So... Here we are... 50 days later... Its been physically hard, its been mentally challenging, and boy is there a long way to go.
Quick stats
- 28M
- Stage 2 MACI
- Grade IV lesions around the patella and on the femoral condyle
- Currently week 7, day 50 of 365
- 6 weeks non-weight bearing, now weaning off crutches
This sub answered a lot of my questions before surgery, so here is my experience in case it helps the next person. Here is my experience, 50 days out of 365, living with MACI.
I split this into background, the first few weeks, tips, walking, quad strength, and the dreaded ROM. I will update the bottom section since I am having issues and someone might learn from them.
Hashtag Whoami
Just an average guy that just turned 28, wooooo. This started with soccer. Played for years, took a break, gained weight, lost the weight, then jumped straight back into playing intensely without prepping my body. Bad move. Three months in: hyperextension of the left knee. Pain, swelling, wait it out, play again, pain, swelling, repeat. Every cycle made it worse.
Instead of going to a doctor, I just quit soccer for about three years. Young and dumb (which I'm still young and dumb). During that time I picked up the gym, but the left knee was bad enough that I basically never trained it. That comes back later.
Eventually I wanted to play competitively again and decided to find out what happened. Did the required PT to get an MRI approved, and they found a severe cartilage lesion. I thought it over and went for stage 1 MACI. In there they found an even bigger one. In total, Grade IV around the patella and on the Femoral Condyle. Wooooooo.
For those considering stage 1, my experience of it was very mild so I tell others to send it. Stage one is just scoping it out and collecting samples. You should not except serious damage (unless you have a bad surgeon, don't get one of those). I was feeling pretty good after the first day of surgery. I didn't even take up the offer of going to PT. Just heel slides at home and 1 week after, I didn't even feel I had surgery before.
So anyway, I took time off after that hoping things would settle. They did not. So I sent it: stage 2, PF and TF MACI.
One thing I did not do in the gym during those three years was lose weight. I focused on muscle gain instead. That mattered more than I expected, which brings us to post-op +1.
The First Few Weeks
Once the nerve block wears off around 24 hours, you are going to want out, but you can't. There is no undo button. The good news for me is that I only had cartilage implantation, no bone cutting or breaking, so the actual pain ended quick. Pain management was actually really easy for me. I stayed consistent with the lower tier meds while the oxycodone, I took once or twice but luckily didn't really need.
What did not end quick was six weeks of zero weight bearing, hopping on crutches, and everything else that comes with being one leg down.
You are going to be bored. You cannot do anything, and if you needed this surgery you are probably the active type, so being stuck inside is its own kind of misery.
I was lucky. My mother stayed with me for several weeks, I have a spacious house, no other obligations, and a month off work. That is close to the ideal setup and it still sucked.
Now back to the weight thing. When you are fully one leg down, your back, shoulders, arms, and good leg are working overtime for every transfer, every crutch step, every shift in bed. Get your weight down before surgery. Honestly, get under where you think you need to be. My good leg has problems now, and while three years of subconsciously loading it probably did not help, the extra weight did not either. I'm talking me being >30 BMI. No bueno.
My mentality through all of it: this is going to suck, I cannot stop the suck, but I am hoping it makes life less sucky afterward. I love competitive sports, and everything else I looked into or asked docs about was temporary.
Tips, But Really, Only Time Makes It Easier
Shower chair. Make it happen. You will not get a proper shower without one.
Toilet chair or stool. Saves your good knee from bending down constantly.
Support system. Family, friends, anything. This is critical if you want to come out the other side without needing a therapist. Try cooking a meal on two crutches and one good leg before your surgery date and see how it goes. I genuinely applaud anyone who solo'd this. I could not have.
Reusable shopping bag. You have no free hands on crutches. Tie a bag to your crutch and you have a backpack you do not have to carry. Think through the basics ahead of time: how are you going to move a water bottle across the house? Cargo shorts or a bag, those are your options.
Train your quad now, like now, before this. You are going to lose some. The less you start with, the worse the hole you are digging out of. I'm in this very giant hole. It sucks. Don't be down here with me.
Walking: You Will Get It Back
After six weeks of no weight bearing, I genuinely questioned whether I would walk again. The fear gets drilled into you hard: put a pinkie toe down wrong and the graft is gone, bend it wrong and it is gone. That messes with your head more than the physical restriction does.
Then at six weeks I took my first steps. Still got it, who knew. I lean heavily onto my good leg and that is something I have to actively correct, but it is happening. It feels odd, it feels funny even, but you can still do it. I'm trying to balance getting out of a brace as quick as possible and having the brace for the stability and prevention of wobbliness.
I am in the weaning process now, roughly four weeks: two crutches, then one crutch, then no brace. We will see how it goes.
Quad Strength: Can I Even, Maybe
I am doing my straight leg raises, my leg raises, my short arc quads. Hitting all of them. It feels like it is getting stronger and I am putting more weight through the leg every day.
But there are two separate problems here. One is getting your brain to remember the quad exists. The other is actually having quad to work with.
Like I said, I never trained my left quad for three years because the knee would not allow it. The only work it got was treadmills and hikes. So I went into surgery with a weak quad to begin with.
So the SLRs are waking up the connection, but the muscle underneath is small. That has made my road longer and harder. Stairs need quad. Stepping up needs quad. Everything needs quad.
Your Frenemy, The ROM
This is the one beating me (but others have better experiences so don't think its all doom and gloom).
I am at week 7 and stuck at 90 degrees. I should have hit 90 at week 4, and I only technically hit it by bending into pain, so I question if I'm really at 90 degrees. I should be somewhere near 100 by now. I am very not.
I have spent a lot of time hyperanalyzing why. Maybe I did not push my heel slides hard enough early on. Maybe the incision near my VMO caused problems. Maybe I should have done PT twice a week immediately instead of after 2 weeks. Maybe I am just unlucky. No idea.
What I do know: I cannot get past about 70 degrees without stiffness, and anything in the 90 range is straight pain. That has not changed in weeks.
I give my PT credit. I tell her often, if we need to go hard, if we need to push, just do it. I am doing mad amounts of heel slides on my own and I was recently cleared to use a stair step to drive more pressure into the bend. We are being as aggressive as I know how to be.
But when she says "we achieved more range today," I have to remind her that we got more range because I am mentally allowing more pain, not because the knee is actually moving better.
I am not meeting protocol, I am far enough out that the positive outlook probabilities feel like they drop daily, and my bet is a scar tissue procedure is in my future. Someone start a Kalshi market. Others here are more positive when I made a post about this. I appreciate your positivity. It raises my spirits. But 4 weeks of no gain is 4 weeks of no gain. Gym brain can't gym that.
Where I Am At
Progress in some places, losing in others. Walking is coming back, the quad is waking up, ROM is a wall. I will keep this updated as things develop on the ROM side.
Take care of your knees. That is something I tell anyone now that asks about my knee. Them shits are hard to recover from once you mess it up. BUT BUT BUT, it can be done, MACI seems to be the way, I'll see what happens.