10 weeks post op-I feel very good. When I wake up, before doing exercises, I still feel weakness in quad. Rest of the day, feel strong and steady. I still do not walk far-but, I feel that I could walk farther than I have in the past-the most that I did was 4 blocks. I went further than that once or twice shopping at the mall for back to school clothes a couple weeks ago. Still, that was limited to one 45 minutes.
I think there is some risk in this time because one could overdue it when pain and stiffness don't automatically tell your brain not to attempt too much. I guess I tend to be pretty cautious, at least up until this point-I'm not sure if I have been overly cautious in terms of walking. I really would like to walk my dog-but I chicken out each time I plan it (good for my kids though-they are getting more responsible about walking him without me begging!) The underdeveloped calf is tempting me to walk more to get that back. I am trying to be conscious of pushing off my toe in my stride, which engages the calf. I think that walking unnaturally after surgery and not pushing off my toe in that way (plus being on crutches for a couple weeks) is what lead to the atrophy. So far, I have not really enjoyed walking, except perhaps for the first minute or so. I do not like standing for much time and start looking for a place to sit if possible. I recently took a tour of a group home for teens (a friend is on the board of the program) and I did fine with the walking, but sat down whenever we stopped.
A few times this week, I have felt a pop around my knee that felt good afterward, looser and stronger, although I had not felt any tightness prior. My guess is scar tissue or something detaching, but I don't know. I am going to therapy once weekly and the therapist is still working on moving my knee, but I have not had the problem of the tissue around the knee tightening up between those sessions. I have expanded to a few new exercises: the "speed skater" movement, where a small band is both ankles and then I kick back with one leg while balancing on the other-both legs. Sitting on the edge of raised table/bed, extend leg (using the other leg to bring it up-still not supposed to do leg extension using my muscles due to risk of shearing the graft-but I do do this movement at night while tossing and turning falling asleep and in my sleep-apparently ok as long as it is not a repetitive movement according to therapist-no brace needed to sleep). And then keep leg out with quads engaged for 5 minutes. Lots of balancing on the balance boards. The first time I did balancing on one leg, ie the operated leg, I was nervous, but felt good afterward. On the leg press machine (on which the seat moves back and up as you push with feet) I am doing leg press, then calf strengthening with toes on the machine. They have this machine at the gym where I (try to motivate myself to) work out and swim and do the bike, upper body machines and this leg press. 30 minutes on the bike at about level 5-6 at a quick, but not 'all out" pace, no longer causes swelling.
With the continued and rapid improvements, I am thinking more about my second surgery. I wish I had the feeling that when the doctor and I agree on a date, we will be able to proceed, but there is the insurance issues to contend with of course. I meet with Dr. Gillogly on September 20. I will plan to discuss the next surgery with him on that date. I believe that there may be another xray that day (?) and consultation with the physical therapist - Gillogly will come to the PT room and observe me with therapist as part of the evaluation.
I think there is some risk in this time because one could overdue it when pain and stiffness don't automatically tell your brain not to attempt too much. I guess I tend to be pretty cautious, at least up until this point-I'm not sure if I have been overly cautious in terms of walking. I really would like to walk my dog-but I chicken out each time I plan it (good for my kids though-they are getting more responsible about walking him without me begging!) The underdeveloped calf is tempting me to walk more to get that back. I am trying to be conscious of pushing off my toe in my stride, which engages the calf. I think that walking unnaturally after surgery and not pushing off my toe in that way (plus being on crutches for a couple weeks) is what lead to the atrophy. So far, I have not really enjoyed walking, except perhaps for the first minute or so. I do not like standing for much time and start looking for a place to sit if possible. I recently took a tour of a group home for teens (a friend is on the board of the program) and I did fine with the walking, but sat down whenever we stopped.
A few times this week, I have felt a pop around my knee that felt good afterward, looser and stronger, although I had not felt any tightness prior. My guess is scar tissue or something detaching, but I don't know. I am going to therapy once weekly and the therapist is still working on moving my knee, but I have not had the problem of the tissue around the knee tightening up between those sessions. I have expanded to a few new exercises: the "speed skater" movement, where a small band is both ankles and then I kick back with one leg while balancing on the other-both legs. Sitting on the edge of raised table/bed, extend leg (using the other leg to bring it up-still not supposed to do leg extension using my muscles due to risk of shearing the graft-but I do do this movement at night while tossing and turning falling asleep and in my sleep-apparently ok as long as it is not a repetitive movement according to therapist-no brace needed to sleep). And then keep leg out with quads engaged for 5 minutes. Lots of balancing on the balance boards. The first time I did balancing on one leg, ie the operated leg, I was nervous, but felt good afterward. On the leg press machine (on which the seat moves back and up as you push with feet) I am doing leg press, then calf strengthening with toes on the machine. They have this machine at the gym where I (try to motivate myself to) work out and swim and do the bike, upper body machines and this leg press. 30 minutes on the bike at about level 5-6 at a quick, but not 'all out" pace, no longer causes swelling.
With the continued and rapid improvements, I am thinking more about my second surgery. I wish I had the feeling that when the doctor and I agree on a date, we will be able to proceed, but there is the insurance issues to contend with of course. I meet with Dr. Gillogly on September 20. I will plan to discuss the next surgery with him on that date. I believe that there may be another xray that day (?) and consultation with the physical therapist - Gillogly will come to the PT room and observe me with therapist as part of the evaluation.
September 22, 2013-12 1/2 weeks post op- I visited with my OS and physical therapist 2 days ago to discuss my progress and I asked about planning for surgery for the next knee. The doctor said I am progressing well and this indicates that my graft is successful-at least so far. He said since the change from using a periosteum harvested from bone in the patient's leg to making a patch to covER graft from animal skin (pig) has made a huge decrease in complications and lack of success. I believe that especially refers to the complication of overgrowth, ie when the new cartilage cells would leak out past the area where they were placed. I am restricted until 6 months from "open chain" movements. I am still doing stairs one step at a time. I am strong enough to alternate legs, but this is one of the restrictions.
I asked about planning for the next surgery and the doctor was positive about moving forward wih that. His assistant/nurse will speak with someone from the office to contact my insurance company. I am worried about the insurance's response since I had such trouble with approval for the first
ACI surgery. Dr Gillogly just this week submitted an article for publication (or it was published in the journal-I forget which) re the success rate of patellar ACI in his practice. Also another review article by different authors was also just published. I hope these will affect the insurance's decision as well as my success on right leg, but who knows. It would be ideal for me to have he surgery in December so I can get two weeks of recovery over the school break and not have to worry about driving my son for school. It will be my left knee-so perhaps I won't be limited for driving as long next time. December is my goal-but I may not have control if the insurance gives a denial.
I continue to do occasional walking-I have not walked the dog so far since I did go quite a ways about a week and a half ago. I had a bit of swelling and a bit of swelling-which may not have been bad for me, but I am so nervous. It's hard for me to not walk the dog when my family is busy. Then my son sprained an ankle playing sports yesterday-so now I feel more pressure to walk him. I can do a couple blocks-but he really likes a half hour at least. So trying to walk him short distances and encourage those who are not limited in family to take him for some more each day. I enjoy being outside and walking-weather is a little cooler now-so it is hard to hold off for many reasons! Meanwhile, I am swimming and enjoying that alot.
I asked about planning for the next surgery and the doctor was positive about moving forward wih that. His assistant/nurse will speak with someone from the office to contact my insurance company. I am worried about the insurance's response since I had such trouble with approval for the first
ACI surgery. Dr Gillogly just this week submitted an article for publication (or it was published in the journal-I forget which) re the success rate of patellar ACI in his practice. Also another review article by different authors was also just published. I hope these will affect the insurance's decision as well as my success on right leg, but who knows. It would be ideal for me to have he surgery in December so I can get two weeks of recovery over the school break and not have to worry about driving my son for school. It will be my left knee-so perhaps I won't be limited for driving as long next time. December is my goal-but I may not have control if the insurance gives a denial.
I continue to do occasional walking-I have not walked the dog so far since I did go quite a ways about a week and a half ago. I had a bit of swelling and a bit of swelling-which may not have been bad for me, but I am so nervous. It's hard for me to not walk the dog when my family is busy. Then my son sprained an ankle playing sports yesterday-so now I feel more pressure to walk him. I can do a couple blocks-but he really likes a half hour at least. So trying to walk him short distances and encourage those who are not limited in family to take him for some more each day. I enjoy being outside and walking-weather is a little cooler now-so it is hard to hold off for many reasons! Meanwhile, I am swimming and enjoying that alot.
Thank you for sharing your journey. It's a help to read the experiences of other and get an idea of whats about to happen.
October 16, 2013-About 3 1/2 months post surgery-I just returned from a 5 day trip with lots of walking and I am pleased that it went well. I toured 4 colleges in the northeast with my daughter and did all the tours, as well as walked around the towns/cities. I actually took a crutch with me, so for the first 3 days I used that when I was going to do alot of walking in hopes that it prevent swelling of the knee. I had no swelling those days. In NYC, I did not use the crutch and had a small amount of swelling-very minor. We walked around and did shopping in the city and I felt ok. I'm glad I went because it showed me what I can do now. When I returned home, I took the dog for a walk two days in a row and I think that one reason I have some discomfort walking in the neighborhood is due to our driveway being very steep and long. So, I plan to drive up the hill to take walks in the future. Its actually the knee tht did not get the surgery yet that hurts going downhill, and iI am really slow and tentative on steep downward inclines.
Note: December 12, 2013 I am adding this note at approximately the 3 month mark to be helpful to someone reading this that is planning to have ACI surgery. I am now at the 6 month mark and planning to have my 2nd ACI surgery in 2 weeks. I spoke with my PT last week and was dismayed when I asked her about starting to walk stairs one at a time and she replied that I was able to do them at 3 weeks. The lack of practice with stairs has made it all the more daunting to try this and I have found that I am having difficulty going down the steps using my right leg. At present, I am unable to do this. So, for anyone who has had this surgery and is approaching the 3 month mark, I suggest that you consult with your physical therapist if they have not mentioned returning to walking stairs in a normal manner.
In my rehab, the area of my leg that could be stronger are my glutes and hip because I can balance much better on the left leg than on the right. I still do not do stairs alternating legs (very slow and kind of embarrassing on stairs) and was wondering if this lack of using my right leg to climb is contributing to the weakness. I have exercises to do for that area-pilates hip sequence and also the skater exercise using a small band. I still experience quad weakness-but much less-sometimes in the morning and sometimes after sitting for awhile, I will have a brief loss of the muscle. If I do my exercises that day, it is less likely. When i was on my trip, I did not do as much therapy exercises.
Note: December 12, 2013 I am adding this note at approximately the 3 month mark to be helpful to someone reading this that is planning to have ACI surgery. I am now at the 6 month mark and planning to have my 2nd ACI surgery in 2 weeks. I spoke with my PT last week and was dismayed when I asked her about starting to walk stairs one at a time and she replied that I was able to do them at 3 weeks. The lack of practice with stairs has made it all the more daunting to try this and I have found that I am having difficulty going down the steps using my right leg. At present, I am unable to do this. So, for anyone who has had this surgery and is approaching the 3 month mark, I suggest that you consult with your physical therapist if they have not mentioned returning to walking stairs in a normal manner.
In my rehab, the area of my leg that could be stronger are my glutes and hip because I can balance much better on the left leg than on the right. I still do not do stairs alternating legs (very slow and kind of embarrassing on stairs) and was wondering if this lack of using my right leg to climb is contributing to the weakness. I have exercises to do for that area-pilates hip sequence and also the skater exercise using a small band. I still experience quad weakness-but much less-sometimes in the morning and sometimes after sitting for awhile, I will have a brief loss of the muscle. If I do my exercises that day, it is less likely. When i was on my trip, I did not do as much therapy exercises.
October 29, 2013- It is 4 months since my ACI and osteotomy surgery. I have begun walking regularly 2-3 miles outside and on the treadmill with very little or no swelling. I feel very close to normal on the operated knee and am free if pain. According to the protocol, I still do stairs one at a time and do no jumping or running.
Those of you who read this who are interested in insurance coverage for the patellar ACI or who are planning to have (or have had) this surgery on both knees, may be interested in my progress on getting my second surgeries approved. I have been worried about getting approval for a second ACI surgery and wondered about my options if the insurance denied the surgery. Get a knee replacement and give up my dream of being as active as I would like to be for the rest of my life? Get only the Fulkerson and have the damage contained to the cartilage already worn away, but live with major cartilage damage? I try to avoid ruminating about it, but it seems bleak....
My doctor's office began the process to request coverage for an osteotomy (Fulkerson) and ACI after my appointment with Dr. Gillogly on Sept 20. Two days ago, I received a letter from my insurance company stating that the Fulkerson was approved. That was not a surprise. Then yesterday, I received a letter saying my ACI surgery was denied. I had expected this, but still felt down about it. I hoped that an appeal would make a difference-but was pessimistic-since last time that did not help.... Then today we received another letter saying the ACI PATELLA had been approved. Tomorrow I will call my doctor's office and see if they can interpret the letter. I hope it means that it is approved and we can set the surgery date.
I will try to restrain my excitement until I know for certain.
Those of you who read this who are interested in insurance coverage for the patellar ACI or who are planning to have (or have had) this surgery on both knees, may be interested in my progress on getting my second surgeries approved. I have been worried about getting approval for a second ACI surgery and wondered about my options if the insurance denied the surgery. Get a knee replacement and give up my dream of being as active as I would like to be for the rest of my life? Get only the Fulkerson and have the damage contained to the cartilage already worn away, but live with major cartilage damage? I try to avoid ruminating about it, but it seems bleak....
My doctor's office began the process to request coverage for an osteotomy (Fulkerson) and ACI after my appointment with Dr. Gillogly on Sept 20. Two days ago, I received a letter from my insurance company stating that the Fulkerson was approved. That was not a surprise. Then yesterday, I received a letter saying my ACI surgery was denied. I had expected this, but still felt down about it. I hoped that an appeal would make a difference-but was pessimistic-since last time that did not help.... Then today we received another letter saying the ACI PATELLA had been approved. Tomorrow I will call my doctor's office and see if they can interpret the letter. I hope it means that it is approved and we can set the surgery date.
I will try to restrain my excitement until I know for certain.
December 05, 2013
ACI surgery for left knee scheduled for Dec 26. I am trying to plan for some help in the house and driving me and my kids. I am wondering if return to driving will be easier with the left knee. My rehab for the right knee has gone smoothly and I hope I will have such good luck with the second knee, but I realize that it could be different.
I did an hour hike over Thanksgiving and have taken other long walks since then. I realized by asking physical therapist that I had mistakenly thought I was not to do stairs u tip 6 months. She said I was able to do stairs using both legs, by 3 months! I am now at 5 months post op so I lost precious time! It is hard goi g down stairs! I am going to spend as much time as I can working on this because my right leg will be my "good" leg when I have surgery on left. My knee has gotten swollen a couple times recently-I am not sure if it is related to hike and walks or the stairs.
I did an hour hike over Thanksgiving and have taken other long walks since then. I realized by asking physical therapist that I had mistakenly thought I was not to do stairs u tip 6 months. She said I was able to do stairs using both legs, by 3 months! I am now at 5 months post op so I lost precious time! It is hard goi g down stairs! I am going to spend as much time as I can working on this because my right leg will be my "good" leg when I have surgery on left. My knee has gotten swollen a couple times recently-I am not sure if it is related to hike and walks or the stairs.
I am still planning to have my 2nd ACI surgery on December 26. My revelation about the stairs, ie that I was able to do stairs at 3 months, continues to be a worry to me. I have found that I am able to go up stairs using my right leg, but going down is a problem. I'm not able to do it without holding onto the rail. Really, I cannot do it and certainly would not be able to do it if my left leg is weak. I am working on quad exercises and trying to do the stairs daily. Today, I rode my bike for over an hour including some tough hills. I love biking, but I feel a bit daunted because I am not back to normal in terms of quad strength. On the flat surface I don't notice it, but on the steeper hills, it was tough. I am going to ride as much as possible leading up to my surgery. The weather is cool, but with warm clothes, it is fine (I am in Atlanta). Definitely experiencing anxiety about how it is going to go given that my right knee is not back to normal, but excited to proceed with the process of the 2 ACI's, rehabilitation, and hopefully a return to being as active as possible. Some of the anxiety is also that the date has been set so recently and I only have a couple weeks to prepare.
I have arranged for someone to help me and do some housekeeping and cooking for 2 weeks. I do not know if I will be able to drive more quickly since this will be my left, non driving, leg, but hoping that will make it quicker. My kids will be on school break when I have surgery, so we arranged for them to visit with family for 5 days and then when they return, my husband will be off work and we will also have the person to lend a hand. We have no family in town and this time my mom will not visit, so we have decided it is a worthwhile expense to have a person to help. She will drive me to daily physical therapy appointments once my husband returns to work on the 3rd and also drive my son home from school each day.
I have arranged for someone to help me and do some housekeeping and cooking for 2 weeks. I do not know if I will be able to drive more quickly since this will be my left, non driving, leg, but hoping that will make it quicker. My kids will be on school break when I have surgery, so we arranged for them to visit with family for 5 days and then when they return, my husband will be off work and we will also have the person to lend a hand. We have no family in town and this time my mom will not visit, so we have decided it is a worthwhile expense to have a person to help. She will drive me to daily physical therapy appointments once my husband returns to work on the 3rd and also drive my son home from school each day.
This week, I have practiced stairs one at a time and have adapted well. I hold on to the rail, but it is not difficult..... I have not had as much time as I had hoped for strengthening exercises, but have been practicing with crutches and doing the stairs each days, continuing to do stationary bike, leg weights, and other exercises. I had meant to also do exercises with weights on the left leg, which is the leg that will have the surgery next week, but have not done it. In general, I am doing very well at 6 months. If I do not do some weighted exercise, ESP if a couple days pass without exercise, the quad can feel less engaged every once in awhile. When I do strengthening exercises, my muscles feel the best.
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