Banner - Hide this banner





Author Topic: Failed ACI...now what? Try again or something else?  (Read 5080 times)

0 Members and 1 Guest are viewing this topic.

Offline mknmaa

  • MINIgeek (20-50 posts)
  • **
  • Posts: 32
  • Liked: 1
Re: Failed ACI...now what? Try again or something else?
« Reply #15 on: August 20, 2015, 04:46:58 PM »
Thank you! I definitely feel like I'm in good hands.  If anyone can come up with a plan, it's Dr. Farr! I'll update tomorrow after my appointment.
8/91 L & R chondroplasty
12/94 R chondroplasty w/ lat. release
9/99 L chondroplasty w/ lat. release
5/10 L chondroplasty and ACI biopsy
7/10 ACI
12/10 chondroplasty and ACI biopsy
5/11 R ACI
10/4/11 L AMZ
4/27/12 R AMZ
9/1/15 L scope- exploratory- prep for PFJR
9/29/15 L PKR- PFA
2/28/17 L TKR

Offline mknmaa

  • MINIgeek (20-50 posts)
  • **
  • Posts: 32
  • Liked: 1
Re: Failed ACI...now what? Try again or something else?
« Reply #16 on: August 23, 2015, 06:22:51 PM »
I had my appt. with Dr. Farr on Friday. As expected, he cannot do another ACI or other similar surgery (DeNovo or Catiform). I'm going to have a scope- if not this week, it will be next week.  He said he will either do an osteochondral allograft or a PKR (same thing as a PFJR he said) depending what he sees when he does the scope.  I asked him if the allograft would be similar to OATS. He said no because my entire patella is bad. He would cut my patella in half- front to back- and attach a new back side with cadaver bone and cartilage. The allograft only addresses the patella. Since I'm not having a lot of pain in other areas, he's hoping this will buy me about 10 years before he does a total knee.

He also confirmed that my patellar tendon was not anteriorized, only medialized, with my AMZ and that is more than likely what caused the ACI to fail- and the new damage in other areas. I'm so mad about this! 
8/91 L & R chondroplasty
12/94 R chondroplasty w/ lat. release
9/99 L chondroplasty w/ lat. release
5/10 L chondroplasty and ACI biopsy
7/10 ACI
12/10 chondroplasty and ACI biopsy
5/11 R ACI
10/4/11 L AMZ
4/27/12 R AMZ
9/1/15 L scope- exploratory- prep for PFJR
9/29/15 L PKR- PFA
2/28/17 L TKR

Offline willrunagain

  • Regular Poster
  • ***
  • Posts: 111
  • Liked: 55
Re: Failed ACI...now what? Try again or something else?
« Reply #17 on: August 24, 2015, 02:54:58 PM »
Thanks for the update. Hopefully Dr. Farr can perform the OCA on your patella instead of a PKR.  The longer you can avoid metal and plastic the better.  I am only two weeks out from my cartiform surgery with him.  Needless to say, I am very nervous but ready to be on the road to recovery.

Offline dal_knee

  • Forum Faithful
  • ****
  • Posts: 367
  • Liked: 47
Re: Failed ACI...now what? Try again or something else?
« Reply #18 on: August 24, 2015, 03:24:27 PM »

mknmaa,

Just an FYI but Dr Farr himself recently has had a Partial knee replacement....I would ask him who did his and consult with the surgeon that performs knee replacements on fellow orthopedics, if in fact a PKR is indicated.  If you do get that information, please post it here for others benefit.   

2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline mknmaa

  • MINIgeek (20-50 posts)
  • **
  • Posts: 32
  • Liked: 1
Re: Failed ACI...now what? Try again or something else?
« Reply #19 on: September 04, 2015, 05:05:15 AM »
I had my scope on Tuesday, and I will be having a PKR on Sept. 29th (he wants to wait until I'm healed from this surgery).  Dr. Farr said PKRs are a little more reliable and last longer than OCAs; OCAs either work or they don't- no middle of the road. He said if I was younger, he would recommend OCA. I'm only 38, so still pretty young. I just want to return to an active lifestyle; I know it's not completely unrealistic!

dal_knee, I forgot to ask Dr. Farr about his PKR.  I'm always interested to know who drs. go to for their own care.

willrunagain, your surgery is getting closer!  I wish you the best of luck and speedy recovery! I can't wait to hear how it goes!
8/91 L & R chondroplasty
12/94 R chondroplasty w/ lat. release
9/99 L chondroplasty w/ lat. release
5/10 L chondroplasty and ACI biopsy
7/10 ACI
12/10 chondroplasty and ACI biopsy
5/11 R ACI
10/4/11 L AMZ
4/27/12 R AMZ
9/1/15 L scope- exploratory- prep for PFJR
9/29/15 L PKR- PFA
2/28/17 L TKR

Offline dal_knee

  • Forum Faithful
  • ****
  • Posts: 367
  • Liked: 47
Re: Failed ACI...now what? Try again or something else?
« Reply #20 on: September 04, 2015, 06:07:19 AM »

I wish you luck, I hope this works out well for you.   Did he give you a sense of which activities are allowed vs not?   Did he give you any indication on how long the PKR will be good for?   

 
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline willrunagain

  • Regular Poster
  • ***
  • Posts: 111
  • Liked: 55
Re: Failed ACI...now what? Try again or something else?
« Reply #21 on: September 12, 2015, 07:03:58 AM »
Hi mknmaa. I hope your pkr goes well for you on the 29th. My cartiform surgery went very well. Dr. Farr said he barely had to trim the cartiform implant as it fit very nice and snug on my patella. My defect ending up measuring a little smaller than expected at ~3.25cm^2 compared to the anticipated 4cm^2 on MRI. He feels confident that I can be another cartiform success story since the defect is in the medium-small range. Plus, he said the rest of my knee looked perfect. It was just the patella that had wear.

Before implanting the cartiform, he removed a 3mm patellar cyst and plugged it with bone from my femur. He said it was common among patella cartilage restoration to see these cysts, so it shouldn't make my procedure any less successful.

I'm now almost 4 days post op and the pain has been quite manageable except for a few bad hours here and there. These however, only occurred when I tried to go without as many pain meds. Now I'm just doing some basic PT exercises and 8 hours of CPM a day! Oh how fun it is!

Overall the surgery is not as agonizing as I thought it was going to be! I'm even weight bearing about 30-40lbs when locked in my brace. Good luck and best wishes to all!

Offline mknmaa

  • MINIgeek (20-50 posts)
  • **
  • Posts: 32
  • Liked: 1
Re: Failed ACI...now what? Try again or something else?
« Reply #22 on: September 16, 2015, 08:17:49 PM »
dal_knee, thank you so much for the well wishes! I, too, hope this helps. I spoke to Megan from Dr. Farr's office today. She told me at least 90% of patients who have this done feel completely normal and pain free- other than having a robotic feel which they usually get used to.  I told her I used to be a runner, but I never felt like I could return to running after my ACIs and AMZs (mainly because of my botched AMZ). She said I will definitely feel like I can run...but shouldn't. I've sadly come to the realization that my running days may be over. :(

As far as activity, high impact activity is not recommended and no kneeling. He said I could do hiking, swimming, cycling, etc.

He told me he would be happy if I got 10 years out of this. I do have thinning on the tibial plateau and femoral condyle.  As long as I am asymptomatic in those areas, he does not want to do anything. So the hope is that the PFJR will be enough to get me by for as long as possible- with 10 years being the goal.

Thanks again!
8/91 L & R chondroplasty
12/94 R chondroplasty w/ lat. release
9/99 L chondroplasty w/ lat. release
5/10 L chondroplasty and ACI biopsy
7/10 ACI
12/10 chondroplasty and ACI biopsy
5/11 R ACI
10/4/11 L AMZ
4/27/12 R AMZ
9/1/15 L scope- exploratory- prep for PFJR
9/29/15 L PKR- PFA
2/28/17 L TKR

Offline mknmaa

  • MINIgeek (20-50 posts)
  • **
  • Posts: 32
  • Liked: 1
Re: Failed ACI...now what? Try again or something else?
« Reply #23 on: September 16, 2015, 08:37:00 PM »
willrunagain, thank you so much for your well wishes! I've been thinking about you and wondering how your surgery went. It sounds like you're doing great! Hopefully you will be a success story! It helps a lot, as far as treatment options, that only your patella was defective; you become very limited in treatment once other areas are affected.

I also have a very large osteophyte on my patella. I think they become common due to repeated trauma. It's the bone's/body's way of healing.  Obviously I won't have to worry about mine for much longer. :)

I am not looking forward to the CPM at all! Oh the hours I have spent in that thing! The Vascutherm on the other hand, I love it!

You know what really surprises me? I may not need PT! I don't know if it's the same with you. I go to their PT department and hour before I check in at surgery. They will go over all of the exercises with me that I need to do at home. When I go back for my post-op apt., Dr. Farr will determine how I am doing on my own and decide then if I need to go to PT. I think that's great! I am a very determined patient and always do awesome with my therapy (especially on my own).  The last thing I feel like doing while I'm recovering is going to PT. 

Thanks again, and I'm happy to see you coming along so well!
8/91 L & R chondroplasty
12/94 R chondroplasty w/ lat. release
9/99 L chondroplasty w/ lat. release
5/10 L chondroplasty and ACI biopsy
7/10 ACI
12/10 chondroplasty and ACI biopsy
5/11 R ACI
10/4/11 L AMZ
4/27/12 R AMZ
9/1/15 L scope- exploratory- prep for PFJR
9/29/15 L PKR- PFA
2/28/17 L TKR

Offline willrunagain

  • Regular Poster
  • ***
  • Posts: 111
  • Liked: 55
Re: Failed ACI...now what? Try again or something else?
« Reply #24 on: September 17, 2015, 09:08:38 PM »
mknmaa, I also went to PT a few hours before my surgery.  They went over my exercises for the first two weeks and gave me the quad stimulator and CPM.  10 years out of a pkr would be great!  if Dr. Farr says that it's possible then I definitely believe him.

I personally have a lot more physical therapy ahead of me.  I will be going to a local PT 2-3 times per week over the next two months.  I traveled from Cincinnati to see Dr. Farr, so that's the reason it's more convenient to do my therapy locally.  Fortunately, Dr. Farr and his PA Megan write word for word instructions for whoever ends up doing your PT.  They are well aware cartilage restoration is not very common and they'll make sure your physical therapist knows what they're supposed to do and not do.

On a positive note, Dr. Farr has approved me to return to running if the physical therapy goes well and I have no pain a year from now.  This is a huge motivator for me to work hard in PT.  My first OS acted like I would never be able to run again.  Running was my a huge part of life before my injury, so I am going to fight like hell and religiously follow my PT over these next 12 months.