Banner - Hide this banner





Author Topic: ACI June 2010 - Still in pain! - Any experiences?  (Read 3464 times)

0 Members and 1 Guest are viewing this topic.

Offline fattusp

  • Regular Poster
  • ***
  • Posts: 65
  • Liked: 0
ACI June 2010 - Still in pain! - Any experiences?
« on: January 03, 2011, 07:58:38 PM »
Hi all,

I hope someone can help with my situation and hopefully has experienced similar issues to me before.

I had an ACI op in June 2010 on my right knee where both the medial and lateral sides of my femur were implanted. Around 4-5 weeks after surgery when I started to weight bear I would occasionally get shooting pains from the joint on the medial side, the doc said this was where he had put most of the implant and it simply needed to grow further.

The problem is this has been pretty much the same since. The pain shoots from the medial side close to full extension and sometimes produces a loud click then a sharp pain.

I had an arthroscopy in December and the surgeon said that its likely that the pain is coming from the implant site on the medial side, but that he could not find any other issues with the joint, and that the implants seemed to be growing well.

But now im more confused than before. I thought id atleast see a slight improvement in this pain seeing as it has been over 6 months. The surgeon syas it needs more growth to thicken up but im just concerned that this pain will never go.

Has anyone had pain since ACI that has subsided as the implants have grown??

I would be really grateful if anyone can throw any success stories my way??

Many thanks

Tom

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #1 on: January 03, 2011, 08:42:18 PM »
Tom

If the OS has been inside your knee again it's likely that the pain you experienced is due to still being in the early stages of your rehab (6 months is still quite early days).

If you're looking for success stories look up JulianUK, NickNack, Erinee and djs60 (?).

You've mentioned the location of your grafts but have given no details as to size and your current activity levels.  If you can provide these then people may be able to comment further.  You also haven't mentioned how the rehab has been going.  Have you moved onto strengthening for instance and are your muscle groups balanced?

You may want to look up the STAR study on long term outcomes from ACI.  You can Google to key words to find the abstract.  I'm sure there are also more up-to-date studies available, but I've not updated my research recently.
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.

cdubb

  • Guest
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #2 on: January 04, 2011, 02:21:37 AM »
I was told pretty much prior to my ACI that it could easily take 12-18 months for te cartilage to mature and harden, so at 6 months you are early on still. My defect is in a different location and I also had a TT, but ACI graft maturing timeframes I would think would be comparable.

Offline fattusp

  • Regular Poster
  • ***
  • Posts: 65
  • Liked: 0
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #3 on: January 04, 2011, 08:37:51 PM »
Thank you both for responding.

Rennschnecke, here is th extra info you mentioned, apologies my first post was done in a bit of a rush!....

The medial graft is about 0.8cm sq and the lateral graft is just slightly larger. I am walking normally on both legs, however my right leg tends to point slightly outwards, I think due to poor muscle symmetry.

Before my last Arthroscopy (December 23rd) I was doing a supported leg press machine with weights going up to about 30-40kg on each leg so I was def progressing. I was also on a recumbent bike 3 times a week for 25-35mins when I could. The problem is that I could see this routine getting cut down because every day I experienced this shooting pain more than 2-3 times the soreness would prevent me from exercising the knee for atleast 2 days. Its reached the point in December where I wasnt exercising at all hence I asked for the arthroscopy sooner rather tha later. I was told there was nothing wrong and that the pain must be when the joint was sitting in the medial graft at full extension, and where the graft isnt at full thickness Im getting this pain.

Another complication to the matter is that Ive actually had this exact medial pain for over 2 years. The ACI was a last resort to solve the problem. My concern is that the pain is unchanged even after the ACI. In other words Im concerned that the damaged fixed by the ACI may not have even been the origianl problem, as I would atleast expect an increase or decrease in pain if its been played with, theres actually been little change at all.

Hence, the point of this post was to see if anyone had an ACI and what they noticed in terms of changes in pain levels at the graft site. If others have had no change in pain at first but then eventual return to sport then I have some hope!

Please accept my apologies as I understand I may be quite premature in my concerns, ive just been living with the same pain for over 3.5 years and am quite frustrated. Once again thank you all for your responses and for taking your time to read the post.

Tom

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #4 on: January 04, 2011, 10:12:17 PM »
Hi Tom

Your grafts don't sound incredibly large and actually might have been borderline for ACI (i.e. you could have had other procedures but I presume ACI was preferred for reasons I'm not aware of).

To me, doing leg press at this stage may be somewhat early.  As far as I'm aware all you need to do is the basics of bike, SLRs, quad sets and ROM work.  Have you tried to cut back to just the early days stuff to see how your knee is?  If you try this then the trick is to add things in slowly, one at a time allowing time to see whether there is a reaction to any particular activity.  If your PT gives you pain then you are likely to be overdoing it or should avoid it altogether.

Have you noticed any change in the pain whatsoever?  I noticed that my pain was different immediately post-op, i.e. I no longer had pain at rest and did not wake up in pain (but this was only if I hadn't overdone it).  However, my grafts were in a different location (PFJ) and considerably larger than yours – really salvage surgery.  If you still have pain at rest and there is no change between pre and post-op then I think it's important to discuss this with your OS.

FYI I have had some horrendous problems post-op and my OS told me of someone else who'd had a bad time for the first year or so.  But 6 years on they are back to their sport of canoeing etc.

It would probably be good to trawl through the earlier posts on this board or visit the Post-op diaries to read up on the successes.  The initial posts will be some time ago as the rehab takes a long time.  Please also bear in mind that those who have recovered successfully either no longer visit the board any more or are less regular that those who are currently still battling their way through this.
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.

cdubb

  • Guest
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #5 on: January 05, 2011, 02:06:52 AM »
I would agree that leg press is a bit early to be doing.  I'm not sure when my protocol permits that, but I'm sure it's not for at least 6  months...but reallly...not sure I should ever be doing leg press again.  Again, I am also a patella defect, so shearing force really needs to be protected, so no forcefull flexion.  My defect was 20 mm x 20 mm and on the central/distal part of my kneecap, so what is that 4 square cm?? I'm really not sure if I did that math right? 

Maybe there is still some bone marrow edema under the grafts?

Offline CR_UK

  • MINIgeek (20-50 posts)
  • **
  • Posts: 48
  • Liked: 0
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #6 on: January 06, 2011, 01:16:22 PM »
Hi Tom,
I'm 3 months post MACI of lesion MFC which has always caused  a sharp catching pain on loading in full extension, more specifically with even the tiniest medial rotation. This affected my gait as a normal heelstrike was not possible. I need to plant my foot with the knee bent and foot pointing to about 11 o'clock.Hence wearing heels helped. This was present for 3 years following my failed MFX procedure.
Unfortunately this still seems to be the limiting factor in my progress at the moment. Over the last 2 weeks I have made signigicant progress generally but walking without a crutch is still eleuding me for precisely the old reason. In fact I'm still worse off than pre MACI, but am hoping that its just the sensitivity of the graft site. Certainly I notice worsening after specific activities that also affected it pre op. I seem to progress better if I mange my exercises around this ie avoiding loading within that range of movement eg , turning medially I place my affected sides foot on toes with leg bent so as to avoid catching. For standing straight I first straighten the leg without full loading and then place it. This avoids shearing over the graft site. It seems with these adjustments I am progressing but more slowly  :(. In reading various posts it seems those that have a lesion in similiar position have also experienced more difficulties describing similiar symptoms. I'm not suggesting you do as I do as I'm not sure where exactly your lesion is, but by analysing when or after what you experience your symptoms you may be able to work out exactly which movements stress the graft and work around it. I certainly agree that the leg presses sound a bit much so try changing that in the first instance .
I hope things improve. I'm anxiously following your progress and let us know how you get on. Its reassuring that your arthroscopy was OK , so its more than likely just a matter of time.

Offline Youthist

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 0
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #7 on: January 10, 2011, 01:29:48 PM »
Hi

I had an ACI on my medial femoral conydle mid October last year . I am told it was a Grade 4 2cm x 2cm lesion with chondral flap, fwiw!...

So I am currently just under 3 months post-op, and I am having similar doubts and questions as yourself, so your thread is interesting! At the moment I can go on an excersise bike (indoor) without an issue, for 35 mins a day. I am getting about 135ish degree ROM, and full extension.  There is no pain or real discomfort when resting, problems really only when putting weight on it (see below).

I am still getting localised pain on the graft site - like a dull ache that is very similar to the feeling I had before all of this began when I didnt know what was wrong.  Some days its worse than others.   If I stand on one leg and slightly bend the knee (one of the PT excersises) , at a certain point  in the bend I will get that same ache / pain right at the graft site.  My physio wishes it wasnt there but at the same time doesnt seem overly concerned as there is still swelling and heat on my knee, and this could be causing problems elsewhere. I also have been getting the occassional shooting pain as I put my heel down when walking at full extension, but more on the outside of the knee and nowhere near the graft site.

The graft site is more of a concern though - as it does create similar doubts - is the cartilage supposed to be hard yet? Why can I still feel the ache when I gently put load on it?  Is it normal? did the op do anything?  etc. I have mentioned being able to "feel" the graft site to Dr Skinner at my 8 week check and he didn't seem too concerned about it, seemed to think it was normal as it was still going to have trauma around it etc.  However that was 4 weeks ago ish.

So bottom line is that my leg is feeeling pretty good, I am fairly mobile, but I still have a localised pain at the graft under certain conditions  / positions and these were very similar to those I had  before the op.   The leg itself is a lot weaker in terms of the muscle, and this may well account for more weight now being put onto the problem than used to happen when I had more muscles supporting the leg. Hard to know.

But I am "hopeful" or confident that this is quite normal as the graft has only been in there for a short time, and while it will have started to fuse, it will not be in a condition that allows it to protect the lesion at this point when putting weight through the knee.

I am desperate to get back to running if I can (2012 of course) and football, and I am crossing everything that the ACI has been a success and I can get back to sporting activity at some point in 2012.
« Last Edit: January 10, 2011, 01:37:40 PM by Youthist »

Offline Rennschnecke

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 881
  • Liked: 1
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #8 on: January 10, 2011, 03:13:24 PM »
The Chester Knee Clinic ACI rehabilitation guide outlines what consistency your ACI graft may be like at various stages post-op.  After 3 months it may be like yogurt and after 6 months like dough.  You can download this document from http://www.kneeclinic.info/problems_articular_cartilage.php.

Even when the cartilage has changed consistency you may continue to experience some symptoms because you may not have achieved full thickness cover yet.  FYI I am 18 months post-MACI and my defects are both fully covered, but I do not yet have complete thickness throughout.  The evidence indicates that the cartilage will continue to mature over the next 2 to 3 years.  It is probably taking a long time for me because I had large kissing lesions (10 sq cm and 6 sq cm).

At 3 and 6 months you are at very early stages so the symptoms you experience are not uncommon.  As far as I know, if your graft has failed you have absolutely no doubts about it.

HTH
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 Youthist

  • MINIgeek (20-50 posts)
  • **
  • Posts: 47
  • Liked: 0
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #9 on: January 10, 2011, 10:48:22 PM »
Cheers Renn - good info once more - thanks!

The article and link is great also. However I cant find the reference to dough like and yoghurt like consistency at different time periods anywhere on the link ? Am I being dumb (definitely possible?)

cheers again for the post, it has made be redouble my efforts not to get too down on the progress I have made thus far...

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4861
  • Liked: 409
  • Neelie knee!
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 Marco Polo

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 0
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #11 on: January 13, 2011, 10:39:39 PM »
Great feedback on the pain levels post op in what appears to be a long recovery.  I had my ACI and tibial osteotemy on 12.13.10 and am just getting through phase I of the rehab.  Good to see the large defects healed well.  My medial defect was 8.25cm2, others on the patella were much smaller.  More soon on the recovery, ROM is at 115-120, and have been told to stop there for now.

Offline fattusp

  • Regular Poster
  • ***
  • Posts: 65
  • Liked: 0
Re: ACI June 2010 - Still in pain! - Any experiences?
« Reply #12 on: January 16, 2011, 08:18:13 PM »
Hi everyone,

Sorry for my delay in replying to your posts, I have been unable to check the net for a while.

Thank you all for your responses, it seems there is a good mixture of technical advice as well as personal experiences which has been really useful.

In response to the earlier posts and specifically the leg press comments..... I was actually told by my OS that leg press was Ok at this stage. I had a faster recovery than usual partly because I have had lots of knee ops (12 to date) and was well prepared, but mainly because according to my OS the graft sites are not in areas that were at great risk of impact on walking. This meant that I was off of crutches slightly earlier than usual.

However, after reading your responses I have decided to only use recumbent bike to exercise for the next 2 months. The pain still has not changed and this is a pain ive had for 2 years now, when my original injury actually occured 4 years ago, I havnt returned to sport at all in this time. I guess my concern was that even though ive had the ACI procedure the feeling of this pain is exactly the same, making me concerned that they have assumed that the cartilage damage was the problem when it may have not been at all.

Like you say though, the doc did say the arthroscopy was all good so i guess I have to assume the pain has always been from the ACI graft area. I guess I justed wanted to see if people have had continued pain after ACI that has eventually died down. If people have had this occur it gives me some hope and a little more determination to stay patient.

Thanks again for all your replies and ill try to keep you all up to date. As for now im going to just stick to the bike and hope this gives the grafts some time to improve (assuming they are the pain source). I still get a big click from the knee joint on standing up from my seat at work, this causes a very painful shoot from the medial side shooting from my knee and can leave it sore for 2 days just from that one click, If i can try to avoid this then maybe the grafts will heal better?

Anyway, thanks all.

Tom















support