2 Years Post Op

It has been 2 years since my ACI surgery.  

Here are the things I’m able to do:

Running (walk/jog 10 min/mile for 3 miles)

Walking (no limitations or pain)

Hiking (no limitations; minimal pain on steep terrain)

Yoga (any posture; no limitations on knee bending)

Walk up and down stairs with no issues ( I don’t even think about my knee going up and down stairs anymore.  For over a year I used to think about each step and concentrate of flexing my quad and making sure my leg was stable before taking a stair)

Things I can’t do:

On leg squat (on bad leg; this causes pain in my injury site and I feel unstable)

Hop on one leg

Let me explain a little more about running.  I started running in June (about 22 months post op).  By running I mean very slowly jog for about a minute at a time with walking in between.  I really noticed the weakness in my leg when I did this even though I work it out regularly.  My gait also feels different.  I feel like I run differently on my left leg.  It’s almost like I have a slight limp.  I feel a sharp pain if my knee bends a certain degree and I push off with it so I have compensated.  I’m not sure this is the best for me because I worry that I am not running correctly.  Nonetheless, I have been experimenting  and slowly upping the distance and the pace.  Currently I can run about 2 miles non-stop at 10 minute/mile pace with minimal pain. When I run/walk I have gone 3.5 miles as my longest distance.

No problems sitting like this!

I am not sure I will keep running.  For the last 30 days I have not run at all.  The reason for this is I have been in India at a yoga teacher training course to get my 200-hr yoga teacher certification.  I have class about 12 hours a day and do physical yoga for about 3-4 hours a day.  So this program doesn’t leave much time for running.  I have found yoga extremely helpful in my recovery.  Especially balancing on my bad leg.  This has helped me tremendously to build back the strength and flexibility that I lost during the recovery.  I have no limitations concerning yoga. My bad knee is just as flexible as my good knee.  However, I do notice differences in strength and balance.  It is much easier to balance on my good leg and my bad leg tires sooner.  One of the benefits of yoga is that every pose is done on the left and right side so you are isolating parts of the body and staying balanced.  So for poses on the left side I am not able to “cheat” with my right leg by helping like I many subconsciously do during squats.   

Even after 2 years I am still working on building back strength.  There is still a difference in quad size between my left and right leg.  It’s probably not noticeable to other people when they look at me but I can feel the difference in definition when I place my hand on my quads.

After my course I may experiment once again with running.  I think one of the most important things to know about ACI is that recovery continues for years after the surgery.  I have heard the graft continues to harden for a five year period after surgery.           

20 Months Post Op

After my surgeon reviewed my MRI and didn't see anything wrong with the graft, he suggested trying an injection.  He recommended PRP (plasma rich platelet) as the first option or hyaluronic acid.  It was good to hear the graft looked ok in the MRI but puzzling as to why I'm not feeling much different since the surgery.  I decided to go with the PRP injection.  The risks are minimal and it feels good to try something else.

I waited to get the PRP injection for awhile since I had a hiking trip to Patagonia planned. I heard there's a recovery time associated with PRP and I didn't want to be sore for my trip.  I spent 3 days hiking in Patagonia.  I was able to hike 12 miles the first day, 8 miles the second, and 15 miles the last day over some fairly steep terrain.  My knee held up ok.  It was sore and I felt the same pain in my medial femoral condyle but I was able to do this without too much discomfort.  I could tell my left leg is still much weaker that my right leg especially on the steep terrain.  Overall, I am thankful I can still do these kinds of activities but I still hope for more improvement.

PRP involves drawing the patients own blood and putting it in a centrifuge to separate the platelets and plasma from the rest of the blood.  Then the platelet rich plasma is injected back into the joint.  The platelets and plasma offer healing properties and lubrication for damaged joints.  The injection also causes inflammation which is part of the healing process.  From what I've read, there is mixed results about whether or not PRP can help with osteoarthritis. I was told the effects of PRP aren't felt for about 4 weeks.

I received the PRP injection 2 days ago.  The injection was quite painful but it was a quick procedure.  I was told my knee would be sore and stiff over the next couple of days.  I've actually had no pain since the injection and barely any stiffness.  My injection site doesn't even hurt.  I am very surprised at this because I expected to be in a lot worse shape.  I asked when I could work out after the injection and I was told I should take it easy for the next couple of days.  I feel like I would have no trouble doing my normal workout routine but I've decided to take it easy even though I have no additional pain from the injection.  So I am a little perplexed by the lack of pain from the injection and hope the injection is doing what it is supposed to.

I'm curious, has anyone else tried PRP? And what were your results?    

18 Months Post-Op

It's been awhile since I wrote an update.  This is mostly because I haven't had any changes in my knee.  It's been a year and a half since my surgery and I feel the same as before I had the surgery.  I don't feel any relief from my initial symptoms.  Fortunately, I'm not in a lot of pain on a daily basis. But I haven't been able to get back into running which is disappointing.

I got an MRI in Oct.  Unfortunately I had some trouble getting my surgeon to read it since I had to mail the disk.  My surgeon is in San Antonio and I live in New Mexico.  The nurse I have been working with gave me the wrong address and it was returned to sender.  She has been very difficult to deal with and 50% of the time doesn't respond to my emails or phone calls.  Anyway, I finally got my surgeon to look at the MRI.  He said everything looked normal with the graft and the "pothole" in my cartilage looked like it had been filled in successfully.  So I asked, "why do I feel the same as before the surgery?" His response was, "sometimes it's hard to tell exactly what is causing the pain."  I've done some more research on ACI and read several articles in medical journals.  I think I have damage to the subchondral bone beneath the cartilage lesion and while ACI filled in the missing cartilage, it did nothing to address the underlying issue with the bone.  I've read about procedures in which the damaged bone is replaced with a graft and then ACI is performed on top of the bone graft.  It is described as an "ACI sandwich."  I don't know why this wasn't ever addressed with my case.  Maybe my surgeon was not really experienced with ACI.  So I believe my pain is coming from damage to the bone that was never addressed with this procedure.

I don't plan on having any additional surgeries.  At some point I'm sure I'll need a knee replacement but after this experience I'm not in a hurry to do anything surgical.

My surgeon did suggest trying PRP (plasma rich platelet) injections.  So I will try this in the next week or two.  I'm not expecting much from it but it won't hurt to try.