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Author Topic: Sune's Oct 18/2012 MACI and fulkerson  (Read 23724 times)

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Offline sune

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Sune's Oct 18/2012 MACI and fulkerson
« on: October 19, 2012, 10:44:33 AM »
Just wanted to start up my post op diary today, the day after my MACI and fulkerson osteomy on left knee. 3 cartilage lesions were grafted, two on the patella and one in the trochlea.
Things went well, and I am still at the hospital and feeling fine. Will be going home in a few hours - which is nice as today is my birthday.... Going to be pwb over the next 6 weeks.
My motivation for keeping a diary is to help others contemplating similar surgery, and to document my recovery for myself, making it easier to follow the progress. I'll be back soon with more.
Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline Forevergimpy

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #1 on: October 19, 2012, 11:33:39 AM »
Happy birthday! I hope your trip home is uneventful and you can get comfortable enough to enoy a bit of your birthday. Thanks for the diary - it really does help to hear how others are doing.
Right Knee:
1993 Plica removal
1994 Lateral Release
1995 TTT & chondroplasty
1996 HW removal & debridement
2005 Meniscus trim & chondroplasty
5/17/12 Meniscus trim & ?

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #2 on: October 20, 2012, 08:40:53 AM »
Thanks, forevergimpy. I got home and had a bit of celebration. I am doing great actually, not in much pain at all. Nothing like I feared. I am on contalgen, 2 x 10mg a day, so not so much I think. I'll start stepping down monday or tuesday.
At the moment I am confused about how much weight I am allowed to put on - one surgeon and one physio said I could put up to half the normal weighbearing load on it when stretched, the other surgeon and physic (all 4 part of the team) talked about "shadow loading" and up to about 10kg. Maybe they mean more or less the same, but I am phoning on monday to make sure what's best for my knee.
I realized I posted in the wrong thread... should have been <50 posts. Maybe it'll get moved.
Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #3 on: October 22, 2012, 09:34:21 AM »
Day 4:

Still feeling great  ;D ! Regarding pain medication, I am now down to 2×10 mg of Contalgin daily, in addition to NSAIDs, and pain is really not bad at all.  I plan to take my last dose of Contalgin tomorrow morning, and I'd like to stop with the NSAIDs as well, as I know they can be hard on my stomach. I am doing exercises 2 to 3 times a day,  focused mainly at activating my inner quad and strengthening adductor, abductor and buttock muscles.  the exercises do aggravate pain  under the kneecaps slightly, but I guess this is unavoidable. I'm not sure whether it would be better to stick to two times exercising a day, as the physiotherapist told me to the day after my surgery, or if it would be better to do three if I'm able to. I'm calling them anyway today in order to ask about the weight-bearing question mentioned in my previous post, so I will ask about the exercises as well.
 my knee is somewhat swollen, but this was of course expected. There is also some mis-coloration of the shin, but it's not bad. My angle is a bit swollen also.
Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #4 on: October 23, 2012, 02:02:19 PM »
Day 5:
still doing great! It seems that the swelling is already receding, although my left knee is still significantly larger than the right. I have stepped down the pain medication dose, and this morning, I took my last Contalgin (I hope).
My sleep is not as good as before, this is not so surprising, given that I'm sleeping with the brace (and being extremely inactive during the day). That means I'm pretty much restricted to lying on the back — I guess it must be kind of the same as being pregnant. I'm also starting to get bored… I've been watching some shows on iTunes and Netflix, but I am tiring of that also I guess I am looking for some inspiration regarding good movies and TV shows. I've also begun working a little bit. I'm trained as a theoretical physicist and work in neuroscience research. That means I'm able to do a lot from home, even lying down, such as reading papers, writing Matlab programs, do calculations etc. but I think I'm still mentally affected by the surgery/medication, I don't have the same energy and ability to focus just yet. Besides, I also wanted to have a bit of "vacation" out of these six weeks in a brace :D.
I'm curious how my right knee will tackle these weeks. Already before the surgery, it was starting to act up, and I did have days where there was more pain from the right than from the left. It has never been diagnosed with anything, so hopefully it is just overloading? My surgeon is aware of it and will do an MRI in due time.
My theory at the moment is that the left knee injury has been caused by trauma in my childhood. I distinctly remember falling very hard directly on the patella , with severe knee pain. Subsequently, I have always had problems sitting prolonged periods with bent knee,, and my left knee has always been my bad knee. My real problem then started about 10 years ago, at age 28, when my knee suddenly swelled after doing about an hour on a stationary bike. It turned out that a big chunk of cartilage was detached from the patella, which they removed with arthroscopy. Since then, I've not been able to do much sports, and since the most recent arthroscopy in 2009, it's been worse, and I've not been able to do more than 1 to 2 km of walking. Before this, I've always been leading a very active life, with lots of sports.
My greatest wish for the surgery therefore is that it will allow me to do more or less unlimited walking, and also some form of aerobic exercise. I hope to be able to some bicycling, 2 to 3 times a week, 30 minutes at a time would be perfect. I don't think these are unrealistic goals, and I will work hard for them. Reaching them would make me extremely happy.
Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #5 on: October 24, 2012, 03:07:47 PM »
Day 6:

Last morning, I thought I took my last Contalgin… However, I did have some pain during the night and in the morning… I would say five on a scale from 0 to 10, where zero is no pain and 10 unbearable pain. I was debating whether to stick to my original plan, but in the end, I decided to cut a pill in half and continue to take 2 x 5 mg a day for a few days. I don't want to be scared completely away from doing my exercises etc. I'm still doing exercises twice a day, including a few straight leg rises lying down. That one is pretty tough though, hurting under the kneecap.

My lower leg and foot are swollen, and there's also some misscoloration of my foot and shin. I have read about others experiencing the same thing, and I was also warned about it by the nurse, so it's not something I worry about. My thigh muscles are already shrinking… After just one week barely. It's really kind of shocking, even though I knew this was going to be the case, but it's quite different to experience it yourself. I'm already hating the look of my inward curving thighs.

One thing I'm noticing when writing these words is that somehow, all the things happening to me seem less scary than when I was reading about it in others posts. Maybe it's because I'm doing relatively good, but I also think that often the fear of something bad is much worse than the actual thing itself. Nevertheless, I still feel that reading other people's diaries and posts in this forum helped prepare me, and also helped me making up my mind about whether to go for the surgery or not.

Does anybody have any good advice on nutrition to support healing? I feel that I eat quite healthy generally, and the only nutritional supplements I take is fish oil and vitamin D. I know that some people will recommend glucosamine, but last time I checked, there doesn't seem to be any documented effects.

Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline Room 101

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #6 on: October 24, 2012, 06:13:05 PM »
Hi, Sune - Glad you are doing so well!  Congrats on that  :D  -- It's a long haul but it is outstanding when all goes smoothly!  Keep up the good stuff!  I am 7 weeks today post AMZ and patella ACI.  I am certainly able to be more "out and about" now and went back to work on day 7 (my hubby and I work together, so he drove).  Work kept me sane I think as I also tire of tv and movies... and I seemed to always fall asleep upon trying to read, haha!

just wanted to give you props on a successful start to to your rehab!!

Room 101
February 1 2008 - left knee AMZ/LR/Debridement/ACI biopsy
December 2 2008 - left knee ACI - Patela
May 25 2011 - Left knee mfx - trochlea  (ACI growth looked "pristine"), Right knee ACI biopsy
September 5, 2012 - Right knee AMZ/ACI - patella

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #7 on: October 25, 2012, 07:45:37 AM »
Hi room 101.

Thanks for stopping by  :D! I have previously been reading in your diary. I'm really impressed that you went back to work on day seven… I couldn't imagine doing that. I mean, I have to have my leg somewhat high, so I wouldn't be able to sit on a chair the whole day. But I've also begun working from the couch… Otherwise, I think I would go crazy also. It's interesting how your perspective changes a bit when your normal life is put on hold. Work for example just takes up so much of your time, energy and focus. But somehow when you're away from it, it seems strange that it should be so important and that it should be such a big part of your life — and then you start wondering about your priorities in life etc. On the other hand  I wouldn't know what else to do… And I like my job. I guess it's more a feeling like, is that really all?
Anyway, I'm glad to hear that you are also doing well, and I hope it continues. I'll be following your progress with interests!
Sune  8)
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #8 on: October 25, 2012, 03:24:43 PM »
Day 7:

One week postop anniversary! Five more to go, and I'm ready to go back to the office… :-)

Overall, things are going well. I'm taking very little pain medication, and I hope to stop altogether as of tomorrow. Pain is worst in the morning when I stand up immediately after getting out of my bed, and sitting up eating breakfast. It's not unbearable at all, just uncomfortable. Then I go sit on the couch for half an hour, and after that I'm fine for the rest of the day. I walk around a bit on my crutches with no problems at all. Some of my exercises are a bit painful, especially the one where I have to sit on a chair and press my heel down on the ground while trying to activate my inner quad — that gives me some sharp pains under the kneecap. I try to to avoid the sharp pains as best as I can while still activating the quad. Another thing that causes minor pain is while releasing the tension after activating the quad in stretched leg position… Especially after the first few repetitions. But given the kind of intervention I've been through, I'm pretty sure pain during rehabilitation is unavoidable. But it's definitely on a level that I can manage.

I'm also very sore on the upper thigh/groin area, where I got the nerve block injections. It doesn't bother me much except when I put a little bit of pressure on it… Ouch  :o! I think and hope that is normal. Anybody else had any experiences like that?

Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #9 on: October 27, 2012, 01:22:13 PM »
Days 8 and 9

I'm officially off pain medication  :). Pain is not bad at all, worst time for the knee area pains is getting out of bed in the morning, as mentioned earlier. However, it quickly improves. During the night my knee area also aches somewhat, which certainly deteriorates the quality of my sleep. Apart from that, I have pain/aches from all kinds of other places in the body… The worst place is the back of my right (the other leg) thigh (hamstrings probably)… Ouch . It's not constant, but during activation of those muscles. Also my hip/groin area is somewhat sore, and lower back. I guess it must be from altered walking patterns, and also from lying down so much.

The bruising is still not going down, and the swelling is not changing much either. The back of my leg looks pretty beaten up.

I've taken a slightly different strategy with my exercises. Since the pain usually increases in the course of the exercises, I decided to break it up into more but shorter sessions. I'll try to listen a lot to the pain signals. I think a bit of pain is unavoidable, but I will try to keep it at a minimum, and then be very flexible about the amount of exercising I have to do. This is a challenge to me, because I am very competitive, so if I set a goal of having to do a certain number of repetitions, I tend to do that regardless of the amount of pain it triggers. That's stupid of course. Like someone else pointed out, this journey is really an opportunity to learn and grow. In my case, patience and flexibility of mind are some of the characteristics I hope to further improve.

I've already begun worrying about my good knee, the right one. Already before surgery, there were times when I had more pain from that than from the other after activity. I can also fill in a bit these days. I guess it's my impatience… I just can't wait being able to lead a more active life, and I fear that my right knee will very soon become a bottleneck for that. And then I might be facing more surgery… Postponing my active life dreams with a year at least, given that my surgeon will not even talk about the other knee before then. This is of course taking the sorrows in advance, and perhaps it will improve somewhat when I will be compensating less with it. Regardless, I don't think its condition is as bad as the left knee, so hopefully in the case of any intervention, it will be a much smaller one. Still…

Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

cdubb

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #10 on: October 28, 2012, 05:40:58 AM »
Hi Sune, Thought I'd pop in on your thread to see how you're doing.  You seem to be doing pretty well at this stage.  I have no idea what the pain medication that you are on is though.   My doc used the Oxycontin 10 mg for the long acting narcotic 2 x's day and then Norco 7.5/325 mg 1-2 every 4-6 hours as the short acting narcotic.  I started reducing the narcotics from the very consistent dosing of the Oxy every 12 and 2 Norco every 4 at about day 3-4, but took me until about 3 weeks out to be done.  Although, there certainly are days throughout the rehab where you'll still need one here and there.  I still randomly will take one if it is a particularly bad knee day.

Don't stress about the right knee yet...as you said, it's way too early.  I also spaced mine out 13 months apart and in hindsight, that may have been a bit close.  I think 18-24 months may have been better....although, I do have to say that I am glad that they are both done and even though I still have quite a fair amount of symptoms, they are better than pre-op and now I know that my activity is really just based on my tolerance with no formal restrictions.  I haven't really tested that "freedom" out so to speak being only 3 weeks out of the scopes, but over the next few months, I'll see what I can do!

I also see Room 101 has popped in on here...she is an excellent resource as well....I know her personally!

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #11 on: October 29, 2012, 11:34:36 AM »
Days 10 and 11:
In the last couple of days, I feel that my pain levels have increased slightly. I'm not sure why, as I haven't changed any of my routines or increased intensity of my exercises. Perhaps it's part of the normal healing process. I don't know if it could be because of quitting the pain medication Thursday, but it seems unlikely that its effect could have lasted that long. I'm also wondering whether it could be because I have started putting more weight on the operated knee without being conscious about it? Different people have given me different directions regarding weight-bearing, as mentioned earlier, one surgeon said partial weight-bearing up to half of my weight, whereas the other surgeon has said "shadow loading", which by one physiotherapist was interpreted as up to approximately 10 kg. So apparently, they don't agree about the instructions, and of course, they should have cleared that out with one another before instructing me. In the end, I agreed with the nurse that I should be weight-bearing as tolerates, which I feel like I have been doing. Anyway, I hope everything in there is this should be, but I'll try to take a bit weight off my leg and see if that makes a difference.
I'm starting to look forward to my first postop appointment the coming Monday! I'll see the physiotherapist and the surgeon. Hopefully, they'll be satisfied with my progress.

Otherwise, not much news to document. I've started feeling a bit of pain around the tibial tuberosity, which was moved as part of the procedure. I'm also wondering when the bruising will start to go down… It looks terrible.
I will probably begin to decrease the frequency of my updates, so I hopefully have some more to tell.

Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #12 on: October 29, 2012, 11:35:55 AM »
Dear cdubb,

Great seeing you in here, thanks for stopping by!

The pain medication I was given is morphine… The name was just a brand name. In Denmark, the rule is to try morphine first, and only use oxycodone if that doesn't work, or have severe side effects. I was slightly tempted yesterday to go back to taking half a pill twice a day, corresponding to 5 mg twice a day, because my pain increased slightly. However, I didn't do it since the pain wasn't unbearable, more annoying and perhaps making me a bit grumpy :) I like to avoid strong medication as I can, but of course I'm not fanatic about it. I still take nonprescription pain medication a couple times a day.

Best wishes for continued recovery to you! Keep me updated on your progress.

Sune
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release

Offline randomlife

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #13 on: October 30, 2012, 02:32:06 AM »
Hi sune,

Thought I'd drop in and say hi! Found your post-op diary, and it sounds like you're progressing steadily. Nicely done! I think you're exactly one month behind me; I had surgery on September 18. I'm impressed that you've weaned off the pain medicine so early! I'm still taking one narcotic pain pill when I go to bed at night, but I take nothing else during the day. It took me a while to wean down to one pill, but I didn't worry too much because pain doesn't help you heal. At least that's what I told myself.

I also wanted to mention I had terrible bruising down my shin well below where the osteotomy was and behind my knee. The bruising on my shin was painful, too. It took a long time (about 5 weeks) before all the bruising disappeared. So hopefully, you don't have to worry just yet. My shin still hurts when I rub it, but it's getting better. I think one thing that really helped my swelling was wearing the TED stocking all the time for the first several weeks. It went from toe to thigh, and I hated it, but I do think it was quite helpful.

You asked about nutritional supplements... I think I have a generally healthy diet, too, but I have changed it a little bit since surgery. The biggest change is that I've nearly doubled the amount of protein that I normally eat. I've been told this will be important for re-building my muscles. I am also taking a daily calcium supplement with vitamin D because I don't eat very much dairy, and I want to make sure the bone has what it needs to heal. The other thing that I'm taking is a hyaluronan supplement. I have no clue if it works or not because I have been taking it since surgery, so I don't know the possible difference if I didn't take it. It's supposed to help with joint lubrication. I previously took a glucosamine and chondroitin supplement when I was trying to avoid surgery, but I could not tell that it made a difference at all.

At any rate, I really hope that you continue to heal and progress positively!!

Cheers,
lk
03/10: Lateral tibial plateau fx
05/11: Chondroplasty of lateral tibial plateau and patella w/ extensive synovectomy
02/12: Grade III lesions on patella, new Grade II fissure on medial femoral condyle
09/12: DeNovo and Elmslie-Trillat TTT
01/14: Hardware removal and arthroscopy

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #14 on: October 31, 2012, 10:17:29 AM »
Days 12 and 13

As mentioned in my previous post, I experienced some deep, aching pains coming from somewhere deep inside my leg/knee (can't pinpoint it exactly) in the evenings. Curiously, I can provoke the exact same pain simply by bringing my toes towards my shin when lying down, or by trying to touch my feet with my hands while sitting in the bed - i.e., no motion or activity around the knee of any significance, I would think. Perhaps that means it's not a problem of the knee joint? Yesterday, I decreased the amount of weight-bearing on the operated leg, and this pain was not quite as bad in the evening has the two previous days. Whether or not that was actually the cause is probably too early to say, based only on one day. But it does make me worry a bit, because it brings me back to the contradictory instructions I received upon waking up. One surgeon said "shadow loading", but he was also the one instructing the physiotherapist who saw me, and she said I could put up to half of my weight on the operated leg. The other surgeon had also said I could put up to half of my weight on the operated leg. I just really hope I haven't damaged anything. I don't think so, since I don't have any steady pain at all, and I don't take any strong pain medication, only over-the-counter pills (and not so much of that). But I am the worrisome type and then I also begin to worry about other things. For example, all the time I've had the impression that it would be one surgeon, A, who should be operating me, that was what I was told and that is the one I've been consulting. When I wake up, I find that it was another surgeon B who did the surgery, with A acting as an assistant. Why? I don't have any particular reason to be nervous or unhappy about that - it's just a bit odd. It's my impression that both surgeons have very good reputations, but I've mostly asked around about A, because he was the one who was supposed to operate. But I try to reason that I trust A,  (his surgical skills), I can also rely on his decision to let B do the cutting… I guess I'm just a little neurotic, and these things unsettle me a bit. I knew these worries were going to come though, but that doesn't really help much.

Regardless, my knee feels quite good. The swelling has gone significantly down. The bruising around my ankle has also diminished a bit, but not behind my knee, where it's still quite terrible. Doesn't really hurt though, just looks ugly. I have increased the intensity/number of repetitions of my exercises, and I have hardly any pain when doing it. One of the exercises though, sometimes still not provokes a mild but sharp pain, which is familiar from preop. It occurs when sitting on a chair, heel on the ground, and trying to activate my quad while pushing down my heel. I just hope that it's not a sign of failure!!!! Hopefully it will disappear once the cartilage matures and grows.
SUNE
1999: Chondral lesion on medial patellar facet. Synovium changes, grade II degeneration of neighbouring cartilage. Debridement (shaving) and lavage.
2009: 2nd arthroscopy,  debridement (shaving) and lavage.
2010: steroid injections
2012: MACI (2 patella, 1 trochlea)+Fulkerson+Lateral release















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