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Author Topic: Dr. Mandelbaum  (Read 1484 times)

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Offline laforce18

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Dr. Mandelbaum
« on: September 02, 2006, 03:23:43 AM »
Hi all,
I have had 2 surgeries within the last 6 months for my knee.  I tore my ACL, had it reconstructed in March and then an arthroscopy in june. I still don't have extension (about 2 degrees) which i know is not horrible, but trying to run is very difficult as my hip is now hurting and there is constant pain in my knee.  I have heard that Dr. Mandelbaum is the greatest orthopedist around, and I was just informed that he takes HMO's.  Does anyone know if this is the case!!  ???I wish I knew that he accepted that before, I would not be in the situation I am in now.  Should I get another opinion, or wait??? I play soccer religiously, am a pe. coach and a soccer coach.  I can live a normal life, but I really want to be in shape and playing again!!
thanks for your input..
Shannon
Shannon
ACL allograft 3-22-06
lat rel and manip 6-29-06
patella femoral arthrofibrosis
lat rel and chrondplasty  9-26-06
arthroscopic surgery scope 6-12-07
lateral meniscus tear, cartilage and scar tissue removal

Offline Jaci

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Re: Dr. Mandelbaum
« Reply #1 on: September 02, 2006, 02:19:59 PM »
Hello Shannon,

Sorry to hear that you are still having problems with your knee.

I know Dr. Mandelbaum is well-known for his work with cartilage restoration procedures such as ACI (autologous chondrocyte implantation). He may have experience dealing with scar tissue problems since they sometimes occur following cartilage restoration. It certainly wouldn't hurt to see him for a consultation.

Jaci

PS-- I know he also works a lot with soccer players so maybe he has seen his fair-share of ACL recons as well.
« Last Edit: September 03, 2006, 10:45:36 PM by 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 laforce18

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Re: Dr. Mandelbaum
« Reply #2 on: September 03, 2006, 01:59:10 AM »
Thanks for your reply... again...Jaci.  Yes I am still having problems.  Do you know anyone who has used him?? I was just making usre that he took HMO"s.   ???
Shannon
Shannon
ACL allograft 3-22-06
lat rel and manip 6-29-06
patella femoral arthrofibrosis
lat rel and chrondplasty  9-26-06
arthroscopic surgery scope 6-12-07
lateral meniscus tear, cartilage and scar tissue removal

Offline Jaci

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Re: Dr. Mandelbaum
« Reply #3 on: September 03, 2006, 03:10:17 AM »
Hello Shannon,

You'll need to find out if he is a provider for your specific HMO, not HMOs in general. Your HMO may have a website where you can check the specialists that work within their provider group. You could also try calling your HMO to find out or calling Dr. Mandelbaum's office. In any case, if he is within your provider group, you'll still need to follow your HMO rules for seeing a specialist. In most cases that means your care is directed by your GP and you'll have to get a referral to Dr. Mandelbaum using your HMO established referral procedure. Some insurance policies for HMO allow people to self-refer for a consultation with certain specialists. You'll have to check in the evidence of coverage from your insurance provider or call their customer service.

I was a little surprised that you mentioned running in your post. It seems way too early to be trying that.

Take care,

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 laforce18

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Re: Dr. Mandelbaum
« Reply #4 on: September 03, 2006, 05:15:21 AM »
Jaci...I just looked and he is in my HMo Plan!! ;D I am so excited.  Yeah...I finished pt about 2 weeks ago with running for about 20 minutes on the treadmill.  The pain was not that bad then, but it seems to be getting worse with time.  It has been amlost 6 months since my first surgery, and I know each person is different, but a normal person would be back playing by now.  It is so frustrating knowing that I am nowhere near ready to play.  I don't run much, maybe 10 minutes at a time, but I thought I would be able to build and run further, but no such luck.  I really just want to get a mri to see if there is anything wrong in there.  It hurts down my shin sometimes, and aolt in the back of my knee.  It just doesn't seem normal.  I have been really patient, i think with my exercises and I never push myself to the point of discomfort...except with the running.  I expected it to hurt a little, and go away, but it just hasn't.  what do you think???
Shannon
Shannon
ACL allograft 3-22-06
lat rel and manip 6-29-06
patella femoral arthrofibrosis
lat rel and chrondplasty  9-26-06
arthroscopic surgery scope 6-12-07
lateral meniscus tear, cartilage and scar tissue removal

Offline Jaci

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Re: Dr. Mandelbaum
« Reply #5 on: September 03, 2006, 08:04:46 AM »
Shannon,

It sounds like you're struggling with what I found to be one of the most difficult aspects of dealing with scar tissue: your knee is on it's own schedule and it's going to keep it a complete mystery from you. I know it seems like you should be better by now and, yes, if you had had a 'normal' recovery you would be returning to sports. But, remember you had another surgery just a couple months ago; although it may seem minor compared to the ACL recon, it really was a pretty invasive procedure. That surgery became the new starting point for recovery.

Have you read Lynn's story on the arthrofbrosis board? She goes by tri-sport-- she's a tri-athlete who is a patient of Dr. Steadman. She had two surgeries with him. Her last surgery was in Sept. 2005. Dr. Steadman cleared her to do a tri-athlon in June as long she walked the running portion. Also, at her appt with him in May 2006 (9 1/2 months after her surgery), Dr. S told her she should wait another year before resuming weight-training for her legs.

Here are some links to her posts:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=20495.msg204016#msg204016

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=27433.msg216651#msg216651

You're right that everyone's recovery is different, but one the biggest challenges with scar tissue is that it's very easy to cause a flare-up and start the whole d*mn scar tissue forming process over again. Now, I'm not saying your current issues are from scar tissue, but until you know other wise you really have to treat your knee as if they are.

I hope you can work things out to see Dr. Mandelbaum. Just keep in mind that the fact that he is well-known and highly regarded is not an assurance that he knows anything about treating arthrofibrosis. You still need to do your homework and go to the appt. armed with lots of questions. Also, MRI may or may not show scar tissue, plus they are only as good as the person reading the films. Many of us have had the experience of radiologists completely missing scar tissue that was quite obvious to an OS or radiologist that was more knowledgeable about the condition.

Regards,

Jaci 
« Last Edit: September 03, 2006, 10:49:02 PM by 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 laforce18

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Re: Dr. Mandelbaum
« Reply #6 on: September 04, 2006, 06:33:20 AM »
Thanks Jaci for that post.  It was truly inspiring.  I understand the scar tissue issues, but I really don't think that my doctor is listening to my problems.  He is so short with me and I just think that it is time to get yet another opinion.  If Dr. Mandelbaum tells me I just need time, then I will listen.  But for some reason I have a feeling that there is something else wrong.  my shin hurts when I bend my knee.  I think that from reading others posts and my own feelings, that this isn't normal.  Beside that, I get pain in the back of my knee that could be swelling, or I really don't know what else.  thanks for caring about me and listening to my problems.  It is hard to talk to others.  they just don't understand why I am not "better" already.  Hope all is great with you.   Iwill let you know when I hear any news.
Shannon
Shannon
ACL allograft 3-22-06
lat rel and manip 6-29-06
patella femoral arthrofibrosis
lat rel and chrondplasty  9-26-06
arthroscopic surgery scope 6-12-07
lateral meniscus tear, cartilage and scar tissue removal

Offline Jaci

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Re: Dr. Mandelbaum
« Reply #7 on: September 04, 2006, 07:39:05 PM »
Shannon,

I know what it's like to have a OS who just isn't listening. I told my first OS over and over again that something wasn't right with my knee. The bozo kept telling me that I couldn't bend my knee because I was tense. He went into a complete and utter panic at the point where I had so little ROM that he could no longer deny there was a problem. I had about 30 degrees total ROM then, but the early warning signs for arthrofibrosis had been there from the beginning. His panic sent me running to find another OS. My second OS was very talented, he did a fellowship with one of the pioneers in ACL recon and treating cyclops lesions (a variation of scar tissue), but I found that that knowledge and experience did not translate into treatment of recurring arthrofibrosis like I have. FWIW, he has a very low incidence of scar tissue problems post ACL recon because of his surgical skill and adherence to proven accelerated rehab protocols. He had never seen scar tissue like there was in my knee. I knew within a very short time after my surgery with him that things were not going well, he was very supportive but I realized he couldn't help me when he refused to do a cortisone injection in my knee at 4 weeks post-op saying it was too soon for scar tissue to have formed. He finally did an injection 2 weeks later and could barely get the needle in my knee because there was so much scar tissue. At that point I decided to seek the help of one of the experts we talk about so often on the arthrofibrosis board.

My reason for mentioning that you are still in the early stages of recovery from your recent surgery was not to suggest that you need to give it more time, frankly I'm glad I didn't listen to such advice, I'm only suggesting that you should be mindful that the activities you are doing may be a little too aggressive for this point in your recovery. I think getting a second opinion is probably a good idea. And, as I said do your homework and remember that you can't make assumptions that expertise in one area translates into skill in treating other issues.

I also understand what it's like to have people not understand why your knee isn't better already. While I know that most people want to be supportive, it does get tiring having to explain what's going on with your knee and deal with people's 'helpful' suggestions on what you need to do to get better. I have a few people that I talk to about my knee, but mostly I just don't even discuss it. The folks on kneegeeks have been a refuge for me during some very trying times so, of course, I would want to do that for others-- you know, repay the debt of gratitude and pay it forward for the future.

I hope you find some answers soon.

Best wishes,

Jaci

Edited to add:

PS--- Be sure to take another look at the article on causes of motion loss after ACL recon-- the 2 part series by Millett in 2001. It will give you some ideas of things, other than scar tissue, to ask the doctor about when you see him. 
« Last Edit: September 04, 2006, 09:19:28 PM by 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 laforce18

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Re: Dr. Mandelbaum
« Reply #8 on: September 05, 2006, 11:09:30 PM »
Hi Jaci...Well I had another MRI done today, and they put some fluid stuff in my knee as well.  Like you, they said it was very hard to get the fluid in becasue of what I believe is scar tissue.  He said he couldn't see it then, but the MRI would be able to identify it.  I also switched my medical group so I can see Dr. Mandelbaum.  But now I have to be referred by the primary doctor first, so I don't know when I will actually be seeing him.  I hope sooner than later.  I just want to hear what that second opinion is.  Well, thanks for listening and that great message.  I know that after this experience I hope that I too can pay it forward and give advice to those who need it. 
Shannon
Shannon
ACL allograft 3-22-06
lat rel and manip 6-29-06
patella femoral arthrofibrosis
lat rel and chrondplasty  9-26-06
arthroscopic surgery scope 6-12-07
lateral meniscus tear, cartilage and scar tissue removal















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