Advertisement - Hide this advert





Author Topic: Third ACL Reconstruction and Cartiform allograft on L Medial Femoral Condyle  (Read 2171 times)

0 Members and 1 Guest are viewing this topic.

Offline Llamarebel

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 6
Hey, I've lurked here for over a year while I made my decisions regarding my most recent surgery, and I wanted to try to give back so to speak to others who may have similar pathology.  I had my first ACL reconstruction 8 years ago, hamstring autograft.  This failed after 4 years, and I had a double bundle allograft performed.  This second I could feel stretch out over time, and then roughly one year ago, I landed awkwardly on the edge of the driveway while jumping, and felt the rest of it go, and swelled enormously.  It turned out I had no intact ACL, another partial tear of my medial meniscus, and a large 1.5x2.5cm defect in my medial femoral condyle.  I went a variety of places for consults, a few OS's recommending microfracture, but from my own research with the size of the defect this seemed like a poor choice, and short-term at best.  I was offered a clinical trial, but due to my job, I couldn't afford to spend more time than absolutely necessary outside the office, and the clinical trial was two stages.

So, I found and OS in my area who had a fellowship in sports medicine and is the ACL reconstruction specialist for the practice, (who also actually repaired the labrum in my left shoulder, another story for another day) and had a consult with him.  He recommended either full osteochondral allograft, so waiting for a perfectly sized plug, DeNovo NT, or Cartiform.  I didn't like the idea of the full osteochondral allograft because if it doesn't take, you've burned a significant bridge by taking out a layer of bone I was not missing.  We elected to request Cartiform, and after one denial, it was approved!

Surgery was yesterday, 5 hours total.  Used a nerve block.  The former tunnels were correctly placed, but large, so he said he barely had a large enough ACL graft to fit, but it did perfectly.  A mini-arthrotomy was used to place the Cartiform graft, he cleaned up the edges of the lesion, drilled pilot holes for the suture anchors, and few microfracture holes to stimulate marrow, and sutured it in.  He traced the lesion on the graft, so on the pictures, it looks neat as a pin.

Yesterday was minimal pain as the nerve block was effective for probably 18 hours.  Today, it feels like my knee is 6000 pounds, but it's more of a dull ache than a stabbing pain, which I can deal with.  I'm currently on Aspirin, OxyContin, and Zofran as opioids tend to make me nauseous.  Non-weightbearing for 6 weeks, so that's going to be the main challenge.  First PT tomorrow at 11:30! I'll try to keep this periodically updated
Andy

Offline BarefootPilgrim

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 5
Good luck Andy, let us know how you get on!

Offline Llamarebel

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 6
First PT yesterday, kept knee in full extension, did straight leg raises, quad sets, ankle pumps.  I have been able to finally today get rid of the Percocet and use only 1 Oxycontin twice per day, though there is a considerable amount of pain.  Managed to shower, which felt amazing, but i'm not too excited about 6 weeks of showering like that...oh well, do what you must.  The cryocuff seems to have helped with the swelling, but it still feels like my knee is a bowling ball when I go to the bathroom.  Here's hoping!
Andy

Offline Llamarebel

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 6
Day 5 post-op
Pain has been dropping considerably, slept in a bed for the first time last night, and though sleeping in a brace isn't so lovely, it was nice to be off the couch.  MY PT has me started on straight leg raises, quad sets, leg raises on my side and my stomach as well.  The straight leg raises have done wonders as far as increasing my comfort with getting up and down off of the couch, lets me stabilize.  Right now the biggest discomfort is the itching and topical pain, very little pain in the joint itself.  I'll be going to PT 3x weekly starting next week, hopefully starting ROM exercises.  The PT is at the surgeon's office so he is keeping close tabs.  I'm already realizing the hardest part will be the length of time on crutches, so i'm trying to mentally prepare.

Offline taylob

  • MINIgeek (20-50 posts)
  • **
  • Posts: 26
  • Liked: 9
HeyL, Thanks for posting. I'm a Cartiform man myself. Have it on both of the backs of my patellas. Please continue to share as much as possible and I'm cheering for you. It's a long hall, I tell you. You might have checked my posts. I also had a Unicap on my medial femoral and I'm not yet happy with it but maybe in time.

Offline Llamarebel

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 6
Sorry I've been away for so long but I thought I would update now.

Officially 9 weeks out and 3 weeks weight bearing, 2 with crutches 1 without.  It feels marvelous to walk again.  Right when I started putting weight on it again I had pretty severe pain right at the graft and of course for a few days completely panicked and assumed total failure.  However, after a few weeks of slow transition, PT, stationary bike and low weight machine exercises that pain has all but vanished.  I still have some when I wake up and obviously if I try to jog or do anything with impact but hey I'm only 2 months out.

So the past week has been almost all good news.  I can already climb, but not descend stairs without pain and can do 10 minutes on the stair machine.  I can do body weight squats and leg presses at low weight without pain.  I can swim freestyle with no pain.  All of these were not possible before surgery so in many ways even at 2 months out I am doing better than pre surgery.  Some of this will be due to the ACL revision as well but I do think the cartiform graft has already helped some as well. Next Dr appt in 1 week.  I will try to update periodically to help those of you with surgery decisions.

Offline BezProblemów

  • MINIgeek (20-50 posts)
  • **
  • Posts: 40
  • Liked: 6
Llama, thanks for sharing and keep us apprised of your progress!

Offline BarefootPilgrim

  • Regular Poster
  • ***
  • Posts: 62
  • Liked: 5
Glad to hear it's going well so far, do keep us updated!


Offline Llamarebel

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 6
11 weeks out update:
Progress has slowed, not depressingly slow, but the first few weeks off of crutches were just amazing strides every day.  I have overdone things two times now, just long walks, one time just around the neighborhood, the other time at the zoo and paid for it the next day.  Just general soreness and more difficulty with stairs.

Stairs and inclines/declines continue to be the biggest issues, unsurprisingly.  How quickly I improved after crutches made me feel like there would be no way it would be 1-1.5 years before I was back to "normal" but I'm beginning to believe it.  However, still much more stability than pre-surgery

Offline Llamarebel

  • MICROgeek (<20 posts)
  • *
  • Posts: 8
  • Liked: 6
8 month update!
It has been a roller coaster to be sure but I know in the ups and downs I searched for posts to reassure me so thought I'd add one myself.  Basically, months 4-7 were worse than before surgery. More pain, more swelling. There were times I dreaded even walking from the couch to the bathroom because I knew it would hurt. I went from climbing stairs easily after 2 months to being almost unable to around month six. I was totally convinced I had a failure.

I had a follow up MRI which showed the Cartiform graft had taken and everything looked to be in place so basically no reason for the worsening pain. Any time my PT would try to increase weight or add exercises things were worse. I ended up just riding stationary bike and doing stairs and exercises in the pool, up to when I would feel pain then stop. I started gaining strength and about 4 weeks ago I turned a corner

As of today I can definitely say my knee has less pain than before surgery. I do have a plica, which is a fibrous band of tissue by where the joint capsule was entered which causes pain but it too is getting better. I can go up and down stairs without pain, still a limp going down but that's from weakness still. So if you haven't seen the results you want at 4,5, 6 months, keep hoping. We will see if any light jogging etc ever returns but I am pretty happy with the progress so far

Offline jackson7

  • Regular Poster
  • ***
  • Posts: 112
  • Liked: 7
Very good.  Thanks for the updates.
12/2015: slow speed bicycle crash
1/16: many x-rays & 2 MRIs only show tendinosis
3/16: bone scan shows uptake in all compartments
8/16: cortisone jab (no effect)
3/17: diag scope (part med meniscectomy, med fem chondroplasty, full synovectomy)
4/18: Pain finally diminishing. 65% function.