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Author Topic: Possible graft issues/failure almost one year out NOW WITH GROSS AUDIO!  (Read 6151 times)

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Offline redlotus

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Hey all
Long time no see.  I'm looking for folks' experiences with graft failures or complications on their ACI and the symptoms they experienced.  I had an ACI on my MFC and patella last July.  I had about a very large lesion on my MFC (about 2 sq inches) and two on my patella.  I also had a TTO with a lateral release and VMO advancement.  About five months out form the initial procedure, I had a revision to remove a large scar tissue adhesion and to smooth out a graft on the patella that had gotten frayed.  I had been having crepitus on active extension, and an MRI had revealed the issue.  After the scope, my knee moved smoothly and my recovery advanced well.

Now, the last few weeks, the crepitus has returned full force.  It's worse than before, and is starting to be noticeable even when I'm just walking etc.  My knee is also popping a lot, sometimes locking for a moment.  It's been hurting again, too, much like it did before my ACI - a sort of achy, arthritic feeling and no matter how I prop it up I can't get comfortable.  It's a very familiar, very unwelcome feeling. 

There's not too much fluid on the knee (some) and it's not hot. 

I called my doc's RN/research assistant, and I'm being referred to get an MRI and see what's happening.  Now, I know that's really the only way to tell what's going on (or a scope) but I was wondering if anyone might have an idea of possible causes.  Has anyone had a situation like this?  I'm very worried that a graft has failed in some way (delamination, etc) but I'm having trouble finding specific symptoms for graft failure.  Any ideas? 
« Last Edit: June 26, 2009, 09:02:07 AM by redlotus »

Offline Hathor

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Re: Possible graft issues/failure almost one year out
« Reply #1 on: June 21, 2009, 01:09:20 AM »
Hey Redlotus

Sorry to hear your news. I had a failed patella (3.5cm) ACI at 18months post op a few years back and am now 6 months post a MACI on the same defect.

The cause of the last failure is not clear but in summary the anterior margin of my medial patella facet had marrow grow instead of new cartilage and I developed a full thickness chondral split of the mid lateral facet. Not sure exactly how all that happened and neither do the 2 OS's I saw. It was hard to tell when the symptoms changed but as it's a slow evolving process I assume it developed from the start. The knee was feeling good at 6,9 and 12 months and I had a scope to clear overgrowth and scar tissue which showed good graft uptake. I had a little bit of grinding but no pain so assumed it was all ok. At @ 18 months I was getting pain that lasted a few hours after a hard bike ride/race and it gradually got sore for longer until I was on pain meds before and after exercise. That's when I went back to look at my options with another OS.

Note sure if that helps but Jonhark may have some stuff to share as he also had a failed ACI.

Let me know if you have more questions

Hathor



aci left patella 05
MACI left patella Dec 08

Offline redlotus

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Re: Possible graft issues/failure almost one year out
« Reply #2 on: June 21, 2009, 01:44:58 AM »
Thanks, Hathor!  I appreciate the response.  I've definately experienced the renewed symptoms as a gradual progression as opposed to any sort of sudden change or identifiable incident.  My knee is at the point where it throbs constantly, and I'm limping more noticably than I had been in months.  I really don't want to have to redo any of this!  But thanks for sharing your experience and for refering me to Jonhark.  :)

jonhark

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Re: Possible graft issues/failure almost one year out
« Reply #3 on: June 21, 2009, 06:49:43 AM »
Nope. No ACI failures for me. I had a mfx failure in my right knee about three years ago. Since then, I've had ACI on both knees.

I am about 22 months post op from my right knee. I literally have zero pain in the knee. My defect was about 4 cm in my patella. It has gotten SIGNIFICANTLY better in the last six months. This is truly a 24-36 month process for the patella!!!

My other knee is 6 months post op. It has been a slow progressor but is now showing signs of improvement as I'm able to do a decent bike workout and incorporate some leg presses and such into my workout.

I had a precautionary MRI done at 4 months to rule out delamination as my knee was catching. Graft looked fine wiht some scar tissues and overgrowth.

RedLotus---The fact you've had three defects filled with ACI makes you a different patient. It is not unusual to have some pain at 12 months for patella ACI. Especially after a decent workout or lots of activity. I've seen continuous improvement over 22 months. The fact you have aching and throbbing should be a little bit worrisome. MRI will show graft fill and bone edema. If you have good graft fill but some edema--that means your graft is still soft and immature.

I'd take a hard look at your rehab protocol. I've noticed my knees are much better after incorporating a one hour glute and ab workout 4 days a week. Many times, patients stop doing rehab and think there graft fails, but really, the legs muscles aren't doing their work.

Keep in mind you will have repair cartilage and NOT 100% hyaline cartilage in your defects. ACI doesn't give you a license to do impact activities again. Success is judged by the ability to do activities of daily living.....

Good luck with your MRI.

Jon

Offline Room 101

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Re: Possible graft issues/failure almost one year out
« Reply #4 on: June 22, 2009, 06:08:28 PM »
Redlotus - Sorry to hear of your troubles.  I hope it all works out well for you.  I am almost 7 months post at this point, and the one big lesson I have learned from you guys is in the words of Han Solo... "Don't get cocky, kid!"  -- it just isn't worth it, on any level.

Thanks for all the updates,
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 redlotus

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Re: Possible graft issues/failure almost one year out
« Reply #5 on: June 26, 2009, 09:01:28 AM »
Well, I'm still waiting on the MRI to be approved by workers comp, and in the meantime my knee is beginning to get more and more uncomfortable.  The crepitus and mechanical symptoms seem to be getting worse as well.  I used my camera's video setting and held the microphone next to my knee while I bent and straightened it, and it sounds really awful.  Granted the audio is a little louder in the video, but I could still hear it very clearly while I was recording it.  Warning, it's NASTY, so if you have a weak stomach or you ever want to be able to crack open fresh walnuts again without thinking of my knee, look away now.   :-[


http://s260.photobucket.com/albums/ii5/redlotus13/?action=view&current=MOV05972.flv

Offline redlotus

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So, for anyone brave enough to listen to the vid of my knee, what do you think?  Is that really bad?  Should I be worried?  Or does it sound like normal crepitus?  :P

Offline Penny W

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I am sure it feels terrible but I had to laugh when I opened it there was a bowl of pop corn popping I had to listen twice but I recognized that sound.I hope you get some answers soon.
June 2003 L knee scope with the holes for tissue regeneration
Sept 2003 R knee scope
March 2005 L foot cyst removed
June 2006 Broke L ankle 2 plates 18 screws
Feb 2007 L ankle scar tissue removal
Nov 2007 Plate broke in ankle removed and replaced with bone putty
Dec 2008 R knee TKR w/lat rel.

jonhark

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hmmm..sounds like scar tissue to me. Any idea what compartment of the knee this is coming from? Do you get pain from your patella defects or MFC? That should be pretty telling.

I sometimes get a "bubble-wrap sound" snap when I extend my knee in the patella area. This is mostly like scar tissue or the bioguide causing this sound.

Strange you would have increased noise after having a scope.

What level of PT are you able to do without pain? Biking, one-legged stuff?




Offline redlotus

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Thanks for the replies. :) 

Penny W, it does sound like popcorn popping!  I'm going to use that simile to describe it to people from now on!   ;D

Jonhark, it's hard to say which compartment.  When I put my hand over the knee and extend it FEELS like the patella, but the pain seems to be more in the MFC.  But the whole joint just aches, so it's hard to localize it.  It's that all-over achey arthritic feeling that my knee always had before the ACI.  It feels exactly like it.  That's what has me concerned, since that particular pain was much improved after the ACI initially. 

As for PT, even walking around right now hurts so it all feels uncomfortable.  I still haven't really regained alot of the muscle strength in that leg yet.  I had a lot of atrophy.  :(

Offline stereohearts143

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Re: Possible graft issues/failure almost one year out NOW WITH GROSS AUDIO!
« Reply #10 on: December 02, 2012, 09:35:25 PM »
hello redlotus.  what is the status of this? 
R antero-lateral condyle / trochlea ACI 2.0 x 2.5^2 July, 2012















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