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Author Topic: Arthrofibrosis Specialist FOUND  (Read 16077 times)

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Offline hottubpam

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Arthrofibrosis Specialist FOUND
« on: December 03, 2004, 03:22:04 AM »
I met with Dr. Eakin in Palo Alto (formerly a fellow at the Steadman Hawkins Clinic) and he spent a lot of time with me, probably more time then my previous 2 OS’s combined.  Dr. E did a thorough hands on exam of both knees, took xrays and took a detailed history from me.  Although I brought the records from both previous surgeons, E seemed much more interested in MY account of what had transpired with the knee.  How refreshing.

He explained in detail what course of action he is proposing with my knee, drew me pictures and went over my xrays with me.  He said he has dealt with cases of arthrofibrosis that are much much worse then mine.  In fact he says I'm a moderate case of arthrofibrosis not severe.  I have surgery scheduled for Dec. 29 and will have an insufflation (injection of saline solution into the knee to break up the scar tissue and then suctioning it out) also he will perform an anterior interval release and a lateral release all under general anesthesia.   I will remain in the hospital overnight.  I then will be placed in a CPM (continuous passive motion machine) for several days/weeks.  He has ordered one for me to take home.  His theory is that you have to fool the knee into thinking it has NOT suffered any trauma.  Then 1 week post op I go back for a cortisone injection into the knee to keep the swelling down and prevent scar tissue from growing.  I may have to have another shot done again several weeks later, depends on the knee.  He has a definitive plan for post op treatment to prevent recurrence of scar tissue.

He says there is a 70-75% chance I will be totally happy with the outcome, i.e. return to skiing, etc.  There is a 20-25% chance that I will say thank you dr., you did the best you could, but this is not good enough and less then a 1% chance that he will actually make the knee worse.  

On Dec. 1, I met with a different OS in Aspen.  He says he invented ACL reconstruction surgery.  I do know that he is quite well known in orthopedic circles.  He is about 70 years old and just moved from Birmingham, Alabama (and a noted sports rehab clinic) to Aspen.  He also spent a lot of time with me and took xrays and drew me pictures.  His recommendation was to do the anterior interval release and the lateral release (same as Dr. E).  He did not mention anything about insufflation.  He also said that I had about a 70% chance of returning to skiing.  The reason I am not selecting the Aspen OS as my new surgeon is that when I asked him what would we do to prevent scar tissue from recurring he said We would pray.  I think he was joking.   He went on to say that excessive scar tissue occurs most frequently in African Americans people and that I didn’t “look” like I was prone to growing scar tissue.  Well, I've grown excessive amounts of scar tissue 3 times this year, so I think he is dead wrong about that.

So I am really excited about the outlook and looking forward to the surgery on 12/29, even though it will be my 3rd knee op this year.  I have really good vibes about this one.  Third times a charm.

I know that Heather, Janet, Laurie, Jennifer and Jaci to name a few have all been through this and their advice and posts on this site have been a knee-saver.  For those of you that have just begun to fight arthrofibrosis, the very best advice is to get yourself an OS that has LOTS of experience in dealing with this rare and complicated condition.  Do NOT settle for anything less than an arthrofibrosis specialist!!!!!!

Some warning signs that your dr. might NOT  be an arthrofibrosis specialist:

Do they recommend MUA?
Do they tell you just keep going to PT, work through the pain?
Do they seem to "blame you" for the problem; accusing you of not complying with PT, home exercises etc.?
Finally ask them, how many patients with arthrofibrosis have they treated?

I'll keep you all posted, but right now I'm pretty optimistic that I've found someone who can "fix" this knee.  Oh yeah, besides the arthrofibrosis, I have infra patellar contracture but NOT patellar baja.

Pam
 
« Last Edit: January 21, 2006, 08:11:29 PM by The KNEEguru »
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

bumbknee00

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Re: Arthrofibrosis Specialist FOUND
« Reply #1 on: December 03, 2004, 03:59:52 AM »
Pam,

    I just read your reply to my post and thank you. I have read your post and that is great you have some positive perspectives. I was wondering what do you mean by MUA? When I was reading your post I told myself I need to ask my OS about the saline solution to help break up the scar tissue. I have been reading lots on here and getting info to ask him when I see him again in a few weeks.

       I just became a member on this site last night so this is all new to me. I'am not sure if seeking out of state right now is an option. I need to educate myself more before I look down that road. I just went through this research stuff with infertility and debating about going to Dr's out of state, so I need to get educated first.

       But what do you do when your OS says yes he has seen a few of these cases and yes they do get better it's just arthrofibrosis can take a long time to burn itself out, that is what he says. He is one of the best knee Orthopaedics around but this arthrofibrosis is very difficult to get rid of. He says I will walk again it just takes time. ???

          Again I wish you the best and I have learned some techniques I will pass by him from your post and thanks again for your response to my post.

                                  Kelly ???

Offline hottubpam

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Re: Arthrofibrosis Specialist FOUND
« Reply #2 on: December 03, 2004, 05:50:47 PM »
Hi Kelly,

An MUA is manipulation under anesthesia.  The surgeon under general anesthesia tries to break up scar tissue for forcing the knee into full extension and full flexion.  This can't be done other then under general anesthesia because the pain would be too unbearable.  

Many surgeons, perform the MUA after they have done some scar tissue removal, to assure themselves that full range of motion (ROM) has been restored.  This is what I had done.  However, since my surgeon had not removed ALL the scar tissue, it was still a traumatic procedure as reflected in his op report which stated "the knee was ultimately flexed to 130 degrees with audible and palpable release of tissue".  He could hear and feel some of the scar tissue breaking up.  A day or two after the procedure, I had bruising from my hib/butt to my ankle that lasted for well over a week.  I think that trauma caused scar tissue to start forming again.

I know how difficult (and costly) the decision to go out of state can be.  I resisted it too.  After my first surgery was botched, I went to THE best OS in the state, who also lived where I do.  He is even listed on Knee.guru.com as one of the best.  However, he has almost NO experience in dealing with arthrofibrosis and he just didn;t know how to treat it.

I do not believe that scar tissue "will burn itself out".  Another red flag in your message is that your OS says "you will walk again, it just takes time".  Both of my former 2 surgeons said the same thing.  All the time in the world will not help arthrofibrosis if you are not getting the right treatment.

From reading some of the old posts on this site, I know that some of the drs. that have worked at the Steadman Hawkins clinic are willing to work with other orthopedic surgeons and coach them through the Steadman Hawkins protocol for arthrofibrosis.  If you decide to stay with your current OS, you might see if he would be willing to do that.   However, so many of the OS have superinflated egos, that they do not want to take direction from anyone else.

I can't tell you how relieved I am to have found an arthrofibrosis specialist.  I only wish I had listened to others on this web site sooner.  I think I could have saved myself at least 1 surgery.

Best of luck to you.  And if you have any other questions, please let me know.

Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline Sarahreindeer12

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Re: Arthrofibrosis Specialist FOUND
« Reply #3 on: December 03, 2004, 10:49:24 PM »
""From reading some of the old posts on this site, I know that some of the drs. that have worked at the Steadman Hawkins clinic are willing to work with other orthopedic surgeons and coach them through the Steadman Hawkins protocol for arthrofibrosis.  If you decide to stay with your current OS, you might see if he would be willing to do that.   However, so many of the OS have superinflated egos, that they do not want to take direction from anyone else. ""


That is REALLY good to know. I am getting a second opinion next week and will definitely pass this along!!  Sarah

Offline Janet

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Re: Arthrofibrosis Specialist FOUND
« Reply #4 on: December 05, 2004, 11:40:25 PM »
Pam:

Good for you! It sounds like you found a doctor who knows what he's talking about. In fact, someone else heer (sorry, I can't remember who) is a patient of Dr. Eakin.

Just remember that the rehab protocol is very important.
If I remember correctly, Dr. Eakin doesn't have his own rehab facility. So it is important to "interview" a therapist to find out if they have worked with arthrofibrosis patients before and to make sure they will follow the dr's protocol even if it is different from what they are used to.

Good luck to you. I hope everything goes really well. Keep us updated!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline Jaci

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Re: Arthrofibrosis Specialist FOUND
« Reply #5 on: December 06, 2004, 08:40:35 AM »
Hello, Pam.

What great news.

I was really impressed with Dr. E when I saw him in June. I seriously considered having him treat my knee, but decided that Steadman Hawkins was a better choice for my particular situation.

Are you planning to stay in Palo Alto (or the surrounding area) for an extended period after your surgery? Palo Alto Medical Foundation does not have negotiated special rates with local hotels. However, the patient coordinator at PAMF mentioned that Stanford Medical Center does and that it might be worth contacting some of the hotels to see if they'd offer a special rate. I found a list of hotels on Stanford's website, but never called any of them. I looked into corporate housing since I planned to stay 6 to 8 weeks for PT and follow-up (based on my knee's previous inflammatory response). Oakwood apartments had a great setup and was reasonably priced.

Good luck with your surgery and rehab. I'm keeping my fingers crossed that surgery #3 will be the end of your scar tissue problems.

Regards,

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline hottubpam

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Re: Arthrofibrosis Specialist FOUND
« Reply #6 on: December 06, 2004, 06:26:12 PM »
Janet,

You are right that Dr. Eakin doesn't have his own PT facility.  He and I discussed the post op protocol and the first week or so it will consist of CPM (he ordered one for me) and a bike with zero resistance.  I have opted to continue with my PT near where I live, who is more then willing to follow the arthrofibrosis protocol,  He does not have a lot of experience with arthrofibrosis but he has been doing his research, as have I.  I think between Dr. E's Rx for PT and my knowledge of the "Steadman" protocol it will work out.

Also after reading the histories of other arthrofibrosis patients on this web site, I know I'm not as severe a case as most of you.  I know my knee produces excessive scar tissue as a result of trauma, that's why I like Dr. E's theory of "fooling" the knee into thinking it has not suffered trauma and doing mild to moderate PT at first.  Prior 2 surgeries were VERY traumatic and afterwards in in PT both of the prior surgeons said I should "work through the pain".  I was in tears a couple times.  We all know this is about the worst thing you can do for arthrofibrosis sufferers.

I will keep you  posted.  The difficult part for me now is waiting for the surgery on Dec. 29.  I hope the time goes quickly, because I am really ready and totally optimistic for the first time in 10 months, that real recovery is at hand.

Thanks for you input.
Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline hottubpam

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Re: Arthrofibrosis Specialist FOUND
« Reply #7 on: December 06, 2004, 06:56:22 PM »
Hi Jaci,

How are you doing?????  I have read your posts from way back when.  I was a bit concerned when I did not see anything new from you for several days/weeks.  Are you still in Vail?  What's your prognosis???  I think you have had a really tough time and I admire your perserverance.

I just don't think my case is as severe as yours because, number 1 my 1st OS was a quack and not only put the ACL graft in WRONG (mal-positioned at the far anterior notch) but also he operated way too early.  I only had 90 degree flexion when he operated and although his Op report states he did "debride the area" I doubt if he got all the scar tissue out.  The pain for the first 3 days after this surgery was as close to unbearable as I have ever experienced.  

The second surgery by a different OS took out the mal positioned acl graft, cyclops lesion and a ton of scar tissue.  However even though this OS is the best in the State I do not think he got all the scar tissue, since his Op report states that when he did the MUA there was audible and palpable release of tissue.  The PT he ordered was very aggressive and painful.  Although the immediate post op pain was not nearly as bad as the first surgery, probably cuz I had a femoral nerve block and a better technical surgeon.

I am planning to stay in the Palo Alto area for a while and I am looking into accommodations.  I have found one hotel with discount rates for Stanford Hospital patients and I thought maybe I'd contact them to see if I could get the same deal.  Thanks for the suggestion to check Stanford's web site.  I will do that this a.m.

I don't plan to stay much more then a week, unless Dr. E changes his mind and thinks I need to.  At our meeting last week, he feels comfortable working with my PT who is the 3rd one I've worked with since Feb.  and I REALLY like him.  He has worked diligently with me and spends a lot of time with me.  I went every day for the first month.  Also Dr. E has ordered a CPM for me and I'm buying an exercise bike that can be set at passive resistance.  One other thing Dr. E will be doing is cortisone shots and has recommended anti-inflammatory drugs.  Neither of my prior 2 OS's even mentioned cortisone OR anti-inflammatory medication - not even aspirin.  My PT did recommend aspirin or Ibuprofen.  I opted for the aspiring (cuz my stomach won't tolerate ibuprofen - it aggravates an old esophageal ulcer I had years ago).  For some reason I can take moderate amounts of aspirin with no ill effects and it did reduce the swelling in my knee significantly, although my left knee is still about an inch larger then the right.

Well I seem to be rambling a bit.  Please drop me a note and let me know how you are doing.  I sure hope you are finally on the road to recovery.    

Pam

P.S.  I'm still on the wait list at Steadman, so if anything goes wrong with Dr. E - I'll be flying out to Vail.
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline favouritesearcher

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Re: Arthrofibrosis Specialist FOUND
« Reply #8 on: December 24, 2004, 05:15:07 AM »
Hi Pam,

When you write the story of your 29th December procedure, could you put something in about when to start mobilising the kneecap and patellar tendon?  Good luck with that.

I'm very, very interested in the outcome as my ROM is about the same as yours, but without too much pain, and I'm considering on 18th Feb whether to try to improve it or not.  I'm curious about whether starting on day 1 risks the portals coming undone or causing bleeding.

One thing I have to say to you especially is that getting better needs to be your #1 priority; from some of yoru posts, it seems that it's not always.  I've spent 4-5 hours a day on mine, every day, for over four months and I'm still not able to walk properly.  I don't think you can afford to take time off for holidays, even a day.  It takes over a year to build up the muscles so you should put aside a year of your live to recover.

It's amazing how much better it starts to feel once the muscles have built up a bit.  My 30 degree limp was actually caused mainly by weakness in the muscles all the way up the leg into the back.

Also, when mobilising the kneecap, is that just moving it from side to side and up and down the leg?

I too have infrapatellar contracture and it seems to be what's stopping the flexion going much past 125 (when stretched - 110 normally).  After 90, the kneecap is pulled right into the joint and a mass of tissue swells out on the lateral side next to the patellar tendon.  My extension is +7, probably won't get better as there is a screw embedded in the ACL which I suspect has made it swollen.  I'm interested to follow your story and see if the contracture can be made better.

Regards

John
Mar 04 - avulsion fracture of the tibial spine (ACL attachment) while skiing
Aug 04 - scar tissue clean up
Mar 04 - Tibial spine avulsion fracture (skiing). Open surgery to fix, 1 screw.  Max passive ROM 20-75, active ROM 30-45
Aug 04 - Diag. severe arthro. Scar tissue clean up (LOA, removal of scar tissue).
Feb 05 - Discharged from surgeon's care. ROM 3-125.
Apr 05 - Discharged from physio. Same ROM

Offline Heather M.

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Re: Arthrofibrosis Specialist FOUND
« Reply #9 on: December 24, 2004, 11:40:16 AM »
John,

Here's some links to posts where patellar mobilizations were discussed in detail.  I had to move in all directions--picture a knee as a clock.  I had to go from the defaul position, if you will, to every "number" on the clock.  I'd do #12 for 1 minute or so, then jump to the opposite one--#6.  Then from #3 to #9, nd so forth until I went all the way around the "clock."  I'd also do circular work in halves--so 9 to 3, then back again via 12, repeat.  I also spent time pressing down on the very top center of my patella (12 to someone standing in front of me and looking at my knee, which is how we labeled the views).  When I'd press firmly on 12 (the top center of patella), that tipped the #6 position up--basically got it off of my tibia.  So we wanted to work particularly hard on stretching the scar tissue/adhesions/contracted tissue around the bottom of my kneecap.  I spent a lot more time going up from #6 to #12 than going the other direction...my knee was doing that just fine on its own, which is why I have patella baja.

Also included in the patellar mobilizations was work on the patellar tendon--massaging it in lengthening strokes, pushing it from side to side, friction massage by rubbing hands in opposing directions horizontally across kneecap, using firm pressure and moving both hands at the same time.  It's somewhat like giving someone a friction burn (known as an Indian burn in those non-PC days!), if you remember those days from childhood.  This cross friction massage was meant to promote flexibility in my hardened, contracted patellar tendon.

Check out this post with a lot of discussion and ideas about mobilizing the patella and soft tissue around the knee.  About halfway through the thread that follows, I put in two posts with step by step instructions on the mobilizations.  It' s wierd, but I never did them at all until I saw my latest surgeon...
http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=4;action=display;num=1084920388;start=3#3

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline hottubpam

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Re: Arthrofibrosis Specialist FOUND
« Reply #10 on: December 24, 2004, 05:58:10 PM »
John,

I will definitely post the results of my surgery and post op protocol as soon as I can get access to a computer.  

Believe me rehabbing my knee has been my number one priority since the accident Feb 4, 2004.  However once the scar tissue has "taken root" I have been advised by both my second and third OS that all the PT in the world will not improve my ROM, in fact some PT and some exercises can actually make the scar tissue worse.

At those times, when the OS has said PT has stopped helping, that's when I  have ceased PT and taking "vacations", travelled etc.  Even at those times I do passive type exercises.  For instance right now I am in Florida at my brother's house for Christmas and yesterday I went to "work out" with them at their swimming pool.  My brother's kids are both competitive swimmer's, and his wife is in the master's swimming program so they have access to an awesome pool and instructor.  We did laps for about an hour with some guidance by the instructor for our particular needs.  It felt great and didn't irritate my knee at all.

My patellar moves pretty well, and I do patellar mobs throughout the day.  I have even taught my 13 year old niece how to do the side to side mobs (I guess this is the 3 to 9 oclock range Heather mentioned).  I have a hard time getting a good grip to really do these mobs and my nieve is awesome.

My flexion is stuck at 90 - 100 and extension is in the 10-15 range.  Limping still, I can climb up stairs, can't climb down them.

I'll keep you posted.

Happy Holidays,
Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline favouritesearcher

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Re: Arthrofibrosis Specialist FOUND
« Reply #11 on: January 03, 2005, 09:42:54 AM »
Hi Heather,

Thanks for the advice on the kneecap mobs and also the patellar tendon massage.  I hadn't thought of pushing the kneecap into the joint at the quadriceps end in order to make it pop up at the tibia end.

I have to admit that I've been a little slack with the kneecap mobs, only doing them 6 times a day for 5 mins at a time (30 mins in all).  This is probably why, unlike Pam, my bad kneecap is hard to move whereas on the good leg it's like a puck on ice.

Pam, two other pool exercises I was shown were toe walking (forwards and backwards making sure to fully extend), normal walking (both directions) and 30 mins of stretches (calves, hamstrings, and leg out sideways).  Might be useful in future.  I envy you having a niece to help with the mobs ... they're so-o-o boring and the hands get sore after a while.

John
Mar 04 - Tibial spine avulsion fracture (skiing). Open surgery to fix, 1 screw.  Max passive ROM 20-75, active ROM 30-45
Aug 04 - Diag. severe arthro. Scar tissue clean up (LOA, removal of scar tissue).
Feb 05 - Discharged from surgeon's care. ROM 3-125.
Apr 05 - Discharged from physio. Same ROM

Offline hottubpam

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Re: Arthrofibrosis Specialist FOUND
« Reply #12 on: January 05, 2005, 05:41:33 AM »
John,

Thanks for the info on pool exercises.  I can't wait to get back into the pool, but since the stitches are still in, I have to wait at least another week before I can even take a complete bath.

Just FYI, my OS said patella mobs are VERY VERY VERY important and to do them multiple times a day if I really wanted to get back to normal.  Both the side to side mobs and the up and down mobs.  For the up and down mobs Dr E said to push the patella down towards the ankle and then fire the quad and then release.  My quad doesn't fire real well, but good enough I guess.  So this is my new way of doing them.

Let me  know if you have any questions.

Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06

Offline streamwalker

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Re: Arthrofibrosis Specialist FOUND
« Reply #13 on: January 11, 2005, 03:18:41 PM »
Hi Pam,
I have a similar background to you and I'm looking for a scar tissue specialist. I seem to have tremendous regrowth of scar tissue and pain and stiffness. I am not African American but have been told the same percentages as you; with regards to regrowth of scar tissue.
I'm curious that you were in Aspen so close to the Steadman/ Hawkins Clinic...I've been told Dr. John Richard Steadman is a top name specialist in Vail...Curious as to why you have not considered him?
Thanks,
Ric
ACL Recon, MCL Repair, 3 Medial & Lateral meniscus repairs, 4 scar tissue removals, all in R. knee

Offline hottubpam

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Re: Arthrofibrosis Specialist FOUND
« Reply #14 on: January 11, 2005, 04:37:59 PM »
Ric.

You are right that Dr. Steadman is one of (if not the best) OS for arthrofibrosis.

And I did call Dr, Steadman's office first.  However I was told there was a 2-3 month wait to get into to see him.  Since my condition seemed to be deteriorating I did not want to wait that long.  

Instead I found a dr closer to where I live (although still 200+ miles away) that had been a fellow at the Steadman Clinic.  He follows the Steadman protocol and I think he is terrific.   He was also able to see me within a month of my original phone call.  

Also Dr. S does NOT take my insurance so I was looking at a hefty cost plus all the related travel/lodging expenses.  My out of pocket for the 3 surgeries and post op to date continue to mount and I don't want to even contemplate what going to Dr. S would cost me.

I'm confident I made the right decision for me.  Only time will tell for sure.

Good luck to you.
Pam
ACLR, Menisectomy 3/04; ACL resection, Cyclops lesion removal, LOA & MUA 10/04; LOA, LR & AIR 12/29/04;#4&5 surgery on 2/9/05 & 3/2/05 debridement, irrigation & lavage, portal closure; #6  LOA, AIR, LR & other releases 12/9/05; #7 surgery 1/18/06 portal closure, lavage, debrid etc #8 skin graft 3/06