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Author Topic: Second-Generation Autologous Minced Cartilage Repair experiences  (Read 559 times)

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Offline gaoshanfelix

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Re: Second-Generation Autologous Minced Cartilage Repair experiences
« Reply #15 on: March 13, 2022, 04:11:41 PM »
Working on hamstring really seems to pay of. Today went hiking 300m altitude first time without brace. Yesterday first time went rock climbing for 1 hour. Very easy mainly as proprioceptive training.

In two weeks I will see if it works out. Agreed to join friends in a 5 day hiking/biking trip. Meaning day 1, 160km, 2500m uphill to the trail entry. Then 3 days expedition with 68km, but moderate 3000m up/down. Depending on form we bike back on day 4, or postpone it to day 5 (800m uphill, 160km). And yeah, their fitness is above average too, else they would not do such a trip. So I need to walk at decent speeds. Will use hiking poles however, which I didn't use up to now.

My gait has improved a lot in the last 3-4 days, same for pain...
I still have problems with doing any decent work on the flexor, especially if extended, but go hard or go home. Sometimes a bit of pressure will do wonders.

I really hope training on hamstring will remove some pain, cause with pain you don't gain muscle..yeah this is a bit of a conundrum. Static load seems to be okay in my flexor though, so doing lots of static lunges, squats now.  Will add bosu ball squats .


Edit 7 days later - 20.03
Just came back from my first hiking tour with a heavy backpack - 22kg or equal to 1/3 of my bodyweight. This time using hiking sticks and the brace - uphill was quite a hard task but I was okay - I am fine on steep or flat uphill - but a little steep is problematic.
Downhill was a disaster - I just struggled with all that weight and even though it was only 550m uphill, 390m downhill, 6km, of which 2km were easy terrain, 2km very steep and slippery side facing forest, and 2km a riverbed with strong torrent - just possible to cross without being swept away - maybe needed to cross 8 times  - when I reached our destination my legs were toast and my knee had some pain. Without the brace it would not have been possible - especially crossing the stream - as the sheer forces were very strong to put down your leg in the right spot. The day back my backpack was much lighter 15kg as all the food and drink was gone - but my knee had some pain in the usual spot so I am really afraid of next weekend. I have to pack very very light else I will not make it. Or maybe ask people to carry their stuff up, and they carry my stuff down or so.
« Last Edit: March 20, 2022, 12:39:26 PM by gaoshanfelix »

Offline gaoshanfelix

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Re: Second-Generation Autologous Minced Cartilage Repair experiences
« Reply #16 on: March 23, 2022, 05:12:36 AM »
Hiking trip got cancelled due to constant rain forecast. Yesterday I did my last test before the big hike (didn't know my friends will cancel), 40km bikeride with 800m uphill and heavy headwinds to the trail entry. 1000m up/down on very slippery because of rain earth/mud surface and very steep parts. All steep parts had ropes for security however. Up in 2 hours 10 minutes, which is faster than Strava average for that segment (2:30 average, fastest time is 1:15 hours, 2nd fastest 1:35 with around 400 people) and down in the same time. Using brace and hiking sticks plus light backpack. Knee felt some pain but usual. Today feels fine and first time after such a hike no sore muscles / muscle pain. Though I did use the hiking sticks at maximum load so to say. Without hiking sticks cannot do this yet.

Uphill and downhill I have no big problems with steps up to 80cm or so. But if I would be without hiking sticks I would be pretty lost on them going down.

Then after the hike bike back 40km with again headwinds. Was pretty tired but okay to meet up with friends in the evening. So not completely flattened.

I still don't see a road as to when I can start jogging or going down stairs normally or walking without a limb. Guess working on hamstrings a lot needs to be in focus.


Oh yeah, this super fast protocol I really don't get it, their goal posts aren't reachable for 99 percent of patients, while some are super easy:

ogression to Phase V:
Pain free treadmill walking for 6 minutes
70% isometric quadriceps strength of non-involved side, tested at 60 knee flexion
80% isometric hamstring strength of non-involved side, tested at 60 knee flexion
Single limb stance testing within 70% of non-involved side
Post-Operative Phase V: Return to Sport Phase (Week 12 6 months)
Therapeutic Exercises:
Closed kinetic chain multi-plane activities within pain free ROM
Open kinetic chain activities within pain free ROM
Hip, core, and gluteal strengthening activities
Plyometrics:
Initiate double limb plyometrics at 4 months
Progress as tolerated to single limb plyometrics
Cardio:
UBE (arm bike), Stationary bike, Treadmill ambulation, Elliptical
Initiate running
Progression to Return to Sport-Specific Phase:
80-90% isometric quadriceps and hamstring strength of non-involved side, tested at 60 knee flexion
Single limb stance testing within 75-80% of non-involved side


Pain free walking for 6 minutes. I mean kinda everyone reaches this quite quickly. But the muscle strength goalposts simply are out of this world. I'm hammering my quads now for 2 months with training like no tomorrow, and just reaching 70 percent. With hamstring I'm still far away...

As for 90 percent after 6 months, studies have shown over half of the patients don't even reach that after 2 years. Very few ever reach over 90 percent.

My power numbers on the bike left right Ballance seem to be pretty random between 44-56 to 47-53 all ove the last 2 months. I cannot see much improvement there at all. My power stroke ends much earlier on the left side, as clearly the closer I get to extension the worse my power.
« Last Edit: March 23, 2022, 05:27:04 AM by gaoshanfelix »

Offline gaoshanfelix

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Re: Second-Generation Autologous Minced Cartilage Repair experiences
« Reply #17 on: April 03, 2022, 03:47:01 PM »
Update: well after the last hiking trip got cancelled - there was loads of rain moving in - so not that active. I decided to decrease the training load a bit and move to more high aerobic activities.
My cycling VO2max now reached 60 - 330 watts over 6 minutes (68kg). Not really sure about my body fat - I kinda expected to have lost some fat - if I train my venes pop up all over the body which should be a sign of very low body fat - yet my sixpack is not really improving. I guess I'm still around 10% - and somehow stuck dropping down to the 7-8% I'm aiming for. My FTP somehow is still stuck at 3.8-3.9w/kg since a month however. Not seeing any improvement on my long distance power - maybe I'm too tired all the time - not enough recovery? However my vo2max been improving week by week - and like 3x20min max effort intervalls been improving too. I've always been bad at short intervals - and great over 4-12 hours efforts - right now it's the opposite and my 3-8 minute power is clearly much better than my long term endurance (even though I trained more long term).

Decided to chase some Strava KOM and was able to use good wind to get a rather highly contested one. Such things are always good for your ego and recovery. Even though the old record holder noticed and got it back same day (haha he is known for that - should have waited with uploading until the superb weather window was closed). On the other hand I noticed that for hiking KOMs here even with 1000-2000 participants are much easier to get. Got on the podium of 2 already - and that was far slower than my speeds last year. So even though I feel like my hiking speed is still really slow - it has to be quite decent. But yeah - hiking only with hiking sticks but with them it's quite fine. I'm also taking down steps good leg forward of 70-80cm height now. Yeah still wearing brace while hiking - just feels better that way.
Sometimes on the downhills get that sharp pain in my knee - either inside or outside - sometimes don't get it.

Tried to run on a treadmill with offloading maybe 20kg of weight on my arms - utter failure. Instantly sharp pain after the first steps. So running is still off. I tend to not use the lift in my house anymore to go up - and sometimes also not to go down. Apartment is on the 14. floor so it's around 50m altitude. Depends a bit on how much training I got in before.  Hitting the gym my knee afterwards feels a bit worse than say after cycling. So today in the morning the the 14 floors up and down, then in the evening coming back from the gym had some pain so took the lift up from 4. floor. My glutes seem to be pretty okay in power - hamstring still s**t.

And I'm still easily visibly limping. What a crazy world - I can break most hiking KOMs on Strava in Taiwan uphill if I like to, with right weather get some mid competitive cycling Strava KOMs, sometimes even feel like I want to run a few steps or kinda do with hiking sticks on soft ground - yet I still clearly limp. Also of course still cannot sleep on my back - and need to make sure to keep my knee not extended for too long.

The coming week will be a bit more adventurous - but yet likely less fitness load. Tomorrow plan on doing a quick 100km ride, then on Tuesday a hiking trip with friends however that will feel more like strolling around - only 900m vertical for the day or so - then Wednesday do another 100k on my bike, and on Thursday to Sunday go Canyoning for 3 days. It rained loads recently and that 3 day trip is classified as very difficult by locals. So that will be quite some fun and I will see how well I can stabilise my knee in rushing cold mountain waters wearing around 12kg backpack and wetsuit.

Clearly my walking down stairs has improved a lot in the last 2-3 weeks - up also. But not much improvement in pain or so I feel and neither in limping. Really a very strange process compared to my recoveries from ACL surgery which were much more about instability and too little muscle vs right now pain, limping and daily form going up and down like a rollercoaster but feeling quite stable inside my knee. Flexion is only missing a tiny bit. I get my heel to touch my butt now - but very light - while it's quite firm pressure on my healthy leg. The good thing is - the catching and clicking when going from full extension to flexion is getting less pronounced now quite fast. It's sometimes still there however.

How can my cycling numbers be so good, yet running seems so far away? During the last 2.75 Months I've likely thrown in as much exercise as most people doing ACI/MACI in their first full year. Most protocols have starting to run at 7 months. Well that's two month 10 days to go but I thought it will be much earlier. A friend asked me if I want to register for an IronMan next year in Taiwan. I think I should be fine but yeah still got a couple of months until registration opens up to see if I do it or not. Swimming is not a very liked sport by me.

Offline gaoshanfelix

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Re: Second-Generation Autologous Minced Cartilage Repair experiences
« Reply #18 on: April 19, 2022, 01:17:31 PM »
my fitness seems to be stagnating - then on the other hand I am able to push myself to more exhaustion and reduced my Strava bests quite substantially on some rides.
Did my first 200km / 4000m uphill ride, which I started at a pretty good pace - to do the main climb from 120m to 2940m altitude with a 200m descent mixed in and around 75km in just below 5 hours.
On another day decided to push my 30 minutes power - and even though at the beginning I was still riding in a group so sometimes 350w at front or 200w following I managed a new 264w record over the 30 minutes on average - at 181 avg heart rate (which is pretty crazy with 193 heart rate max). That effort was so hard on my body I had fever for 1-2h after returning home and a hard time finding any sleep until 4AM (well don't ride crazy at 8-9PM in the evening if you want to sleep).

Did quite a lot of hiking, canyoning and river tracing - including once again a hike with a 20kg backpack. I kinda had sore muscles for 5 days due to never really relaxing much or having an off day. This ended last Saturday in 2150 activity minutes within 6 days according to garmin Connect (or actual 1500 minutes).

After a day off I yesterday had an easy day hiking with my girlfriend - so only doing 120-135BPM heart rate max First time those 1000m up/down didn't lead to my knee feeling some pain as the pace up and down was much slower. Feel like I will soon attack running again. I looked through this section on kneeguru and it seems there was only 1 person starting running at 5M post surgery, and two more around 6-7M - while most start around the 1year to 1.5year mark. The better my muscles recover - the less the pain, and the better the progress I feel. If I didn't have that setback of 2weeks or so very early on maybe I would be running already?


What I really don't like - in order to visit the Gym it's mandatory now (or better starting in 3 days) to have a covid booster vaccination. I really don't feel that the data supports vaccination at all for young and healthy people, even more as vitamin D seems to have a better track record than the vaccines which aren't really vaccines. But I will bite the bullet tomorrow and do the vaccination hoping it doesn't interfere with my knee cartilage. I will take Ibuprofen and paracetamol before, 6h after and 12h after the vaccination to make sure the vaccine can only cause as little inflammation as possible. I only do it for the paper anyhow. In general after ACi and so on painkillers aren't recommended - but I had voltaren after the surgery too, as well as paracetamol. So it should be fine I think. As opioids in Europe are much less available than in the US I think in Europe voltaren, Ibuprofen and so on are used anyhow after those surgeries and three doses over 18h should be fine once off - and much better than the inflammation that the vaccine would most likely cause, or would cause much stronger without suppressing it. I could skip the gym and wait 2-3 more weeks with the vaccination - but likely that difference isn't too big so I just hope for the best.

Oh yeah - never had such a long so healthy period food wise than since surgery. Outside of doing sports I am down to maybe twice something sweet like a dessert per week - no sweets, chips or whatever ever - eating nuts or fruits as snacks. On average maybe one pint of beer per week over that 5 months.


In general the next 2-3 weeks I plan to do much more anaerobic and high aerobic training and only few very easy long rides. I need some more recovery and different impulses for my fitness - else I will not reach 65vo2max/ 4.5w/kg FTP by August. The main thing is too keep my hormones in a muscle growing/fitness improving phase and getting that lost muscle back or even improve.
I still cannot do a full body weight single leg squat to 90 without being in pain, but it's really improving now around that 30 flex angle where I have most pain and feeling stuck. I guess in 1 month I can really start effective exercises on muscle building. I will focus a lot on my backside muscles and use some input from the "kneesovertoesguy" Ben Patrick.

I will return to Europe in 4 weeks from Taiwan and hope to then start mtbiking and kitesurfing again. And yeah with mtbiking I mean vertriding, enduro, downhill and so on. Let's see and take it slow at the start. For kitesurfing likely take it even slower at the beginning and just riding along with a surfboard instead of twintip or maybe a foil to get even less vibrations and hits, though of course my aim is again big air.

Offline gaoshanfelix

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Re: Second-Generation Autologous Minced Cartilage Repair experiences
« Reply #19 on: April 28, 2022, 06:48:34 AM »
Well the vaccine (Moderna) seriously got me down with light myocarditis. 8 days later still missing 5-10% performance but seem to be getting better now except needing 10 hours of sleep a day.
After some time of not being in the gym yesterday I went again yesterday. My quadriceps is now at ~80% of the right leg from 90-45 (single leg squat right leg 180kg, left leg 140kg). Flexion from 0 o 30 (30-45 is my pain region so I don't train into it) has improved to ~66%.
In my pain region the power of course is less - but now if my muscles aren't exhausted I walk with only a tiny limp left. If my muscles are exhausted after training my limping is still quite easily visible. The last 10 days I never took the lift to my apartment - except if being with my bicycle. So that alone is about 100m altitude up/down per day. Going up taking two stairs at a time is normal - going down taking two steps at a time is still a bit harder and I don't do it yet.

Yesterday I ran for the first time like 60 seconds at 10km/h and 10% uphill on the treadmill with light or no hand support - then I decreased the uphill angle and noticed less than 5% and it became a bit painful so I stopped. I am pretty sure now in 1 month - or around the 6.5 months post surgery I can start jogging/running. Now is a bit too early. By then I also hope that my flexor strength is at 80% of my good leg.
Or maybe in 2-3 weeks I will start jogging - but exclusively with incline.

While cycling my left/right ratio has now improved to 47.5%/52.5% for below threshold, and 46/54 for threshold or above wattage.


Some perspective into those mentioned goals and why I have a hard time understanding them:
ogression to Phase V (that's where this crazy protocol things you should be after 12 weeks):
Pain free treadmill walking for 6 minutes ### if pain free is like no more pain than just on a couple of steps - I cleared that around the 10 week mark
70% isometric quadriceps strength of non-involved side, tested at 60 knee flexion ### Cleared that around the 4.5 months mark
80% isometric hamstring strength of non-involved side, tested at 60 knee flexion ### Not there yet - likely in 2 weeks so 6 months (this seems to be very fast - the average seems to be nearly a year to get there)
Single limb stance testing within 70% of non-involved side (well I think I cleared that after 9-10 weeks)

Post-Operative Phase V: Return to Sport Phase (Week 12 6 months)
Therapeutic Exercises:
Closed kinetic chain multi-plane activities within pain free ROM
Open kinetic chain activities within pain free ROM
Hip, core, and gluteal strengthening activities
Plyometrics:
Initiate double limb plyometrics at 4 months #### (WTF - this contradicts the above badly - I mean you will never reach 70% quad strength without them)
Progress as tolerated to single limb plyometrics
Cardio:
UBE (arm bike), Stationary bike, Treadmill ambulation, Elliptical
Initiate running #### Again this is really a joke vs the point above.

Progression to Return to Sport-Specific Phase:
80-90% isometric quadriceps and hamstring strength of non-involved side, tested at 60 knee flexion #### Now they see this around the 6 months mark, however actual studies looking at this rather would say this need 1-2 years - for quite many they never reach it).
Single limb stance testing within 75-80% of non-involved side #### that again is a strange things. I can stand single legged now for ages on both legs. Also with eyes closed. On unstable surfaces with eyes closed I am nowhere near however. Maybe I misunderstand this point. E.g. - I cleared myself to use no more crutches only when I reached the ability to stand on the operated leg for like 10-20 seconds without too much pain. That's what I would consider 50-60% limb stance testing result. While 100% is you can stand several minutes with eyes closed on stable surface.


#########
But yes - I also think if you want to start running on a treadmill- you should be at least at 70% of quad, hamstring, and glutes strength of the healthy leg. If you want to run outdoors be at minimum at 80%. Bet well at 80-90% before you start sports like badminton, soccer, basketball, tennis,...
However for hiking 50-60% is fine and for cycling well anything is fine if you have the ROM kinda painfree.
« Last Edit: April 28, 2022, 06:59:14 AM by gaoshanfelix »

Offline gaoshanfelix

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Re: Second-Generation Autologous Minced Cartilage Repair experiences
« Reply #20 on: April 28, 2022, 07:12:29 AM »
again from: https://www.connecticutchildrens.org/wp-content/uploads/2018/04/MACI_Femoral_Condyle_Rehab_Protocol.pdf

Return to Sport-Specific Phase:
Recommend pursuing Transitional Therapy for return to sport activities during this phase
Transitional Therapy a strength and conditioning program that is lead by medical
professionals with a sports medicine background with the goal of transitioning from therapy
back to sport  ##### yeah great if you can afford it. I think most people will be on their own here.
Contact Elite Sports Medicine for details
In addition to ongoing strength, balance, and cardio conditioning, initiate agility drills and sport-specific
plyometric activities as tolerated such as:

#### The below surely make a lot of sense:
Soccer/Football: 2 foot ankle hop, double-leg hop, front barrier hop, lateral barrier hop, single-leg hop, power
skip, backward skip, double-arm alternate-leg bound, and cycled split squat jump
Basketball/Volleyball: 2 foot ankle hop, double-leg hop, squat jump, double-leg vertical jump, single-leg hop,
single-leg vertical jump, power skip, backward skip, double-arm alternate-leg bound, alternate-leg push off box
drill, and side-to-side push-off box drill
Baseball/Softball/Overhead throwing sports: 2 foot ankle hop, double-leg hop, front barrier hop, lateral
barrier hop, single-leg hop, power skip, backward skip, double-arm alternate-leg bound, cycled split squat
jump, and return to throwing program
1 year follow up testing:
Isokinetic testing to assess strength of hamstring/quadriceps
Jump and hop testing




##### The big thing missing here - Outdoor cycling should likely be the N1 activity to get back for anyone after MACI. Stationary bike simply you will not push through with enough motivation. Get clipless pedals, and ride, ride and ride. Then once you can go hiking go hiking. - if you have lifts or public transport start with uphill only - but progress to downhill as soon as you can. Hiking sticks and offloading as much weight as possible are needed - and wear your brace while hiking for some months. Before the 6 months mark very very few will ever be hiking without at least either brace or hiking sticks. But yes if you can hike pain free progress to not using either to get proprioceptive training. Hit the gym to get your weaker muscle side trained up (flexor or extensor) and it seems flexor is very weak for most at 2-8 months post surgery. The flexor muscles are the main thing holding you back from a lot of activities. And yes most important invest minimum 10 hours a week, better 20 hours - into sports to get back. Yes that's loads. I like to monitor my process with a garmin sportswatch (Fenix 6x) to avoid overtraining or knowing when to add intensity. Of course - if you're not lean already - drop that fat. Any kg you are lighter makes it easier on your knee. Well 10% body fat or 5% won't matter much anymore for a male, same as 12% or 18% for a woman.

Offline gaoshanfelix

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Re: Second-Generation Autologous Minced Cartilage Repair experiences
« Reply #21 on: May 14, 2022, 08:24:01 AM »
Another 2 weeks later - no significant changes (the next significant change will be taking up regular jogging) but slowly slowly progressing. Most people don't see I'm limping anymore - but sportive people do. My cycling performance is slowly increasing on long rides - and I had my first training ever with professional road cyclist. Well needless to say 2.5 hours in I imploded aided by the problem that due to torrential rain I could not follow in the wind shadow due to seeing nothing at all then. Did a sprint uphill bicycle race and finished middle of the pack or at the end of most ambitious guys - 20% slower than the winner. Yesterday went bouldering the first time post surgery - at heights over 2m (with around 3m being the max height) I got a bit scared - and I always climbed back down to 1.5m or so before jumping down and then landing mostly on my good leg. Once jumped down from 2.5 or so and that didn't feel too good. Hurt a little for 1 minute even though I landed like 80% on my right leg.

Next week will fly back to Europe, get an MRI and in around 14 days see my surgeon for the 6 months follow up (well will be 6.5 months by then). After reading quite often about IKDC score - I filled this form out and also thought back and filled it out on pre surgery levels: https://orthotoolkit.com/ikdc/#:~:text=The%20IKDC%20is%20a%20patient,and%20lowest%20level%20of%20symptoms).
I am about 68-70 points or 80%. Same as pre surgery just with a bit different points ticked. However knowing I am very close to start running/jogging I guess in 3-4 weeks I will score about 75/87 and 86%. I do hope that by the 9 months mark I will be at 84/87 or higher - only deducting points on the Jump and land on involved leg as slight - with that point however graded according to my own expectations - slight meaning no I will not start again to jump down higher than say 1.20m onto hard ground on the left leg. But yeah - who known can I in 1 year maybe get back to a perfect 87/87? That for me would mean the doctor tells me my cartilage is looking juvenile and I can do anything like before my first ACL surgery - including taking big drops/jumps on snowboard, ski, or stuff like parcours running. I doubt it a bit and guess this will stay off limit for me and I will be happy if I can get back to my knee state like 10 years ago (no pain, just avoiding really dangerous places - like in a snowboard/ski funpark take some jumps - but leave the Pro Line alone. Jump some cliff drops up to 10m - but only with perfect landings. Jump down from like 1.5m on hard ground without thinking much - but not from 2m or even 2.5m).

I plan to start kitesurfing on a surfboard - no jumps in 2.5 weeks time. And hope I do not need to postpone jogging any longer. So many times I thought it will only be 3-4 weeks left before I can start jogging without pain but still not there.















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