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Author Topic: Sune's Oct 18/2012 MACI and fulkerson  (Read 23725 times)

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Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #15 on: October 31, 2012, 10:19:43 AM »
Hi LK

thanks for stopping by! I think you're right that pain itself doesn't help you heal, and I don't think I'm fanatic about not taking pain medication. However, as long as the pain is tolerable, I prefer not taking the strong medicine due to side effects, and also because I believe that pain can be a good guide concerning exercises and activity levels in general. Concerning nutrition, I also take D vitamin, and have been thinking about calcium as well. I do get some milk and vegetables every day though, so I've been thinking that it isn't necessary, but who knows. I also tried glucosamine earlier, but couldn't detect any effects either. Sounds like you're progressing nicely also… The amount of walking, and just being able to stand on a wobble board with one leg is impressive, and it's not something I could even do preop without significant pain! Keep up the good work! I hope to progress as nicely as you.
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 #16 on: November 02, 2012, 10:22:22 AM »
Two weeks:

Finally, I made the two weeks mark.

Now I can finally start seeing the bruising coming a bit down, and the swelling in my foot is gone. There's still some swelling around the knee though. One thing that continues to worry me is the rather mild, but sharp pain, that I get from below the kneecap once in a while. For example, when I try to activate my quad while sitting up and pressing down the heel in the ground, or when swinging my leg over the bedside (both with the brace on and locked to 20°… I have it on at all times). I wonder what it could be? It feels similar to the pain I would have preop when loading the leg in a bent position. Has anybody else had that experience so quickly after MACI or similar? Of course my great worry is that somehow the graft doesn't cover the lesion completely, or that it isn't attached properly, or failing in some other way… I really really hope it's none of those things, and that it's just a matter of time before it gets better....!!! In my exercises, I've tried to avoid triggering that pain, but I'm thinking maybe I should drop that particular exercise all together!?
I also have a "catching" sensation when 'walking'. It feels almost like the kneecap is maltracking, but I expect that to disappear as time goes by.
As of yesterday, I have also dropped nonprescription pain medication, because I have generally very little pain. I do my exercises, try to increase the load very gradually, and listen to my body. I feel quite all right, but it's rough having to be so immobile. I have aches in my back from lying down most of the time, and I'm just really tired of being so inactive. I feel like I'm living in a parallel universe to everybody else, even my family, feels like I'm just a passive bystander observing their lives unfold… I'm looking forward to be able to participate in daily life again! I still have some pain in my hip/groin area, especially when I sneeze or cough… I hope it's just because I'm using some muscles that are not being used so much normally…Pain also in my achilles!

My next update will probably be after my physiotherapy on Monday.

Sune
« Last Edit: November 02, 2012, 10:59:12 AM by 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 #17 on: November 05, 2012, 02:17:32 PM »
18 days postop

Today I went for my first follow-up appointment with my OS and physiotherapist. They were both very happy with my knee, scar, bruising, swelling was fine, and control of quadriceps fine. My ROM was measured to 50°, which they were happy about (I've been locked in the brace at 20° so far). I'm supposed to increase to 90° over the next four weeks when I have my next appointment.

I was given some more exercises involving standing SLRs with a band for increased resistance, as well as passive bending of my knee to increase range of motion. I was also told to increase the number of forward SLRs lying down, and to put more weight on my operated leg when walking/standing. It turns out that I'm allowed to be weight bearing as tolerated, when the leg is straight.

I did notice my knee swelled up a little bit after doing the exercises at the physiotherapy, but it doesn't worry me, and it didn't really hurt.

I was also given a green light to shower my operated knee, although I should still use a stool. They told me to wear some kind of plaster over my scar at all times, to reduce the strain on the skin in order to improve the cosmetic outcome. I will do that, but I have to admit that cosmetics is the least of my concerns…

That's it from me for now…

Best wishes to everybody.

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 #18 on: November 05, 2012, 06:13:07 PM »
Congrats on the positive appointments! Sounds like you're doing great, if you're increasing activity/exercise with therapy. Showers are awesome, aren't they? Taking my first solo post-op shower was quite the milestone for me. :)

Keep up the good work!

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 Room 101

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #19 on: November 05, 2012, 06:26:42 PM »
Hi, Sune.  Work has been killing me lately, so I am delayed in getting back out here.  Sorry about that.  It seems you are still doing quite well, and that is great.  I kind of read your diary quickly, and I will go back and digest it better as well.  

I think all of what I have read below seems quite normal to be honest.  Day 10 when you mention pain increases.  I am sure you are just doing more with it, and also not taking the meds will affect that as well.  days 12 & 13, the deep pain.  I had very similar.  It felt like my shin and ankle were cramping like mad in the evenings.  It would drive me nutty but only lasted a few days.  I think it was just the osteotomy healing process.  I don't remember it from the first knee, but I think I blocked a lot of things out of my memory banks  ;D  -- My bruising also lasted a good 5-6 weeks, and there was still shadows of bruising 10-14 days ago.  I will be 9 weeks post op this Wednesday.

The kneecap rawness is totally normal.  I don't think you can expect that to go away for quite some time.  The graft has to grow and harden and spread and there will be many weird kneecap feelings.  I still get them when I do the wrong movement.  I am off crutches now and still walking very slowly but walking nonetheless  :P

The way I handle the rawness is if I can do an exercise without changing my facial expression, I do it.  If it hurts and makes me cringe, I stop and try to work on an alternative.

Happy Monday!!

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 #20 on: November 07, 2012, 09:45:50 AM »
Hey lk and room 101.

Thanks again for stopping by… It's always a great comfort to hear that others have had similar experiences, and that makes the journey feel less lonely :-) you don't normally just bump into people who have had ACI, so I really appreciate this forum, and how it enables us to share our experiences. I'm certain I would have had many more concerns and worries over everything happening to me during rehab (and before surgery) without KG.

Room 101, thanks for your advice. I just read your post in lk's diary — I'm simply awed by the amount of activity you were able to do after your first ACI. Wow!!  I really really wish that I can get up to that level, it's almost more than I dare to hope for! If I'll be able to walk more or less unlimited (such as 5 km frequently, and up to 10 km occasionally), and to do some aerobic exercise three times a week, such as a stationary bike or elliptical 3 x 30 minutes… I would be absolutely thrilled!!! Of course, more would be nice, but for now, these are my goals. Anyway, I hope you get back up to that level… Sounds like you've had a bit of bad luck, but I'm sure you will recover well this time also.

Best wishes to you both!!

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 #21 on: November 12, 2012, 12:07:45 PM »
25 days

Today I'm slightly worried about increased kneecap pain. I think it's coming from my ROM exercises. I'm sitting on the floor with leg extended, brace on, and then I use a towel under the knee to lift my knee to a bent position, very slowly. I'm supposed to do four sets a day, each including 3 x 15 repetitions. At physiotherapy last Monday, we established that my ROM was about 50°, and therefore I was supposed to start from that and increase to 90° in four weeks. I don't think I've been able to do the full 4 sets more than one or two times, because it causes pain. Only a little bit while I do it, but then in the evening and night, I get some aches from the knee Area. Today it's worse than usual, and it's from yesterday's exercises…
So the question is, what to do?? It's the eternal dilemma, when is pain destructive, and when is it just unavoidable without being destructive? I'm currently at about 55°, and I'm wondering that perhaps I should decrease ROM - as opposed to decreasing the number of sets or repetitions. I think it's important to get the knee in motion, but it's probably a little bit too much at the moment. I already do them very slowly, so I don't think I can decrease speed any further.
Apart from that, none of the other exercises I do seem to cause any kneecap pain. When standing, I put normal weight on the operated leg, and I'm also putting weights on it when walking (with crutches and braces). The forward SLR sometimes cause quite a lot of pain, not in the knee, but in my upper thigh/groin area. I don't know if that's a side effect of the nerve block, or if it's because of the way that I use/don't use my muscles there.
I still have swelling in the knee, but bruising is almost gone now. Swelling seems to increase a bit after exercise.

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 Adobec

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #22 on: November 12, 2012, 04:06:51 PM »
I enjoy reading your diary.  I had a maquet n November 6, so 6 days ago.  I'm not sure what the difference is between a fulkerson and maquet, but I assume they are similar. 

My doc put a drain in, boy did a lot of blood flow out of that thing!  As a result, I have very little pain swelling or bruising.  I was also surprised to not have a brace.  I am 50% weight bearing.  Right now, my priority is to keep the leg elevated!  I'm so bored!

Anyway, I had a microfracture to the femoral trochlea 7ish months ago.  Going into this November 6 surgery, I was convinced that the microfracture had failed and that my patellofemoral surfaces were shot.  The surgeon even told my husband that he expected the inside of my knee to look like "dog poop". Well, the microfracture had healed perfectly and there was no other damage.  My point, don't worry about your ACI.  I can say that in hindsight ;). The human body is amazing, just trust that.  I wish I'd spent less time worrying about the success of my microfracture.  Good luck with everything!!!
1991 - R ACL patellar tendon, med. meniscus removed (50%)
2002 - R ACL revision, cadaver, lat. meniscus removed (50%)
2011 - L ACL patellar tendon, med. and lat. meniscus REPAIR. 
3/2012 - L Medial meniscectomy (didn't heal from 2011), microfracture
11/6/12  - L TTT (maquet). Micro fully healed

Offline randomlife

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #23 on: November 12, 2012, 10:55:06 PM »
Hi Sune,

Sorry to hear about your rough spot. I hope you find that soon it gets easier as you move along with the exercises. If it helps you to know, I had quite a bit of pain when I first did my heel slides (sounds exactly like the exercise you described). Of course, I'm on a different protocol because I had a different doctor who did a slightly different surgery. I was actually bending to 60 degrees in the CPM the day after surgery and then worked up to 90 degrees from there. I don't know without checking, but I think I was at 90 degrees in the CPM about 8-9 days post-op. At 10 days post-op, I started the heel slides and gradually worked those up, too. I don't recall where I started with those, but I was going over 90 before 2 weeks. There was quite a bit of discomfort behind my kneecap and pain on the medial side, but I don't think I'm any the worse for wear now. Obviously, you know your body better than anyone else, so only do what you're comfortable doing. Can you talk to your doctor so that you at least have peace of mind about what you should or should not work through where pain is concerned?

I hope you get this sorted quickly and your pain decreases!

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 #24 on: November 13, 2012, 11:19:35 AM »
Hey lg and Adobec.

Thanks a lot for your comfort and reassuring words… It helps! I already knew before surgery that there was going to be days like this, and that I was going to worry, but that doesn't prevent it from happening. Anyway, pain is much better today, although it's not all the way back to what was before. I talked to the physiotherapist yesterday, and she told me to decrease the degrees and number of repetitions, so I've done that. But she also stresses that it is important to do the heel slides ( yeah, I think that's what they are lg), so as to prevent things sticking together inside the knee. If the knee didn't calm down, she advised me to talk to the OS, as she wasn't sure to what extent I should ignore the pain. However, I distinctly remember the OS saying last week, that he didn't think I could use pain as a parameter for guiding my exercises, because they basically did so much "remodeling" in there during surgery, and cut nerves. Also, in the theater, they already tested that my knee was able to get bent without damaging the implants. And now they're so supposed to be more tight. And I haven't done anything else then bending my knee very slowly, and otherwise doing exercises that haven't previously caused any problems. One other thing I did, which may have contributed to the pain, was that I went on a long trip with my family. No walking, just a long period of time without having my leg elevated.
Thanks again for cheering me up :-)
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 #25 on: November 19, 2012, 11:32:18 AM »
32 days

In my previous update, I was a bit worried about my heel slides. I did not have significant pain during the exercises, but later during the day and evening, I would develop a kind of burning sensation in the kneecap area, and the knee would feel slightly warmer than the other knee. The strange thing is that there would be several hours (ca 5) between doing the exercises and the pain appearing… Thus I cannot be completely sure that it's the heel slides causing it, but I believe that to be the case, as the pain seems to correlate pretty well with how much I do those particular exercises. Of course it could also just be general overloading which causes an inflammatory response. Anyway, I spoke to my PT and OS about it, and my OS said to skip or decrease the number and intensity of the heel slides. He was not at all concerned that I was damaging my knee, but he did mention that it was the sort of pattern that could potentially lead to a chronic pain condition over an extended period of time. So now I have brought down the ROM to 30° during the heel slides, and I only do 3 x 3 repetitions four times a day. So hopefully, I can avoid that pain. Of course, I still need something to worry about, so now I am slightly concerned that the limited ROM may lead to tethering of scar tissue etc.… I find it very difficult to find the proper balance between pain and progress. I think I can handle the pain, but not if I'm worried the same time about damaging the grafts.
I have started putting more weight on my leg as I walk around with the brace and crutches. That feels fine. Also, my bruising is all but gone, and the swelling is very slowly receding also. It's located only in the knee area. Otherwise, there's nothing new to report. My knee mostly feels fine, but there is not a significant increase in function, I feel. I think it's the plan that I'm supposed to drop knee brace and crutches December 3, which will be a bit more than six weeks after surgery, but at the moment, I find that very hard to imagine. Will I be able to do that? Especially with my limited ROM.

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 #26 on: November 25, 2012, 11:40:43 AM »
38 days

During the last week, the burning sensation after exercises has all but gone. The ROM is progressing only very slowly, I'm now doing 3 x 5 repetitions 3 to 4 times a day, and my current ROM is somewhere between 45 and 60°. I was supposed to reach 90° by next Monday, but that's probably unrealistic. I wonder whether that will mean that I have to keep the crutches and braces for a longer time? Originally, it was the intention for me to lose them by then. I still wear the brace and use the crutches all the time, but I don't put much weight on the crutches while walking or standing. It would be nice to get to sleep without the brace though!

Nevertheless, I hope to go back to work starting in about one week. So far, I've been working from home, which has worked great, but I'm looking forward to get back into the office to my colleagues, and I also need to go to some meetings etc. I think the biggest problem will be how to get there. I have about half an hour's drive, but since I won't be able to drive myself, I'm going to have to take the bus.

Cheers,
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 Adobec

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #27 on: November 27, 2012, 03:31:17 PM »
I don't think you are being neurotic-- I'd be livid if another doctor performed surgery without my knowledge
1991 - R ACL patellar tendon, med. meniscus removed (50%)
2002 - R ACL revision, cadaver, lat. meniscus removed (50%)
2011 - L ACL patellar tendon, med. and lat. meniscus REPAIR. 
3/2012 - L Medial meniscectomy (didn't heal from 2011), microfracture
11/6/12  - L TTT (maquet). Micro fully healed

Offline sune

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Re: Sune's Oct 18/2012 MACI and fulkerson
« Reply #28 on: December 13, 2012, 02:43:33 PM »
8 weeks update:

It's been a while since I've shared an update on my progress. I've been very busy at work.

Since my last update, I have seen my OS, and have started going to regular physiotherapy. My OS said that my knee looked good, swelling was at a normal level at this stage. Bruising is gone. He told me that he thought that the burning sensations I have had earlier on (and still have occasionally) was actually coming from my skin. They cut some nerves during surgery (I also have a "dead spot" on my shin). I find that explanation credible. Then they took my brace — this was one of a half weeks ago. It was a big relief to sleep without my brace on for the first time in more than six weeks.

Then I begun regular visits with a physiotherapist, and aqua therapy. The physiotherapist is pushing me on my ROM. I'm doing flexion exercises as much as I can during the day, and right now I think I'm at about 70°. Additionally, I'm still doing quad sets, SLRs in all four directions with resistance. We have also tried a few exercises with tightening of the quad at low flexion, around 20°, but they still cause pain under the kneecap, which concerns me, so I am avoiding them. Apart from the flexion exercises which I do frequently throughout the day, I do my other exercises twice a day. Afterwards my knee feels swollen/tight. But this is gone again the next morning.

In aqua therapy, I walk around forwards, backwards, and sideways. I have a few other exercises for flexion and strength. I like it. The only problem is that it's such a hassle for me to get in there, as I have to take public transport and change from bus to train… Tomorrow I have another appointment at physiotherapy, and I'm going to ask her when I'm allowed to drive my car again. That's going to make my life so much simpler. I feel that these last couple of weeks have been quite rough actually, not because my knee is hurting or anything, but because I have begun coming in to work, and it's just so complicated getting there, and maybe it's also kind of overwhelming to get back into the normal routine… At any rate, I felt pretty exhausted!

Yesterday, I started walking around in the house without crutches! Major milestone! And it's just so wonderful freeing up my hands… At the end of the day, my knee was pretty sore with the burning sensation back, but I suspect it was actually more due to pushing the flexion. Because this is what has been causing it all along.

All in all, I feel that I'm progressing, but painfully slow. As always, I'm concerned about finding the right balance between pushing my recovery and protecting my knee/grafts. However, I'm also concerned that if I don't push the flexion, I risk having my knee getting stuck at 90° or something. Still, it hurts when I push it. But the cartilage implants should be able to withstand it at this point. I guess it's more important to be careful with the strengthening exercises. The OS told me to still avoid loading the leg at angles above 30 to 40°. I suspect it may even be a lower angle, given the fact that I get pain when I try it.

Cheers,
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 #29 on: December 31, 2012, 01:25:31 PM »
Happy new year to everyone!!!!
 Just passed 10 weeks mark, lost the crutches, and am now doing a bit of stationary biking... yay!
I will post an update soon.
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