Advertisement - Hide this advert





Author Topic: MACI practicalities  (Read 7823 times)

0 Members and 1 Guest are viewing this topic.

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: MACI practicalities
« Reply #15 on: November 21, 2010, 03:52:33 PM »
As far as I know ACI is performed only if the other structures in the knee are intact.  However, ACI is done alongside other procedures, e.g. ACLr, meniscus transplant etc.

DennisBadKnee has had ACI with meniscus transplant and may be able to comment more on your own case.
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.

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4668
  • Liked: 379
  • Neelie knee!
Re: MACI practicalities
« Reply #16 on: November 21, 2010, 06:13:27 PM »
Not mentioned, but it's a different OS to who did the menisectomy (only 10-15% removed apparently) - this new chap is of course aware of the previous surgery.  It wasn't the meniscectomy that has caused the damage, the meniscus got torn at the same time as the cartilage damage
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 mlashmar

  • Regular Poster
  • ***
  • *
  • Posts: 54
  • Liked: 0
Re: MACI practicalities
« Reply #17 on: November 23, 2010, 08:19:11 AM »
Hi Vickster

Sounds like you've got a good situation regarding return to work.  General rule seems to be about 6 weeks, but worth making arrangements so that you may work from home if you can (you may get bored within the 6 weeks or may feel that you would like to remain at home longer to concentrate on physio).

Regarding holiday, I booked to go to Dubai last for the end of October, about 2 months post op.  I had booked it well before the op was scheduled.  The holiday did give me something to look forward to, but it also put a strange pressure on the recovery process.  In the end, I cancelled the holiday, My physio and I didn't think I'd be able to deal with the flight (bending the knee etc) and when I got there, I wouldn't be able to do anything.  I actually felt relieved to cancel the holiday rather than disappointed!  Insurance covered it, but I lost admin fees from Opodo and there was also the excess, all in all about £75 was lost.  I'd suggest holding fire on booking something until you know how things are going, at 3 months I'm confident I could now go on holiday and have a good time of things so I''d feel confident booking a holiday now, but only 3-4 weeks ago I was still walking with crutches and uncomfortable when my knee was bent.

Left knee
Full thickness defect (20mm x 20mm), Trochlea
Arthroscopy x 3 (1997 - 2006 NHS) - lose body removal, lavage and debridement
Microfracture 2008 Spire Southampton - diagnosis of trochlea defect
MACI Stanmore 2010

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4668
  • Liked: 379
  • Neelie knee!
Re: MACI practicalities
« Reply #18 on: November 26, 2010, 01:48:12 PM »
Update - the insurance company have agreed to the MACI - scope on 16th December and then the second op on the 27th January if appropriate.  Eek!
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

  • Forum Faithful
  • ****
  • *
  • *
  • *
  • Posts: 347
  • Liked: 7
Re: MACI practicalities
« Reply #19 on: November 28, 2010, 01:39:11 PM »
They know what they are doing the Stanmore/ Bushey consultants and must have convinced the insurance company it was worth it and that is the attitude to take, any surgery is scary but I haven't regretted my MACI for a second, Prof Briggs told me it was a way better alternative to knee replacement and so far he has been 100% right.

Exercise as much as you can to strengthen the quads before the operation, wastage isn't a problem but the stronger they are the better and stock up on dvds/ book for the first few weeks as you will be as bored as ... we all have been in those first few weeks.

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 :(

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4668
  • Liked: 379
  • Neelie knee!
Re: MACI practicalities
« Reply #20 on: November 28, 2010, 03:00:06 PM »
Thanks Andrew

I am still using the gym - cycling 20 mins 3 x a week, as well as 10 minutes on the XT or today the treadmill (which my knee still hates  ::) ) .  Also a couple of 15 rep sets on the leg press

After the scope, I am hoping to be off work for a week as I will need to work between Xmas and New Year most likely.  I haven't quite figured out likely time off after the second op - seems to be very variable - will need to have that conversation with the OS when I know it is actually happening.  I have said 6 weeks to work, but that might be optimistic from what others have said?  ???

I have now set my sights on a 2 week trip to the West Coast USA in September - the original plan was May, but that isn't going to happen if I have the MACI!  Would be a driving trip, and I should be able to fly premium economy at least so more room
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

  • Guest
Re: MACI practicalities
« Reply #21 on: November 29, 2010, 05:40:27 AM »
Depending on what kind of job you have, 6 weeks should be plenty.  If you have a job where you are on your feet a lot, then more time llikely required.  If it's a desk job, you should be alright.  I'm returning 4 weeks from my ACI/AMZ, but from home for 3 days, the following week half days in the office and finishing up half at home and then the following week to the office full time.  That would be me full time in the office 5 weeks, 5 days post op.  My biggest obstacle is going to be getting from the parking lot into the building and then up to our floor, since I will still be on protected weight bearing and on crutches when I return.  I'll let you know how it goes as I return and if I change my tune....

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4668
  • Liked: 379
  • Neelie knee!
Re: MACI practicalities
« Reply #22 on: November 29, 2010, 07:55:59 AM »
Thanks cdubb

Desk job, but won't have access to ice and will be difficult to elevate my leg simply because how the desks are designed.  I don't know how long I will be in a brace for, as I guess that will make driving challenging, even though it is my left leg and I have an auto car.  Parking not an issue, I have a big space so should be able to open the doors wide and the car park is under the building with a lift to my floor.  I will have to see what the surgeon says.  When I was talking to the first OS about AMIC (didn't happen due to the insurance) he said it would be 6 weeks off.  I was signed off and no driving for 3 weeks after the scope in Feb.

I think they tend to be more conservative in the UK, it's a 2 night stay here after MACI usually, while in the US seems to be day surgery
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 CR_UK

  • MINIgeek (20-50 posts)
  • **
  • Posts: 48
  • Liked: 0
Re: MACI practicalities
« Reply #23 on: November 29, 2010, 01:34:16 PM »
I started driving at 4 weeks with brace on as was allowed full ROM and the car automatic. Short trips only 10-15 minutes as got uncomfortable sitting with knee bent if longer. So if your workplace not too far you may be able to get to work OK despite the brace.

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4668
  • Liked: 379
  • Neelie knee!
Re: MACI practicalities
« Reply #24 on: November 29, 2010, 01:45:45 PM »
Thanks CRUK.  It's around 5 miles, but in the rush hour, the drive can take 30 minutes!  Got to love suburban Surrey traffic.

Where is your defect located, also on the femur?  How long before you were back at work?  Getting to follow up appointments is going to be interesting too, as I am 60 miles from Bushey, although there is a direct train service from my local station, which I shall be trying out on the 16th!
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

  • Guest
Re: MACI practicalities
« Reply #25 on: November 29, 2010, 03:14:21 PM »
Icing and elevation will be somewhat difficult for me too when I return, but now at 3 weeks, 5 days out, I only ice 1-2's day anyway since swelling isn't really isn't much of an issue at this point.  Although, I'm sure once I return to work, the leg will get fired up and swell a bit more since it will be down so much more through the day. 

I have also noticed that the UK is more conservative with some things like hospital stay.  I was out the door and heading home and hour after I woke up from surgery. 

Driving could be a challenge depending on the range that your Dr. permits you to have with the brace and the progression.  I am still at only 45 degrees in my brace and I could get in a drivers seat, but it would be a challenge, but on Friday I get unlocked to 60 and I should fit much better. 

So, you'll probably be able to return ealier than 6 weeks, but if it's not a problem getting it and you don't feel any  pressure from your employer, take the full 6.  I felt somewhat obligated to return earlier (self induced...not pressure from employer) because just before my leave I was promoted, so I kind of feel I should get back as quickly as possible to get settled into my new position.

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: MACI practicalities
« Reply #26 on: November 29, 2010, 07:03:08 PM »
I'm going to be repeating myself here, but some people have been known to return to work from 2 weeks post-op with adjustments to location and/or hours.  The ability for anyone to return to work depends on both their work and their recovery rate – there are no guarantees.

Assuming that all goes well, you will still need to ensure your pain, heat and swelling are controlled.  Icing and elevation are very important for that.  Uncontrolled inflammation can increase the risk of adhesions forming and can lead to complications.

Also important is the time required for doing your PT.  My regime for the early weeks was pretty full on with CPM and other exercises.  Even now at 10/11 weeks post-op (different procedure), I am spending up to 8 h a day on my PT.  Can't fit in my work and that is something I could do at home.

Vickster, you really ought to check with your OS to see what they say.  If they give you a minimum of 6 weeks till you can drive, your insurance is likely to only cover you with that condition.  I know that after my scope I was told I could only drive after 2 weeks and only if comfortable (e.g. no pain or swelling).  After my ACL I was told I could not drive for at least 6 weeks.  I could have driven without cover at 2 weeks post-ACLr, but I'm still testing out whether my knee will stand up to driving short journeys to the gym near home after my scope.

I know you want to make plans, but your minimum constraints will be set by your OS.  BTW the sick notes are now different, they no longer give you a blanket time off work but will also stipulate under what conditions you may return to work, e.g. time off for PT, elevation etc.  If things are better for you you can negotiate with your GP at that point.



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 KartBoy

  • Forum Faithful
  • ****
  • *
  • *
  • *
  • Posts: 347
  • Liked: 7
Re: MACI practicalities
« Reply #27 on: November 29, 2010, 07:28:30 PM »
See what the OS says but I would think six weeks would be a minimum, I kept my leg elevated the whole time I was non/ partial weight bearing unless I was doing physio exercises icing on a regular basis, no way was I safe to drive at six weeks, I had as little as 60 degrees of rom in the first few weeks and while it came back quickly once I started active physio no way would I have wanted the stress of thinking about returning to work in those early stages.
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 :(

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4668
  • Liked: 379
  • Neelie knee!
Re: MACI practicalities
« Reply #28 on: November 29, 2010, 07:29:42 PM »
Thanks Renn.

I can take the time off as required.  Under the terms of my contract, I am able to have 16 weeks off sick a year.  Doing 8 hours of PT a day is going to be a challenge. I will be able to wah and go to appointments as needed, but to be effective in my job, I will need to be in the office at least part time.  I am also not a big fan of working at home, not really set up for it.  I can get to work on public transport, but involves walking and stairs, so also not ideal (especially if it's as cold as it is now  :o ).  I am hoping to be able to work between Christmas and New Year, but if I can't then so be it.  OS sec said a week off is usual, so that will work fine as will have more like 11 or 12 days.

I will of course quiz the OS once I know the second stage is actually happening - not a given until the scope

I realise everyone is different, but I thought that the Bushey/Stanmore femoral condyle MACI veterans could give me some extra pointers :)
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

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4668
  • Liked: 379
  • Neelie knee!
Re: MACI practicalities
« Reply #29 on: November 29, 2010, 07:57:52 PM »
Another question on the PT front...

When do most people start post op.  My plan is to go and stay with my parents for a bit - I'm single, live alone in a house with no downstairs loo and only a shower over the bath, while my mum makes a smashing cup of tea, is a great cook and, more to the point, they have a downstairs bathroom with a walk-in shower  ;D

However, they are in Oxfordshire about 100 miles from me  and about the same from Bushey.  I obviously want to stick to the protocol, but depending on when (instructed) PT starts, I will need to look at possibilities local to them (there is a hospital in Oxford which is part of Active which gives me an option, albeit temporary)!

Apologies for all the questions - I do like to have all my ducks in a row  :D  Been waiting for this to be agreed for months!

Cheers :)
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















support