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Author Topic: Update to A.C.I  (Read 1459 times)

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Offline summerfun

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Update to A.C.I
« on: December 27, 2010, 02:02:19 PM »
Hi Guys,

I hope everyone has had a brilliant xmas and is enjoying the festive peroid, i have found it difficult not being able to do all the usual things a mum would do which is daft really as im always wanting to get more time to put my feet up and now i have it, it's driving me insane  :P

Well i am now 6wks & 3days post op and am feeling quite frustrated at the moment, i am still NWB and dont see my consultant until the 10th January so 2wks today and am under strict instructions to not weight bear until i have seen him. My wrists are swollen all the time from using the crutches and my right shoulder gave up for two days as well so am really struggling to get about which has been hard on my children as we cant go anywhere as i just get to much pain and need to go home, obviously this is down to my joint problems but it dosent make me feel any better.

I have been seeing my PT every week and despite three separate requsts to Stanmore she still does not have a copy of my operation and exactly what was done and is just going by the PT notes from Stanmore which was NWB till seen and download a copy of the PT instructions from their website. The problem is i now cannot do anymore as i am NWB and still on closed chain exercises so she has said not to come back until i have seen the consultant which is at the London hospital in Bolsover Road for some reason, so the should be fun trying to get there while NWB  :-[

My concern is i can still only get to 50 ROM and that really is pushing it and it is so painful there and just above my knee there is a 2-3inch gap between the muscles working and this area where they just arnt working. Im sorry it is difficult to describe but where i have to constrict the muscles from the top of my thigh to the knee it all works until it gets to 2-3 inches from my knee then there is nothing, if we stimulate the area by massage while trying to constrict there is a faint flicker on the inner side but that is it and i still have no feeling on top of my knee cap on the outer side although this has improved to an area of about a 50 pence piece where i can still feel nothing. I am hoping all this will improve once i am allowed to start weight bearing, i am continuing to do the exercises i am able to do 4 times a day but depite this i just cant get past the 50 rom, i can only describe it as feeling as though my flesh is going to tear open if i push anymore, has anyone else had a problem like this or is this normal?

I hope everyone else is doing well and wish everyone a wonderful 2011!!

Offline Rennschnecke

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Re: Update to A.C.I
« Reply #1 on: December 27, 2010, 03:20:22 PM »
Hi Summerfun

Have you tried to get a wheelchair on loan from the Red Cross to help you get out and about?  I'm not sure when they will be open at this time of year if you haven't but it's really worth trying to find out.

If you are unable to bend past 50 degrees at this point the most likely reason is that there will be adhesions inhibiting your bend.  This is a common complication (I had it but it at 8090 degrees bend).  The usual treatment is to have an arthroscopy to release the tissues to put you back on track with recovery.  Look up the section on arthrofibrosis in the soft tissue healing problems section http://www.kneeguru.co.uk/KNEEtalk/index.php?board=9.0.  It'll be very useful for you to read the postings of Laurie, HeatherM, Janet and JakeM among others who detail the protocol to follow to allow for full recovery.  I think NickNack was also successful.

IIRC you were unable to get sufficient icing post-op.  To have the best chance of success in recovering your ROM you need to minimise swelling as soon as possible.  Getting hold of a Cryocuff with a pump is an important tool in this as you can use it continuously and just unplug when you need to.

I did most of my rehab at home and only began regular visits after 8 weeks post-op because there wasn't a lot to do apart from the basics.  There has also been a poster who said he began to work with a physio from one year post-op and his surgeon thought it would save him from over-doing things.  So not seeing your physio for a while isn't a problem.  Your exercises may be closed chain for a while longer (could be up to 6 months post-op or more).

I'm not sure what the surgical notes could reveal to your physio that won't be in the PT notes or the clinic notes (if you don't have a copy of these either request them from the OS or your GP).  All the pertinent information (e.g. size of defect and location along with any other issues arising from the surgery) will be there.  The additional info that is in the surgical notes relates to procedure (e.g. materials used, template made and condition on closure) don't really add much to the rehab you might do.  Any complications etc. should also be noted on your discharge papers, so you could show those to your physio, but as I said, it won't hinder your recovery to NOT see a physio at this point.

The 'gap' you describe might be a sign of muscle wastage (it is difficult to be definitive when you can't see things, but this is most likely and happens to everyone who is unable to use their legs for any prolonged period).  If it is difficult to activate the muscle then massage can stimulate response.  If this isn't working then you may need an Estim unit to help.  I was recommended a Kneehab unit by my OS, so this is a question to raise with your OS.  If you are anxious about this, phone the office up but be prepared for a wait at this time.

The numbness is a feature I was told, not a complication, and is related to the way in which the neural signals go (inside to out).  It may or may not come back over time and is not solved through WB.  Think in terms of a year or so for recovery rather than a few weeks or months.  If it becomes a problem you may be referred on to a specialist.

Best wishes
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 summerfun

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Re: Update to A.C.I
« Reply #2 on: December 27, 2010, 08:48:49 PM »
Hi,

Thank-you for your reply and as usual you have understood everything and given me a very through answer, i wish you were my consultant  ;)

I had a nagging feeling that adhesions could be behind the problem as i have developed these after previous sugeries i have had (nothing to do with knee) that unfortunatly could not be put right as it was far to complicated and so i am on medication to control the pain they cause but fingers crossed this time they can be sorted if they are the cause.

I have had no luck with getting a Cryocuff as they are like gold dust second hand and i simply cannot afford to buy one, i have used up my holiday pay and am now on SSP which is only 33.81 per week which is not alot to feed a family of five on, so i just cant justify it. I did buy a freeze wrap which i put on after i have done my exercises but my pt advised me to only use it for 20 mins max each time.

The notes i was referring to i thought were surgical notes but from what you say are clinical notes, as you will remember my discharge and care was far from normal and so have no idea what they done, size of defect in fact i dont know anything and the notes sent to my pt say nothing either which is why she has been contacting Stanmore asking them to fax them over but as i have said she has received nothing. I am not worried about not seeing her between now and when i see the consultant it's just frustrating to still not know what i have had done ie size of defect and why i am NWB for 8 weeks plus when it seems most get to PWB from week 4.

I am sure you are also correct regarding the muscle wastage and once i can start to do more exercises this will begin to return to normal......

Most of my frustration is from a lack of patience and i am needing to work on this more than anything, i just hope i get some answers on the 10th of Jan, do you know if i will still see my consultant or are there different ones at each hospital?

Once again thank-you for taking the time to help and reassure me  :)

Offline Rennschnecke

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Re: Update to A.C.I
« Reply #3 on: December 27, 2010, 09:45:12 PM »
If you're susceptible to forming adhesions then you need to manage your rehab very carefully as it sounds like you may be susceptible to primary arthrofibrosis.  The posts I mentioned outline the key issues to manage and what to avoid.

If you are using an ice wrap you can use it for 20 min every hour so, 20m on, 40m off.  If your knee is burning it may help to have it on for 30m every 2h.  It can hurt initially even with a sheet to protect from ice burns, but this will settle down.  If you can't ice overnight, you could try to elevate overnight.

Your clinical notes from pre-op and post-op will describe the procedure.  If you are getting no joy from the hospital try your GP.  It is likely to be quicker.

I can't speak for whom you will see at your follow-up.  I have always seen my consultant and he always fishes me out from other consultant's rooms these days as I'm a 'difficult' case.  I did see just his fellow on a few occasions (only one in clinic), but the fallout from that consultation is still being sorted out.  However, I was not treated at Stanmore and can't comment on their processes.

Patience is a crucial ingredient in this recovery.  Try all sorts of different ways to keep your mind off the knee I know it's tricky.  Rehab can consume your life, but I'm sure your family will help.

Take care and enjoy the rest of the holiday season.
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.