mine. Yours is about the medicine, mine is about the bureaucracy! (and a little medicine).
You poor thing, dealing with the knee issues for sooo long. I found it somewhat interesting that even though the right knee was the one you had more issues with the left has needed the major surgery. Much like myself, my left (the TTT victim as I call it) was fine til I buggered it with that fall, but my right has been problematic for ages. When the CT was done and all the angles were measured, the right was better than the left! (not by much, but still I found that interesting.)

So only 48hrs til the big op (I am trying to make an educated guess on that given our time zone differences).. nervous??
Is the hubby all set? I dont think my hubby really understood how big an op it was until the shower chair and granny loo seat arrived.. Reality bites  ;) 
12/9 - Substantial Subluxation of L patella due to a fall
12/9 - 2/10 - PT for injury
3/10 - PT rehab (non responsive)
5/10 - Referred to OS
6/10 - Diagnosed Maltracking & patella alta
9/10 - TTT with LR
10/10 - VMO atrophy & muscle imbalance
11/10 - Diagnosed with Femoral Nerve Inflammation

Offline duckie857

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #2 on: November 01, 2010, 04:13:50 PM »
Awww, you're going to get crutches the day I officially ditch them! It's almost poetic ;)

I think you've got what you need well under control!

Here are the things I couldn't live without the first week post-op:

- Pain killers ;)
- My cooler with drinks and snacks
- Padding on my crutches for under my arms
- 3 different ice packs that I rotated 24 hours a day
- Compression bandage (ACE worked fine for me)
- Instant Watch Netflix Subscription (first month is free)
- My laptop for movies, knee geeks, etc.
- Yoga capri pants from Old Navy
- Stool in the bathroom for my leg
- Memory foam mattress pad to support my back a bit more
- Cell phone and charger within reach at all times

After the post-op appointment I needed:

- A shower chair for in the bath tub
- A removable shower head
- Sleeping Pills
'04 - '10: Years of dislocations & subluxations

01/13/2010 - LR, MR, VMO Advancement
10/06/2010 - Fulkerson Osteotomy (TTT)
09/02/2011 - Scheduled MPFLr

Offline Kat_Walk

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #3 on: November 01, 2010, 05:07:30 PM »
I think Duckie has summed it up quite nicely for you. I would have died without my laptop, pain meds and mobile phone!
of course the toilet seat riser and shower chair come with the territory, but I know you have it all under control.

At this rate maybe you and I will be off the crutches around the same time Cdubb.. LOL  :)

12/9 - Substantial Subluxation of L patella due to a fall
12/9 - 2/10 - PT for injury
3/10 - PT rehab (non responsive)
5/10 - Referred to OS
6/10 - Diagnosed Maltracking & patella alta
9/10 - TTT with LR
10/10 - VMO atrophy & muscle imbalance
11/10 - Diagnosed with Femoral Nerve Inflammation

cdubb

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #4 on: November 01, 2010, 11:11:50 PM »
Thanks for the tips girls!  I wasn't going to do the crutch pads, but I may need to reconsider...I will need the sticks for about 6-8 weeks!  I also will be supplied with a Gameready ice machine, so instead of ice packs, I'll just need to keep it full of ice.  Although, I will need just plain ice packs for the right knee.... I always forget that one is being scoped too....

I'm about 36 hours out now...and yes...I am getting a bit anxious.  I'm sure if my blood pressure was taken, it would be elevated!  I won't have a surgery center arrival time until about 3 pm tomorrow, which really sucks for planning purposes.  My docs PA said that I wouldn't be the first case of the day (I think he likes to pound out some easy cases first) and it would probably be a later morning surgery.  So, that works well for kid drop off purposes and we have one of my son's friends parent's lined up to pick him up if need be if I don't get out of there timely.  I'm hoping I don't get blindsided with a 6 am arrival!  It's much harder to ask somebody if you can drop your kid off at 5:15 am at their house vs. asking if they can pick them up from school.

I'm going to try to go with just using Benedryl for a sleeping aid (docs PA said that was fine). If that doesn't work, she'll call in Ambien for me.



Offline duckie857

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #5 on: November 02, 2010, 12:10:16 AM »
I wish I had sleeping pills that worked more than a day or two. My doctor put me on Restoril and it did absolutely nothing for me. Honestly, Xanax puts me out faster than that! (I had to take Xanax for a while during a hellish job that caused panic attacks. Not fun...but the pills worked amazingly.)

I just wrapped washcloths around my crutches and taped them. It has worked just fine for me!

The worst part of my surgery was that last 15 hours or so before I knew what time I had to go in. I figured it would be the 1PM surgery because his coordinator said he marked down that he wanted me in as the last one of the day. That sucked so bad...not being able to eat. Then when I got to the hospital I had to wait another 2 hours before everything was ready to go. Soooo bad.

Good luck! I'll be thinking about you. Down to the wire now. I can't believe it had been a month since we started talking! Are you spending the night in the hospital or going home? I can't remember! I'll be waiting to read your post op report :)
'04 - '10: Years of dislocations & subluxations

01/13/2010 - LR, MR, VMO Advancement
10/06/2010 - Fulkerson Osteotomy (TTT)
09/02/2011 - Scheduled MPFLr

cdubb

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #6 on: November 02, 2010, 12:26:40 AM »
I know...I can't believe it's been a month either!  I popped in on your thread I think the day or day after you had surgery! Prior to having a kid, I would prefer to be the first surgery of the day, but now there are other responsibilities to consider.  I'm hoping for an 8- 9 am arrival, so not being able to eat won't matter to me.  I once had a 2 pm arrival for an elbow surgery (I know...I've had a lot of surgeries...college softball beat me up) and they even called me to tell me to not get there until 3. I don't think I got into surgery until almost 5 pm that day.  That was brutal!  They had a tough time getting the IV in because I was dehydrated.  Then the anesthesia made me sick, so they ended up keeping me overnight.   That being said, I will be outpatient for this procedure.  I always make sure to tell them to give me something to prevent the nausea and I haven't had an issue since.  The surgery center called me today and  they said that generally 2-3 hours after surgery, they send people home.  I'm going to be sent home in my brace, on crutches, with a CPM and an icing system...good thing we have a van for all that gear and me!

It's kind of funny that you, Kat, Mermaids and now I have threads and we're the one's posting the most on each others threads!  I actually feel like I know you girls! I almost feel I should private message you girls my full name to look me up on FB and then we can see that we all have real lives outside of dealing with our knees!

Offline duckie857

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #7 on: November 02, 2010, 01:32:05 AM »
Feel free to PM me. I'm on facebook and easy to find! I don't mind you seeing me outside of KG. That goes for anyone else, too!
'04 - '10: Years of dislocations & subluxations

01/13/2010 - LR, MR, VMO Advancement
10/06/2010 - Fulkerson Osteotomy (TTT)
09/02/2011 - Scheduled MPFLr

Offline Kat_Walk

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #8 on: November 02, 2010, 02:54:46 AM »
Thanks for the facebook link, I am actually not on there. Its big over here, But I wasn't a big fan of having details posted on the web.. I know, I'm paranoid. Maybe I should re visit the idea. Up until this surgery I never really had time to spend on the net, with working and kids etc. One day just rolls into the next.. Even though 2010 has been a hellish year, when I think about it I cant believe we are about 8wks out from Christmas!

I too, spin out when I think its been 5 weeks since we all met, I feel like I have new friends! I have even recounted some stories to hubby. I particularly like the pregnant lady in the body cast. Hubby's eyeballs just about fell out of his head when I told him that one, I laughed and apologized to him for "not being that lucky".. hehe!

For my TTT I specifically asked my OS about scheduling me as a morning op on his list, as I suffer from migraine which is triggered by fasting. I learned this from previous surgeries. I remember one surgery, by the time they took me into the OR I was almost vomiting from the migraine. I then remember waking up in recovery and the my first thought was 'Hey, my head isn't hurting anymore!' 
As it turns out he only does an afternoon list the day I was booked but assured me I'd be the first cab off the rank. I am told to be at the hospital at 11am for a 1pm procedure. I get to the hospital, and the admitting staff inform me I am the last on the list! Boy was I angry. After voicing my objections.. nicely but firmly, but to no avail, I had to wait til 4pm. By then the headache had kicked in and I was not very impressed. Once again, my OS tells me one thing and does something completely different! I'll give him the benefit of the doubt and assume it was the anesthetist that wrote the list. That's usually how it works here, as far as I know. 
12/9 - Substantial Subluxation of L patella due to a fall
12/9 - 2/10 - PT for injury
3/10 - PT rehab (non responsive)
5/10 - Referred to OS
6/10 - Diagnosed Maltracking & patella alta
9/10 - TTT with LR
10/10 - VMO atrophy & muscle imbalance
11/10 - Diagnosed with Femoral Nerve Inflammation

Offline duckie857

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #9 on: November 02, 2010, 07:40:27 PM »
Cdubb! We're facebook friends now :) YAY!

Kat, You should definitely start a facebook! It's a fun (albeit sometimes really annoying) way to connect and you can hide any information you want from people.

5 weeks...insane. I just don't know where all this time is going! I can't believe you told your husband about the body cast! I know that Adam is glad I have this outlet so I'm not constantly annoying him with knee stuff. I know he gets tired of hearing it.

I hate that your OS is just so unbelievably...rude! I wish you could meet my OS and talk with him. He's so amazing and the absolute opposite of the piece of work you've got down under! Can't you fly to New York? I promise he's worth the trip...in more ways than one  ;) lol
'04 - '10: Years of dislocations & subluxations

01/13/2010 - LR, MR, VMO Advancement
10/06/2010 - Fulkerson Osteotomy (TTT)
09/02/2011 - Scheduled MPFLr

cdubb

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #10 on: November 02, 2010, 10:59:51 PM »
I told my husband about the body cast story too...it was just too funny not to! 

So....11 am arrival tomorrow with a 12:30 scheduled OR time.  They said they hope to have me out by 4 pm....seems a bit aggressive, but we'll see! 

CPM lady just left dropping off the CPM and taught me how to use it.  Glad that someone is coming here vs. the hospital sending me home with it since I'm sure I would completely screw up the set up I'm sure.  This way I am also drug free when trying to figure it out.  The CPM and I will become good friends over the next 6 weeks! 

Offline duckie857

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #11 on: November 03, 2010, 01:11:40 AM »
Good luck :) Let us know how you feel when you are up to it!
'04 - '10: Years of dislocations & subluxations

01/13/2010 - LR, MR, VMO Advancement
10/06/2010 - Fulkerson Osteotomy (TTT)
09/02/2011 - Scheduled MPFLr

Offline Kat_Walk

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #12 on: November 03, 2010, 02:07:29 AM »
Ok Cdubb, we are down to the wire.. its Wednesday morning here so I figure that means its Tuesday night for you guys.
Just know I am thinking of you, and wishing you all the luck in the world.
Looking forward to your update of the big event when you're good and ready.

Duckie, I'd love to come to NY. That would be my dream holiday, even if it was for the knee! LOL!!
Hubby and I have it on the wishlist of travel destinations, along with Italy. Not gonna happen for quite sometime, as we have 2 kids and a mortgage, but maybe in a few years when they are outta school and working themselves.. who knows?  ;)
 
12/9 - Substantial Subluxation of L patella due to a fall
12/9 - 2/10 - PT for injury
3/10 - PT rehab (non responsive)
5/10 - Referred to OS
6/10 - Diagnosed Maltracking & patella alta
9/10 - TTT with LR
10/10 - VMO atrophy & muscle imbalance
11/10 - Diagnosed with Femoral Nerve Inflammation

cdubb

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #13 on: November 03, 2010, 02:41:15 AM »
Funny Kat that the US is on your list of travel destinations and I would love to visit Australia!  Maybe in 20 years???

Offline duckie857

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Re: My Nov. 3rd patella ACI/AMZ (aka TTT or Fulkerson)
« Reply #14 on: November 03, 2010, 02:49:35 AM »
Haha, Kat...what Cdubb said. I've been dying to go to Australia for years. It's on my top 5 list.

I lived in New York City for a while in college. I highly recommend it as a trip...but if you're ever here by some miracle you should definitely take the train upstate while you're around so that you can see the mountains and beauty that they have to offer. The best time to be here is around Mid-October...you get the most beautiful color changes with the trees. It's my favorite time of year!
'04 - '10: Years of dislocations & subluxations

01/13/2010 - LR, MR, VMO Advancement
10/06/2010 - Fulkerson Osteotomy (TTT)
09/02/2011 - Scheduled MPFLr