Synovitis or Fat Pad?

[Aztec]

My story is a very long one (posted in different ways over time here), so here's the shortest version possible: Life-long athlete, 4+ years of a nagging swelling feeling in knee, worsened by any weighted activity, especially bike and standing. That made me avoid full extension and had me standing on one leg all the time. Last year after trying everything anyone could think of, I gave up, had an anterior interval release done by a Steadman-trained OS. I had significant scarring of the fat pad, plica and synovitis (removed). I was pain-free post op, barely had any swelling. My recovery was pretty slow, especially restoring flexion, but shortly after the surgery-related stiffness abated I could tell that my original symptoms were still there. That realization has been the most depressing thing in my life.

I've seen several top specialists. Looking at my fresh post-op MRI, one thinks this is it, you don't dare remove more fat pad, and it's time to head for rheumatology because he believes it's metabolic, not mechanical. Another says it's synovitis, rest it, ice it, worst case we go back in and precisely remove that stuff and more carefully manage the recovery/rehab.

I guess I'm asking this because I'm wondering if anyone has EVER had such a vexing knee problem. My knee almost never really hurts (it did post op when I started stairs again, and still does if I kneel wrong and lean back a little). It's just this nagging swelling that is worse now after the AIR, around the whole fat pad area.

 

[nwc07]

Does the nagging swelling cause mechanical symptoms--maltracking or impingement?  What are your limitations? 

I've been told conflicting informaton about the fat pad.  If chronically inflammed or severely scarred remove it all, dont take it all out, take only the scarred portions out, or dont touch it at all!  I think most doctors have very limited experience with this....

[Aztec]

The nagging swelling makes standing uncomfy and full extension a little difficult. It's not painful, just annoying (and I think that makes me lucky by comparison, given some of the horror stories I've read on this site).

As for limitations -- I can walk, with a slight limp. That's about it. I can't live an athlete's life, that's for sure. My 100 mile Saturday bike rides are now replaced by 10 minute walks for coffee and then hours on the sofa.  :-(

I'm no longer even convinced it's the fat pad. Even the MRI uis far from clear. It could be synovitis, it could be bursitis (assuming it's possible to not be painful), or something else. Opinions differ, and none are with much conviction.

I tried a lidocaine patch last night as a test. No difference. I have been trying McConnel taping, and it sort of works. But an hour after taking it off, I'm right back. Even if I just take it off overnight, as soon as I'm weight bearing, poof.

[kneepaincure]

Hi Aztec,

I have a similar problem since the last 3 weeks and have been wondering if it is the fat pad. I have tilted kneecaps which must surely be creating extra pressure on the tissues underneath. Sometimes I'm unable to straighten my leg fully while walking because I can feel the resistance, and wearing a compression bandage is the only way to get around.. Similar to you, when I take it off, the feeling of pressure within the knee comes back..

If I get some answers from my PT I will let you know..

[kneepaincure]

Hey Aztec, how are things going with you? The symptoms that I have similar to yours reduce a lot with regular exercise. In my case sitting still makes my knee stiffer. We probably don't have the same problem.