Skip to Content

A year after ACI / AMZ knee reconstruction surgery

A year after ACI / AMZ knee reconstruction surgery

I have always been active, playing most sports in high school and then football in college. After all of that, I started to run, and it got to be pretty important to me.

However, slowly but surely, running started to hurt with every step. Not screaming pain, but more like a pain telling you ‘If you keep doing this you are not going to be able to walk when you at older,’ type of pain.

I still wanted to run, so I said to myself let’s try and fix this! I have had 200 + physical therapy appointments and five knee surgeries. This post is to celebrate, and reflect one year after my biggest, and most recent surgery!

AMZ ACI Knee Surgery

All this, and I still can’t even come close to running. In fact, it is significantly worse than it was before. It’s still not possible to kneel in my reconstructed knee, and running is intense pain.

Long bus rides are torture, and huge temple stairs are intimidating. I find myself at the back of the pack of a hike even with significant Ibuprofen consumption. Worst of all getting into position for that perfect photo, I sometimes get stuck like an 80-year-old man.

This past month, it has been a year since I had some major work done, and I wanted to take you through what it’s been like & how it affects my travels.

First of all, what is an AMZ / ACI?

Sounds complicated… well, it is.

The first set of letters – ACI: stands for Artificial Cartilage Implant. Yes, I have cartilage that was taken from my knee in a previous surgery, synthesized in a lab in Boston, and then stuck back into my knee.

The Second set of letters – AMZ: stands for extremely painful and aggressive surgery, well actually, it stands for this long word: Anteromedialization! Okay, what the hell is that? Well, my kneecaps don’t fit properly in my knee joint.

The kneecap glides back and forth in a track, but mine weren’t exactly lined up, so the doctors had to basically realign them. Once they are realigned, they can put back on the new cartilage from the ACI part above, and I will be back in business.

Okay, the next part is a bit graphically described, if that kind of stuff bothers you, I have included a picture of a rainbow.

rainbow nica sjds

I still haven’t fully explained what all goes into the AMZ: In order to change the location of my knee cap, the doctors cut my tibia bone (the larger of the two lower leg bones about 2/3 of the way through and 4″ long from the front, and another 2/3 from the side same length.

So there is a chunk of bone still with a strap of tendon hooked on the other end to my knee cap. The bone piece is the ground and shaped to change the profile of my kneecap track. After it’s perfect, it is screwed the main part of what’s left of my tibia. Sounds fun, right? No, it’s as painful as it sounds.

Just head to YouTube for some graphic videos here is an animated version that is less gruesome, but if you want to see the real deal, there are probably others on the side.

Here is what I have been going through for the last year:

The first week after surgery hurt like hell, even with lots of bottles of Oxy this and Oxy that, my shin throbbed to the point it was the only thing I could concentrate on.

For a good two weeks, I was pretty dependent on Hannah for most things, along with frequent help from my parents. By two weeks, I had stopped pain meds but was still stuck in bed, only moving when I had to go to an appointment or the bathroom.

If you found this article while contemplating this surgery, feel free to ask any questions. Expect this to impact 6 months of your life significantly. I put a good effort into therapy, and all of the doctor’s week marks of what I was supposed to be able to do things were underestimated by quite a bit.

For example, I was supposed to be walking by six weeks, and I was taking steps, but I would hardly call it walking until the 2-month mark. Then, back to full activity by six months; it’s been 12, and I am still limited. Running is painful, basically not possible, even a few steps (which was part of the point of having this survey).

Other effects of the surgery:

You know how annoying it is not being able to kneel on my knee? Very! I’m not sure what about the surgery did this, but it is very sensitive to touch. Even wearing pants that are tighter in the knee will aggravate it. Kneeling and putting weight on it produces a sharp pain. It is basically like hitting your funny bone, that kind of sharp, intense pain. So, taking photos or checking under the hotel bed is always a struggle.

It’s not a total loss because I still have done most things I wanted to do on this RTW trip so far, like hiking in Guatemala, surfing in Costa Rica, carrying around my 21kg backpack, walking on average 8-10 miles per day. It just slows me down, and I can’t do as much, I need more breaks, or I will suffer the next days. We ride public transport almost daily, and every bus ride reminds me that I had my knee ripped apart.

I chose today to post this article because I am still feeling the effects of climbing up to the ruins of Machu Picchu! Even with the help of a walking stick and a bunch of Ibuprofen!

Madeline D

Saturday 3rd of April 2021

I am now 26 but have been dealing with this pain for ten years. My first knee surgery was when I was 19 for patellar instability. Lateral release in 2013, scope/meniscus issues in 2015 and TTO in 2019. May 31st will make two years since the TTO. My recovery was terrible but I also got two infections that pushed me back a good bit. My surgery was on 5/31/19 and I returned to would 7/31/19 STILL on a cane because I was still having issues weight bearing. I only spent one night in the hospital. The nurses were TERRIBLE and refused to give me pain meds stronger than tramadol. I left AMA because I couldn’t take it and no one was listening. They wanted me to stay another 1-2 nights. It took almost a year to feel relatively normal again. Now that I am going on two years, I am feeling bad pain again. However, it is NOT the pain I felt before the surgery. My pain is all on the inside side of my kneecap and different than I’ve ever had. I can’t bend my knee all the way (which I was doing before the pain). I am really at a loss. I’ll be 27 in June. My doctor thinks that a “fluid channel” opened up which is now causing fluid to build up where it isn’t supposed to. He thinks that’s what is causing my pain. In Oct 2020, I had the three screws removed hoping that would help me. My knee felt better for a while and I was even doing some light jogging until this new pain started. I saw him yesterday (4/2/21) and he mentioned pain management first but ultimately wants to open my knee back up. I think something worse is going on than just fluid so I’m not opposed to the scope but something about having a 5th surgery on the same knee before I’m 27 just kills me. My husband and mom said that I might need to just “deal with it”. But I’m YOUNG. I don’t have any children yet. I am a teacher so my job is to be up on my feet all the time.

I wouldn’t say I regret having the TTO. My pain beforehand was unbearable and now I can at least live day to day without that same pain I had for ten years. Yes, something is going on with my knee again but I am praying it isn’t forever. If it is fluid like he claims, that can be remedied. I have virtually zero cartilage left in either knee because of the way my knee cap has rubbed on my bone for years. I NEVER sustained any trauma to this knee either. I ran a lot in high school and it turns out my knee is just shaped funny and does not allow for my patella to stay in place.

I knew going into the TTO that I would never be able to do many things and be active at 100%. But I wasn’t even close to doing it before. Now I can tolerate some things I couldn’t before. I just don’t know what to do now. This is not something I want to “live with” for the rest of my life!


Friday 20th of November 2020

I also feel your pain - I have had 3 L/Knee surgeries with my last being the fulkerson procedure (AMZ) with allograft ligament inserted. The pain is indescribable. I will not have another knee surgery until I can no longer walk (traumatized just a tad). My surgery was in 2015-2016 (I don't recall exact), and the left side of my leg is still "pins and needles" with numbness. I was told it would go away after approximately 6 months (here I am x's 10). Kneeling is impossible. Instead of kneeling, I'm a grown man that has to sit on the ground - my wife is usually there to help me get back up. All of this at 31-32 years 36.

I have not been able to run since 2014, which like the original poster, I feel I was better prior to my first surgery. I was also talked into removed the screw in my tibia to remove some of the pain - that did nothing for me. Just a pay day for the doctor....

It is sad to say - I wish there weren't as many people who suffer after these type of surgery. 80% success rate and 60% full recover back to normal activities rate...

Just Another Droid

Friday 25th of September 2020

Hi. I'm pleased I've found this thread. 27 years ago I had what my consultant now describes as a "barbaric open lateral release and reefing" to my right knee. It's never been great since then - subluxations several times a day but so long as I've stayed fit and active with some decent muscle tone I've been ok and it's been manageable - relocating my knee cap has become a part of every day life! If it's been hurting, there's been a reason and I've dealt with it. That was until about a year ago when it just started hurting for no obvious reason and has not abated. I've been on strong pain meds ever since. Fast forward to now and I'm having a fulkerson osteotomy and lateral patellofemoral ligament reconstruction to reverse the lateral release in 10 days time. Yeah, I'm nervous. I know it's going to hurt but I just hope it's going to sort the problem. I am an active 53 year old and still too young for a total replacement. My job requires me to have a level of fitness and I have been in restricted duties for 6 months now. I just hope this is going to be worth it!


Tuesday 26th of May 2020

Adam I have a very similar situation to you. I am 27 now and have had 6 surgeries on my knee. I was super active as a kid and played soccer, bball, lacrosse, vball... After the first 5 surgeries strength and function never rly got worse, but because of the chronic pain i decided to try out a lateral release (lengthening surgery). It was the worse decision of my life. Not only did it make my pain worse but now I have almost no strength in my leg and can't even run. My doctor was very young and really had no business doing the surgery. It was the worst decision in my life and now 6 months post op I'm extremely depressed and suicidal :(


Thursday 11th of February 2021

Same here on everything you said. Worse Decision of my life, can't run, can't do half the things I want to. I didn't see this comment until now. I hope you are doing better. As bad as it feels there still a lot to live for. I hope you find a new passion, it took me a few years of being pissed off at the doctors and the world.

Shelly Thorpe

Tuesday 28th of January 2020

So I had the fulkerson procedure to my left knee/leg in 2017. Before that I had several surgeries on the same knee to repair meniscal tear, do lateral releases, basically different stuff to prolong the inevitable fulkerson procedure. I did not have the best experience with the surgery. Not only was my surgeon horrible with bedside manner but he actually used a screw that was too long and so it was tearing at my tendons and ligaments (so he said) so he went back in 5weeks post op and completely removed the screw when the bone was only 90% healed (per the CT scan). Now fast forward in June of this year will be 3 years and I'm still having pain. Most of it is on the lateral anterior side of my calf, and below the knee cap is so tender to even the slightest touch. Also around the scar is still really numb. I am a RN and I do work atleast 40hrs/week on the floor, and I am a mother yo a toddler but I'm only 35. I honestly feel like I should not be still having this much pain and issues 3yrs out of surgery. Especially when I was told this will be the end all and it will fix all the problems that I would have no more issues or pain from this knee. I have seen my surgeon's counter part in the office several times and it seems like he is just blowing me off, no MRI only xray and no real diagnostic testing. It pretty much feels like he doesn't either want anything to do with this or he wants to stay away because something was done incorrectly. So I guess my question is: is what I'm going through normal or should I see a total different orthopedic for diagnostic answers to my issues?


Sunday 5th of April 2020

It sounds just like my story, except tearing tendons part. I have seen 2 surgeons since my surgery (8 years ago) and both said there isn't much else to do until you are old enough for a knee replacement which is another 15 years away for me with the magic number being somewhere around 50. But you owe it to yourself to find another opinion and see if there isn't some kind of relief, but I would try to find someone who is at least familiar with the procedure. Hope it gets better for you!