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Author Topic: MACI practicalities  (Read 7826 times)

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Offline Vickster

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MACI practicalities
« on: November 16, 2010, 09:34:02 PM »
Assuming my insurers play ball, I am due to be having a scope to assess suitability for MACI on 16 December and, if appropriate, the implantation at the end of January. 

In order to sort work etc, was wondering how long you MACI veterans out there had off work after both operations, how long on crutches, when cleared to drive, frequency of physio, when able to fly etc

Defect on left lateral femoral condyle, WB surface, assessed at  1.5cm2 when scoped in Feb - currently filled with fibrocartilage but never settled (result of falling off bike 14 months ago), still shows on MRI with damage to subchondral bone. I now have an automatic car, office job, but do need to travel from time to time for work (short and long haul) and I'd quite like a holiday next spring  ;D

I realise that everyone is different and depends on location of defectwould be great to have some ballpark ideas.  At the moment, I am assuming a week off work for the scope and 6 weeks for the big op?

Cheers in advance  :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

cdubb

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Re: MACI practicalities
« Reply #1 on: November 17, 2010, 06:40:55 AM »
I just had an ACI of my patella with an AMZ of my tibial tuburcle.  Defect location different obviously, but I also have the added osteotomy; however, that would probably leave weightbearing restrictions a bit closer to what you would experience than if I had just had ACI, as my aci alone would be FWB.  The AMZ is what restrictis my WB to allow time for the bone to heal.

The scope for the biopsy is a breeze. Had mine on a Tuesday and returned to work on Thursday.  There really isn't a reason I couldn't have returned on Wednesday though.  I never used crutches, walked out of the hospital pretty much status quo walking in.  A week is a bit excessive for just the scope.  Had some swelling for a couple weeks, but really, not much to the scope at all.  Can't say I actually had any increase in my normal pain at all and it actually felt better for a couple days due to all the numbing agents injected during surgery.

The other procedure, you'll need to play by ear based upon how your range of motion is permitted back to actually fit in a vehicle and how quickly you can come off narcotics. .  I currently am locked at 30 degrees being just shy of 2 weeks post op and cannot fit in either of our cars driver seat.  I put in for 6 weeks, but think I may be able to return by 4 weeks.  By that time, I think my brace will be at 45 or 60 and I think I can manage to get in one of our vehicles.  I'll still be on crutches for another 2-4 weeks at that time, but I anticipate pain should be more under control and narcotics greatly decreased by 4 weeks out.   I also have a sedentary, desk job.   I did put in for 6 week at the outset though in case I needed it.  It's easier to return earlier from an approved leave than extend one out if you didn't plan enough.   I'd say anywhere from 2-6 weeks for the 2nd procedure based on a large variety of factors of how you respond to surgery and pain control/management, how quickly your brace is unlocked to be able to fit in your vehicle and how comfortable in general you are with returning. 

Offline Vickster

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Re: MACI practicalities
« Reply #2 on: November 17, 2010, 08:04:39 AM »
Thanks for your reply :)

I was thinking a week for the first scope, simply because I was signed off for 3 weeks last time (and not allowed to drive for 3 weeks), but good to hear.  I don't know if that OS was making sure I rested properly as I didn't after the injury  ::)  I did use the crutches on and off for a month as the knee was pretty sore (partial menisectomy and patella shave). It is the week before Christmas so I'll just play it by ear, workwise, better I can work between Chrismas and New Year probably (loads of leave to take by end of year, but not a lot of chance of that)!

Any idea on flying, when discussing AMIC with the first OS (not done as insurance wouldn't cover), he said no flying for 3 months due to DVT risk? I may not need to fly for work but I want to plan a holiday for some point next year, probably long haul
« Last Edit: November 17, 2010, 08:08:24 AM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

cdubb

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Re: MACI practicalities
« Reply #3 on: November 17, 2010, 03:00:39 PM »
Really talk w/ your OS about flying.  I know that there are people on these boards who fly to see their surgeon and have surgery out of town.  I think some of them have mentioned being able to fly home in about 3 weeks...but really not sure at all.  I would also think there would be different protocols that different OS's follow with that. The amount of swelling that you have may also play into and what sort of anti-coagulation therapy that they do afterwards, which may play into when you are releaesd to fly.  Mine just required I take an aspirin/day for 2 weeks, but I really think that was actually more for the osteotomy than the ACI because my entire leg from thigh to ankle was (still is somewhat) awfully bruised from the bone cut. 

You may respond differently to the biopsy scope than I did.  Mine was so easy that I even decided to have my right knee scoped at the same time as my left knee ACI/AMZ to assess the defect in that knee and determine a plan for that and get a biopsy taken if need be.  Genzyme was called during surgery and they had enough sample from initial biopsy though.  That knee also has a grade 4 patella defect, so some patella clean up was done to the right knee when the left ACI/AMZ was done. Only reason I felt comfortable doing both knees at same time was because of how easy the left biospy scope was...and it worked out just fine.

Good luck and I hope your insurers play ball!  I was worried after my scope that my insurance company would squawk a bit since it's a patella ACI and they don't always like to cover those...luckily, it was approved in less than 2 weeks from submission. 

Offline Vickster

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Re: MACI practicalities
« Reply #4 on: November 17, 2010, 03:19:15 PM »
Thanks again

The insurers do seem open to covering as it would seem to fit their criteria but they have requested some very specific information from the OS which is taking a while to obtain as he is somewhat busy and his sec hasn't seen him for a while!

I didn't think the success for patella grafts was great due to shearing forces, but they so seem to be done ... my patella wear and tear is 'only' grade III, had a short back and sides, and although pops and grinds every time I bend my knee, my other OS told me not to worry about it!
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Rennschnecke

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Re: MACI practicalities
« Reply #5 on: November 17, 2010, 04:12:48 PM »
Hi Vickster

You may be on crutches for 6 weeks but it could be more.  I think thevoice was on crutches for 6 months.

People have returned to work after 2 or 3 weeks with adjustments.  You may have a lot of physio to do and you need to ensure you can ice and elevate the knee appropriately.  Most people tend to return part-time first and some have moved their offices to the ground floor as well as arrange for disability parking at work.

OSs may have different criteria for returning to work.  Sometimes it is a standard 6 weeks after major surgery as long as you are also comfortable.  Some say you need to be off narcotics.  Whichever, the insurance company asks that the OS confirms you are fit to drive or it is invalidated.  Your ability to drive may be limited more by your brace than anything else.

Physio frequency seems to differ according to each physio's approach.  I had physio once or twice during the first 6 weeks then once a week or two thereafter but I was discharged after only 4 months when I was still on crutches (this was a major beef for me so I won't go into detail).  Physio can be more intense so you need to check with your own particular set up what will happen.

I know people have gone on holidays flying quite early on e.g. 5 weeks post-op, but you may need to have a wheelchair to get around.

The recovery from ACI varies quite a lot from person to person.  If it were me, I'd apply for as much leave as possible to allow yourself the maximum time to concentrate on rehab.  You have to play so much by ear.  It could just be me, but I was able to run quite well by 6 weeks post-ACLr so this journey has been really hard.

If you ask your OS they will give you the minimum periods before you can do the things you've asked about.  If you plan your life on this you need to assume that everything will go smoothly on your recovery, and you're best placed to assess how happy you are with this approach.

Best of luck with your forthcoming op!
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 Vickster

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Re: MACI practicalities
« Reply #6 on: November 17, 2010, 07:46:32 PM »
Cheers Renn - invaluable feedback as ever :)

 Work will be reasonably flexible I am sure, having with the company for 10 years, entitled to plenty of sick leave and a friendly GP who will sign me on/off as required

6 months on crutches  :o  6 weeks will be bad enough.  I'll need to find a local physio (as the OS is 60 miles away around the M25  ::) ), doubt the current one has much experience, but can see.  Seems to know his stuff and he has never been overly aggressive on rehab so far, so hopefully be fine.  Am single and live alone in a house with stairs and no downstairs loo so I'll have to decamp somewhere for the second stage!  Going to be a logistical challenge to say the least!

Going to be difficult to ice and elevate leg at work, the building does have a lift, and undergound carpark accessed by said lift - and I have a nice big space to be able to open the doors wide (3 door Golf, so nice big doors but lowish )

Not going to book a holiday, but good to plan and have something to look forward to :)

I'll wait until the insurance signs off and then quiz the OS for the details :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

cdubb

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Re: MACI practicalities
« Reply #7 on: November 18, 2010, 06:05:20 AM »
Vickster,
Patella ACI's do have lower success rates, but recent studies show that when combined with the antermedialization of the tibial tuburcle, success rates jumped dramatically...like from 50% - 80%.  Which is why I  had the AMZ done in conjunction with  my patella ACI.  A lot also depends on the location of the defect on the patella.  A lateral defect may respond well to an isolated AMZ, but my defect was central to medial, so the isolated AMZ only carried a 50% success rate, but if I hads the ACI in conjunction, success rates increase to 80+%.  Going into my biopsy scope in August, I actually didn't know if I would be leaving with just a scope and biopsy or if the AMZ would have been done and microfracture was even a possibility.  MRI showed a lateral defect, but it was actually central to medial (in reality...it's half my kneecap if you look at my operative photos of the defect and the patch). 

Offline KartBoy

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Re: MACI practicalities
« Reply #8 on: November 18, 2010, 11:51:01 AM »
Vickster

I'm in twelfth week after Femoral condyl MACI, non-weight bearing for first four weeks and partial for next two and in brace for most of that time. I drove for the first time at eight weeks, partially because you have to be able to get into and out of car which is still fairly slow process and needs plenty of space to get door fully open. I wanted to be confidant that I could put maximum pressure on brake for emergency stop without any pain before I felt safe to drive. I'm a consultant and could work part-time after about ten weeks but it depends on how much medication your on and what side-effects/ tiredness you feel. I still don't sleep well so full days work is still not possible. I assume the operation is at Stanmore or nearby private (e.g Bushey) by one of their consultants but you shouldn't have much problem with finding a local physio which you really need, even if inexperienced with MACI they will get detailed info from hospital, I'm using NHS physio who has been really great, didn't have any prior experience but just called Stanmore a few times to clarify what was in the notes and everything has been fine.

All the best, I'm still recovering which means lots of work to rebuild quads which haven't really had much use in operated leg for over two years but so far operation has transformed things, in much less pain and more mobile. If I can get off the last of the meds then hopefully will sleep better and all will be well. It was a long wait and major struggle to get the operation but it seems well worth it as I write these words.

Regards

Andrew
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline Vickster

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Re: MACI practicalities
« Reply #9 on: November 18, 2010, 02:04:12 PM »
Thanks Andrew

Yes, likely at Stanmore / Bushey assuming it happens

My function is actually quite decent - can walk, albeit not that quickly and I can feel the knee all the time, and can use the static bike / XT but none of it is very comfortable or fluid and I have seen no improvement for what seems like forever (probably the last 6+ months) - plenty of ups and downs, the knee never feels right and is always puffy but some days are ok but other days plenty of discomfort, burning, stiffness.  I cannot squat or kneel or jog/run.  My quads and calves are ok as I have been able to use the bike, albeit not as much or as well as I would like.  I don't sleep as well as I would like either, partly due to the knee (uncomfortable when I lie on it) but stress too, both knee and work related

My local physio is good, and of course, there is the local OS in case of issues, so that's of less concern - only a 5 minute bus ride away too - so much easier than Bushey!

Good luck with your continuing recovery, sounds like you've had a tough old time of it

Driving wise, I have an automatic car and is my left leg that is gammy, so braking is fine
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline KartBoy

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Re: MACI practicalities
« Reply #10 on: November 19, 2010, 10:08:10 PM »
Vickster

You actually sound like a good candidate, suggest you get that holiday in early. It will help you get through initial recovery if you have recent happy memories to dwell on. I haven't been able to kneel for almost three years and look forward to being able to hand back cane to NHS one day sooner rather than later. You probably won't need access to OS after surgery but local physio that you trust is major positive, they will get all they need from Stanmore/ Bushey and just need to call if you/ they have any queries after your op because everyone is different.

Make sure you get an extra couple of pairs of anti-thrombosis stockings, they keep the leg warm and helped keep swelling down in those first few weeks, The other option would be thick ski socks, anyway thats a digression, all the best getting the insurers on board.
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline Lottiefox

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Re: MACI practicalities
« Reply #11 on: November 19, 2010, 11:22:25 PM »
Vicks

One of the members on here, Cricket, has a fabbo blog about her femoral ACI. Here:

http://allisonsaci.blogspot.com/2010_11_01_archive.html

She has posts with Things that I wish I'd thought of, and essential things to get prior to surgery! Really useful information. Its a warts and all account but she is 7 months out and doing great....

Lottie x ;D
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Vickster

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Re: MACI practicalities
« Reply #12 on: November 19, 2010, 11:30:26 PM »
Cheers Lottie - I assume no gruesome pics?  :o

And thanks again, Andrew :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline KartBoy

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Re: MACI practicalities
« Reply #13 on: November 20, 2010, 09:50:46 PM »
Vicks

I've seen Alison's blog and its a good reference, there are a few gruesome pics but your warned which ones to avoid if you have a delicate stomach.

Andrew
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline JuhaH

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Re: MACI practicalities
« Reply #14 on: November 21, 2010, 03:46:51 PM »
Hi there,

I have also damage in my articular cartilage due to the meniscectomy about one year ago. I was in skiing accident in january 2010.

What did your OS say about ACI treatment after meniscectomy? I have only 20% medial meniscus left and I'm thinking that is it possible to have ACI surgery without medial meniscus?

Thanks in advance and good luck.
Skiing accident in january 2010. Left knee, medial joint space narrowing and constant pain following partial meniscectomy (30% medial meniscus left). Trying to prolong the knee replacement as long as I can.