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| No swelling at 5 months |
Physical Therapy: The exercises I'm allowed to do hasn't changed since month 3. However, I've been increasing the resistance, time, and reps of each exercise. The exercises I do include:
Stationary bike (up to 45 minutes with varying degrees of resistance)
Elliptical (up to 15 minutes)
Treadmill walking (forwards/backwards for 15 minutes)
Swimming (up to 45 mins freestyle stroke)
Leg Press
Hamstring Curl
SLRs
Heel raises
Here's a short clip of me doing leg press. I'm still limited to 45 degrees of flexion so it's hard to really gain much strength doing this. In this video I'm lifting 35 lbs which is difficult. Note how skinny my leg is and how hard it is to see much definition as the muscles contract (I call it my baby deer leg). My surgeon told me at one point I'll probably lose 30-40% muscle strength during the first 2 months of recovery.
A Note on Backwards Walking: One exercise I recently started is backwards walking on the treadmill. Backwards walking is good for people recovering from knee surgery because it primarily works the quadriceps and calves unlike normal walking which works the hamstrings and glutes. Additionally, backwards walking produces less of a sheering force on the knee joint as opposed to forward walking so it is a good exercise to strengthen the muscles without causing too much stress. So I'll be doing this a lot and trying to increase speed and endurance over time.
Other Thoughts: Stairs are still difficult, especially going up. Going down is much easier and I can almost do this normally as long as I'm holding onto the handrail. I am still very careful not to overdo it with my knee. I had a giant snow storm this month and was forced to shovel snow to get out of my driveway. I was very careful to avoid putting too much weight on my operated knee or do much bending with it. However, the next day I felt more sore than usual and was worried I overdid it. But I felt ok a few days later. So what this taught me is that even though I'm feeling a lot better and stronger, I need to not rush the recovery and stick to the exercises I know I can do safely.
Safety is sexy.
ReplyDeleteEven when I'm holding onto a handrail for dear life?
DeleteMegan, I was just diagnosed with something very similar and the surgeon is recommending ACI. My diagnosis is: 15x17x5mm osteochondral lesion medial femoral condyle with contained unstable osteochondral fragment. I got the diagnosis yesterday and got a call from the surgeon's office today to schedule the first surgery. I was not expecting things to move this fast. I'm a marathon runner (8 marathons), play a lot of tennis and workout every day. I can't run any more due to the pain but getting around day to day is ok. My "pothole" is very large and the surgeon doesn't think that micro-fracture surgery would work to restore the cartilage. I declined to schedule the first surgery before doing more research and perhaps getting a second opinion. My surgeon has performed several of these ACI surgeries and comes highly recommended. I still can't wrap my head around this entire process. I've come to grips that I will not be able to run any more marathons but if I could just run 10 or 11 miles, I would be happy. What did your doctor say about your eventual return to running? Thank you so much for creating this blog, it's a huge help.
ReplyDeleteHi Andy, your lifestyle and diagnosis sounds very similar to mine. I also have come to the realization that I will not be able to run marathons but would just be happy if I could run a few miles here and there. My surgeon still thinks the prognosis of being able to run is good. I just had my 5 month post op appt which I will write about in the next post. But I'm still having pain similar to before the surgery and can't imagine running right now. He also told me we can't judge the success of the surgery until I get my quad strength back and wait a few more months. So that's not the best answer and I'm still unsure about being able to run 5 months post op. But there's not a lot of options for cartilage injuries and I had to try so I don't regret having the surgery. I'd love to know what you decide and how your recovery goes.
ReplyDeleteSo, I just went past month 3 this week. I had my 3 months checkup and it went well. Since I have had this problem for so long my muscles are very weak. I get frustrated with things but the stiffness is getting less and less everyday. I cannot do steps. I do not want to even do steps. I do the box at therapy. I get worried this whole thing won't work and I'll be back to being miserable. After workouts did your knee swell? Ugh! I can walk normally though. The first part of the day is always the best for me. Glad to see you are moving along. This is a very slow process :(
ReplyDeleteHi Mary, it sounds like you're doing pretty well! Yes my knee swelled after workouts but I found this got less and less and doesn't do it anymore. Weakness is a big problem for me too. I also worry that thus whole thing won't work as well. Do you still have pain in the same areas as before you had surgery? I do sometimes and it's frustrating. But I've been told by my surgeon that strengthening the quad is the key to feeling better so I'll be working on that over the next couple of months.
DeleteWell I had a 2.5x2.5 inch pothole in the middle of my kneecap. I do not have the pain I had before surgery, which is great but I am not doing stairs or anything. When firing my quad before surgery I had pain and I do not have that now (I'll keep you posted when I start doing stairs lol). I agree that once you strengthen all the muscles you need to it will help pull it all together. I wasn't firing my glutes and hips correctly when running and playing volleyball and my kneecap turned in and that's why I have this problem. It takes time, and I think in a few months you will feel better. My kneecap clicked for about 5 years too and the first time I rode the bike after surgery it did not click, it was the best feeling in the world. I've been battling this 12 years, since I played volleyball in college. I'm 30 now.
DeleteYou know what has really been bothering me? My quad tendon, he said he sliced it to flip up my kneecap and then glued it together. Leg lifts still hurt in that tendon. But is getting less painful ever week. He said this was normal.
DeleteAnd I feel like it's kind of crunchy, which he said is normal from the type collagen patch he used or whatever to kind of tack up as it aborbs? That bothers me also. He said every patient he does this on had complained about crunchiness. I feel it as I start my heel slide back but not coming back down.
DeleteYes! The crunchiness is totally annoying. I thought is was my cartilage grinding. But turns out this is a normal part of recovery from open knee surgery when I asked my surgeon about it. It's a result of cutting the tendon to flip the knee cap up. It should go away in a few months. And yes, leg lifts were painful for me for about 4 months. I have no pain with this now though.
DeleteI'm glad we have had the same symptoms. My worry gets the best of me some days.
DeleteMegan, I've decided to go through with the surgery. Everything I've read points to ACI being the right choice for such a large legion. My family is very supportive and is ready to help me get through it. I think I'll have stage one sometime in February and then schedule stage 2 around my schedule. I'd love to be at a point where I could swim this summer, as my kids are on the summer swim team and I could use our pool to work out and rehab in. Good luck with the rest of your recovery. I'll be following along! Maybe I'll try and do something like this because your blog has been so helpful in knowing what to expect!
ReplyDeleteHi Andy. Good luck with the surgery. Yes, I've read that ACI is really the only good option for large lesions. I was getting in the pool 4 weeks after surgery. I mostly just walked back and forth but that was enough of a workout at that point. But by month 3 I was allowed to swim with no restrictions. So the pool will be a great option to stay in shape while you recover.
DeleteHi. I'm nine weeks post op and my knee is swollen, stiff, and painful everyday. Very discouraging but after reading about your recovery I guess it's normal and there is hope.
ReplyDeleteOh yes, I was still pretty bad at nine weeks. That's totally normal. My swelling really didn't go away fully until like 5 months. Don't stress! It gets better, just very slowly. At 9 months I have no tenderness and my knee looks normal (except for the scar).
DeleteHey I'm 2 and a half years post op from my aci surgery if you have any questions.
ReplyDeleteWhat Dr did yours? And did you have any previous surgeries to your knee before ACI?
DeleteWho was your doctor and did you have prior surgeries to your ACI.. for example microfracture ?
DeleteI'm so glad I came across your blog!! I have been looking to connect with people that have had this done, as it is a rare procedure and not very commen. I want to find someone who can relate to what I have been through :) I have had six knee surgeries total. I had the ACI done july 2015. It's nice to know that i'm not the only one who has days where I feel like "did this surgery even help" Honestly all the exercises I do at therapy hurt just as bad as they did before surgery. I just push through them because I know I need to do them. Also I want to know how do you do with seated knee extentsions? If that is the technical name for the exercise. Basically you sit in a chair or the side of the bed at therapy and extend your leg out and lower it. This exercise is excruciating for me and my knee snaps when going down. That has been the biggest downfall for me. Wanting to know if you experience this too
ReplyDeleteHi Jessica, thanks for your comment! I had my surgery just a month after you and I also wonder if it did anything. Some of the exercises I'm supposed to do hurt pretty bad as well. The worst one for me is the lateral step down. Anything standing on my bad leg and bending my knee is pretty much impossible. I go back and forth if I should be doing it or not because of the pain. I'm worried I'm hurting the graft. I do seated knee extensions now with light weight. I do have some pain with this but it's only when my leg is close to full extension so I just go about half way up then back down. I still have lots of cracking and popping too. Most of the time it doesn't hurt but every once in a while I'll step weird or stumble and get a sharp pain.
DeleteThanks for replying :) Excited to chat with you! Well after hearing your response I don't feel so bad anymore. I thought it was just me. This past year getting through therapy I constantly worried and wondered why is this hurting just the same? Any yepp same here, anything that involves keeping my surgical knee stabilized and then bending down is impossible for me as well. But as I said I just push through it because I have been dealing with this for 7 years, so what's a few more painful exercise? :p Lol. Back to the seated leg extensions. Are these even allowed? I started doing them about 5 months ago or so, can't quite remember and I don't do them all the time, just every once and awhile. I'm getting some contradicting info about this exercise, some websites say this is to be avoided at all costs because it causes shearing forces to the kneecap and it's not really useful. The only problem I have with avoiding it is I feel like it would be so weird to go through life and not being able to extend your leg out. It didn't make sense that some website were saying this isn't an important function. but I do understand about being careful, because this exercise does cause me excruciating pain and I have actually had to stop it completely. What is your take. I guess it is considered an open chain exercise. I just feel like it would be weird to not work on that function, but at the same time I don't wanna damage my cartilage.
DeleteHopefully that makes sense :p But I am going through a bump in the road with my knee at the moment. As I said everything exercise wise has been painful since july of 2015, but the walking did improve! I had almost no pain with walking. I was so excited, because I thought hey on the plus side I can walk without pain! But about 2 weeks ago my knee flared up bad and now I can hardly walk and i'm getting sharp pain under my kneecap that I haven't experienced after surgery. So of course I have been so paranoid about it!! :( almost to the point where I'm going nuts. I didn't want to go calling my doctor freaking out the second it started hurting I thought ill ice it, rest it, and do meds. Well no relief and it's been almost two weeks. That is why I brought up the leg extension exercise. I hope that wasn't what caused it :( I'm so scared now that I have damaged my cartilage because it has not felt like this before. So will see what the doctor says this Friday. I don't even know what would happen if you did damage it? I feel like these grafts are so suspectible to damage! If I did hurt it, I will loose all hope :( lol
DeleteLol boy has this knee surgery really raised my anxiety lol. I have never been so paranoid in my life! This might give you a chuckle, but I have even had dreams or should I say nightmares, where in the dream I have damage the cartilage, then I wake up and realize it's just a dream. I am going nuts!
DeleteJessica, you sound a lot like me! As far as leg extensions go, my PT protocol says I can start doing the leg extension weight machine at 12 months. I sometimes do this with light weight but not full range, just to wear it doesn't hurt. Like you I've read that this exercise is bad for knees because of the sheering forces so I don't do it much. I think there are better ways to strengthen the quad like squats, lunges and leg press. But I would ask your Dr about it. I'm curios to see what he says. Of course I've wanted to set my PT protocol on fire and throw it off a cliff. It has some things on there that just don't make sense. It says to do lateral steps downs (my nemesis) starting at 3 months. I'm at a year and can't really do these. So I've stopped doing exercises that cause a lot of pain. Not sure if it's the right answer but that's sort of what I've stuck with. I've experienced a lot of paranoia with my graft as well. I actually had a knee dream the other night where I ruined the graft! I get them occasionally. From what I've heard graft failures after a year are fairly rare. By then the cartilage is pretty strong. Hang in there! I'm curious, have you had an MRI since the surgery? Has your Dr. mentioned getting one to determine the health of the graft? I haven't seen my Dr. since 5 months post op (he lives in another state) and I'm wondering if it's time to get an MRI? I have no idea what I'm doing with this recovery most of the time...lol!
DeleteI'll head to the looney bin with you because this is driving me nuts too!
DeleteOh wow! Hmm well maybe it was fine that I was doing the leg extensions then. Especially since I was just doing them on the side of my bed, not even doing the leg extension machine which would be more aggressive. and your protocol says you can do them with them weight, probably fine that I did them just seated. Either way, bad on my part, I just have stopped doing them a lot earlier than I did though. I should have stopped doing them once I realized it was an exercise that irritated me. My doctor and therapist have differnet views on exercise. My doctor says push through me and my therapist doesn't encourage doing exercises that cause me severe pain. So i'm like you, don't really know what to do or what is right half of the time lol. I think the reason I get so paranoid is because this was such an expensive surgery and for me, it took months= for my insurance to even approve it. so I don't take it lightly. I just don't wanna mess it up. But I am still worried lol. I haven't had any flare ups till now and the fact that it doesn't feel any better after a few weeks worries me. Also yes, meant to tell you, actually in March, which I would have been 8 months post op I had an arthoscopy. Reason I had one was because I was constantly complaining to my doctor that I felt no different in therapy. So he said he would take a look. He said everything looked fine while he was in there. He removed my screw because I also had a tibial tubercle transfer perfomed in conjunction with my ACI. In fact I think he might of said that there was even a little bit of overgrowth of the cartilage so he shaved it down. (chrondroplasty). But now talking to you I probably wouldn't have even had the scope because it sounds like it is common to feel a lot of pain during therapy! I have also talked to someone else as well online. So I guess it wasn't just me. Well I guess I will find out Friday, maybe he will do another MRI. Hopefully I didn't damage anything, maybe just irritated it at the most. And hopefully like you said, by one year it would be strong enough to withhold getting damaged. But my therapist did say that when I do my leg extensions and lower my leg down and it snaps, that that wasn't good and could damage things if I continued it. That's why it stopped. I have no idea what causes the snapping.
ReplyDeleteJessica, thanks for all the info. I think it's really positive that you had an arthroscopy at 8 months and everything looked good. When I first started PT after a week post op one of the therapists told me, if you're going to screw up the surgery it will usually happen in the first 2 months. You really have to stick to the non-weight bearing instructions. After the first 2 months it's less likely to mess up the surgery as long as you stick to the protocol. So the fact that your graft is ok at 8 months is really a good sign.
DeleteAlso wow I didn't realize you had to drive out of state for this! Is there not any doctors that offer ACI procedure in the state you live in? There was only two doctors that do it in Indiana where I live. Which is even surprising for Indiana lol
ReplyDeleteI have an unusual situation because I'm in the military. My medical insurance does not cover ACI. In fact they took it off the list of approved surgeries just months before I started looking into it. This was most likely because it was so expensive. However, if I had the procedure done by a military surgeon, the military would cover it. There's only a few large military hospitals around the country and San Antonio was the closest since I live in New Mexico. They have a good orthopedic department so I opted for that. But it was a little frustrating not being able to pick my surgeon. I really have no contact with him because it's so far to travel for an appointment and military Drs don't really have the best bedside manner since they're not really competing for business. However, as I approach the 1 year mark I would like to know how I'm progressing.
DeleteAh okay that makes sense! And I can understand how that would be frustrating not being able to pick your own surgeon. Your right about that being a good sign that everything is fine at 8 months! however I am still not sure about this flare. I seen my doctor, almost two weeks ago, I think I told you. So at this point my flare up has being going on for a month now. I still do not feel any better and can hardly walk :( I am in so much pain :( I'm just so worried because it hasn't felt like this once after surgery. When I seen my doctor said take some ibuprofen consistently and see what that does. I have had no relief so far. I am just worried I did something to I with that exercise. Looks like I am going to have to get ahold of my doctor again. I am just really surprised that my pain hasn't let up at all. I have been consistenyly taking ibuprofen and icing my knee for almost two weeks now. Not to mention sitting all day resting my knee. That is what worries me
ReplyDeleteJessica, I'm so sorry you're going through this. I wonder what could have happened? I can't believe you could do that much damage just by extending your leg. Yes, I would definitely go back to your dr. It may be that something just got tweaked and will need time to heal. One thing I've learned from this surgery is that everything takes longer that expected. I'll be thinking about you and sending positive thoughts.
DeleteThat's true. I think maybe i'm just overthinking things. I never really did leg extensions with reps or anything. I would just do them every hear and now if I was sitting on the couch watching tv and just kind of extend my leg out and lower it. But never went out of my way to do reps and sets of leg extensions. So maybe I am just overthinking things. Although I probably should have just avoided doing them all together since they aren't the greatest. I also never did them with weight or anything, but I did extend it all the way out. I probably should have only went half way up and stopped when I had pain. I actually have two physical therapists. There is a really good therapist in a town about an hour and 40 minutes away from where I live and I go to him every now and then when I have questions. I would have went to him all the time after surgery, but he is to far away. So I went to him about a month ago. The only conern I have with the leg extensions is that when I lower my leg down after extending it, it snaps. Both my doctor and him don't know why it does this. But it could be damaging. I'm sure I haven't done this enough to cause significant damage, but it still worries me that I did these and why it does that when I lower it. I have stopped them completely now, which is good, but wish I did earlier. I just get angry at myself for doing stupid things lol. I just wish I was more cautious with what I was doing. Hopefully I haven't done anything, but it has been a little over a month now and i'm still in pain. I guess that is what worries me, because I haven't felt like this before.
ReplyDeleteYou are right though, this recovery is long, I just don't want to do anything to go backwards. I can handle going through a long recovery, because I am in no hurry or anything. I'm not returning to any sports or high impact activity, I have finally accepted I will not be able to do any of those things again. But what worries me is going backwards or ruining what I have progressed in. What I don't understand is how people actually return to sports and running?! I can hardly do one squat lol, I just can't imagine. Of course I had multiple surgeries prior and my knee was complete junk at that point, so maybe it depends on how bad your knee was injured prior
ReplyDeleteAnd sorry I'm bothering you with this! It's just nice to talk to someone who is going through the same thing as me. There is just nobody to discuss these things with! My therapist hasn't even seen anyone with my surgery before, so this whole thing has just been kind of random and a guessing game
ReplyDeleteIt's ok. I don't mind hearing your experiences at all. That is one of the reasons I started this blog. I'm on my 4th physical therapist and none of them have had any experience with ACI either so I'm trying to find out as much as possible from other people.
Deleteoh wow. Well I go to a therapist here in town that I like quite a bit. although I would prefer one that had experience with ACI as well. There is a guy I really like about two hours away, I would go to him but he is too far. I do give my current therapist credit, she does well for never seeing anything like this before lol. Also i'm also thinking about seeing another doctor for a second opinion. I do like my current doctor, but he doesn't spend a lot of time answering my questions when I see him. There is one other guy who does ACI in my state and he is supposed to be one of the world's best in cartilage if not the best. You have prob heard of him. Jack Farr. He works at the cartilage restoration center in Indiana. I thought, wow I should def take the advantage of having one of the best cartilage doctors here in my state. I guess people from all over the U.S come to see him. As I said I do like my doctor, but Jack Farrs office seems more advanced and it is soley dedicated to knee cartilage restoration. That is his only focus. Plus he has researchers at his facility that do constant research on the latest cartilage restoration treatments. I thought why not, especially since I have had this flare up for about a month and half now and my doctor can't offer me anything else. I still have a bad feeling about the health of my graft. I se the new guy on Friday, can't wait! I do hate getting second opinions, I try not to go from doctor to doctor, but it has got to get better than this. This cant be the best it gets. I understand that my knee will never be perfect, most people that have this are never perfect. After you have damaged cartilage it will just never be the same, I understand this, but I would like to improve at least a little!!
ReplyDeleteI think getting a second opinion is a great idea. My surgeon doesn't really answer my questions either. Good luck! I hope you get some answers. Let me know what he says.
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