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Author Topic: Pain under knee, lateral side above fibula?  (Read 3635 times)

Offline Clarkey

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Re: Pain under knee, lateral side above fibula?
« Reply #15 on: February 02, 2017, 04:16:03 PM »
Hi Puffy,

I totally agree with Vicky to report it to one of the staff members at the gym! He might not realise what he is doing is highly impropriate behaviour that is not acceptable practice at a public gym. Male changing rooms and showering area is the safe place to do this if there are facilities available at your gym.

Hope you have better luck with your MRI scan results of your hard to fix knee problems then I did. Good luck in what ever is decided as the next course of treatment.

[email protected]
RK: PFPS, Arthrofibrosis & Tendinopathy
16/01/18
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-Hip - FAI 04/04/17  RK 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline Puffy the Knee Slayer

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Re: Pain under knee, lateral side above fibula?
« Reply #16 on: February 19, 2017, 01:32:03 PM »
Am due my results this week. I mentioned this to someone who said "Hopefully it will show nothing is wrong" and seemed amazed that I actually WANT it to show something is wrong.

Of course I want it to show something is wrong - how else will they know how to treat it?!

I think she thinks I have some minor pain and they are sending me for an MRI just to reassure me everything is fine and that it will get better by itself. Rather than that they know something is wrong and are sending me for the MRI to find out what it is and how to treat it, because it very clearly isn't getting better by itself!

Very strange attitude.

At least I know people on Knee Geeks understand.

Anyway, we shall see.
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Online Vickster

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Re: Pain under knee, lateral side above fibula?
« Reply #17 on: February 19, 2017, 01:45:44 PM »
Good luck, hopefully it shows something that can be addressed conservatively by a good physio and home exercise programme :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline Clarkey

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Re: Pain under knee, lateral side above fibula?
« Reply #18 on: February 20, 2017, 07:05:08 PM »
Hi Puffy,

You are right us KneeGeeks understand each other while others think we are barmy wanting to have a positive MRI scan in order to have a treatment plan set in place in a none surgical way. This would be the ideal scenario if it cures or eases your knee pain and discomfort. There nothing more frustrating not knowing how to go about treating a long term knee problem when you have a MRI scan result coming back negative.

I am still surprised that my right hip MRI came back positive that I was not at all expecting to happen. I thought it would be the other way round that my right knee MRI would show up a new problem. Hip problems are similar to knee problems having good and bad days. My mum was not sure if she should have her left hip replaced or not last year May when she had a good hip day. Turned out it was high time it was replaced when the OS said it was brittle when he removed her old hip.

Will have my fingers and toes crossed for you that something shows up this time on the MRI scan.

[email protected]
RK: PFPS, Arthrofibrosis & Tendinopathy
16/01/18
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-Hip - FAI 04/04/17  RK 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline Puffy the Knee Slayer

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Re: Pain under knee, lateral side above fibula?
« Reply #19 on: February 21, 2017, 08:08:10 PM »
They didn't find anything  :'(

I am gutted. I didn't even see the OS, my physio read the MRI and told me.

He said MRI still shows fat pad impingement but this is not more than anyone might have who is asymptomatic.

There's a slight lateral meniscal tear but it isn't sufficient to warrant surgery.

He's offered me a repeated injection of botox into the TFL. He said if I refuse this my only options would be surgical lengthening of the ITB or to try and convince the OS to do a fat pad debridement.

No exploratory scope was offered.

I know the pain isn't the fat pad, and I don't believe it's the ITB either, though he says there is still tightness on that side.

But I have to accept the botox otherwise they will probably discharge me! They are not even going to give me a new programme of physio, just a botox injection and carry on with the physio I've been doing - which isnt helping! The pain isn't even anywhere near where the ITB meets the LFC!

I can't believe they can't see what is wrong!

I am worse off now than before as I never had this lateral side pain before the steroid into the lateral femoral condyle.  :'(

I don't know what to do? Please help, I am very upset!
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Offline Clarkey

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Re: Pain under knee, lateral side above fibula?
« Reply #20 on: February 21, 2017, 11:00:45 PM »
Hi Puffy,

Sorry to hear that the MRI scan results have not shown up anything new. I would also be upset if my physio told me my MRI scan results. I always thought that you have the rights to see your OS for the MRI scan result or a sports medicine doctor that read both my MRI scan of right hip and Knee. He was happy to refer me to both OS's. PT's can do a referral for an MRI scan and surprised that he gave you your results and not the Registrar, if your OS was is busy in clinic to go through the MRI images with you.

Do not have a fat pad debridement done or you will end up like me having to deal with AF that messed up my gait which has damaged my right hip. Fat pad trimming can cause you more problems post-op up then pre-op.

I can understand why you would want to go ahead with a diagnostic arthroscopy after all the failed attempts of conservative methods of treatment. The meniscus tear might be larger than 1st anticipated that might be causing the pain your are experiencing right now. MRI scans are usually very accurate with just a small percentage of patients where there is a problem that does not show up on the MRI scan images.

I am also tempted to go for a diagnostic arthroscopy, that is always risky, members on KG will say stay well clear! I would personally feel more at ease to going through with it. That just the way I am taking risks and a gamble. I then know I have tried every option available, there comes a point when something has to happen.

I would call your OS secretary or send an email that she will pass onto him. I did this when I was getting frustrated and upset. I got to see him at a private hospital funded through NHS Choice as he knew how frustrated I was getting from my email.

Good luck, hope you make some progress you have always been supportive on my post-op diary that helps psychologically knowing there are others out there that understand what you are going through.

[email protected]
« Last Edit: February 21, 2017, 11:34:13 PM by Clarkey »
RK: PFPS, Arthrofibrosis & Tendinopathy
16/01/18
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-Hip - FAI 04/04/17  RK 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline Puffy the Knee Slayer

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Re: Pain under knee, lateral side above fibula?
« Reply #21 on: February 22, 2017, 07:46:52 AM »
Hi Clarkey,

Thanks for your reply, it means a lot to know there are people on KneeGeeks who understand and are supportive.

I have got my MRI images and am sending off a request for the report today, which will take ages as they first send a form, then you have to make an appointment to show ID and collect etc

Am then going to try and see a private physio for an opinion. The one I see on the NHS is all right but he is part of the Botox study so think he is really pushing that.

I wish they would acknowledge the steroid into the lateral femoral condyle has done something it shouldn't have.

I do find it very strange nothing showed up as even my pes anserine bursitis showed up on the last MRI and the pain from that was nowhere like as bad as this lateral pain. They cannot leave me like this, I can't even do 8 mins of the cross trainer or upright bike without terrible sharp twisting pain.

Physio said the next availability for botox is quite soon so i doubt I will get to a second opinion before I have it. As the MRI still shows FPI I suppose it makes sense to have another go with botox but I don't think this will do anything for the lateral pain which, in spite of what he says, is nowhere near the ITB, kneecap, or anywhere else that has previously given me problems.

The clinic I attend has "Extended Scope Practioners" who are physios and it is not always clear who you are seeing, ie whether they are doctors or not. They do not say!
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Offline Clarkey

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Re: Pain under knee, lateral side above fibula?
« Reply #22 on: February 22, 2017, 09:44:48 PM »
I have also seen an Extended Scope Practioner a while ago back in 2008 at Birmingham Royal Orthopaedic Hospital. He could tell there was problems with my fat pad and tried all the conservative methods before I had the surgery that I now know was a costly decision.

I had CT guided Botulinum Injection into my tensor fasciae latae or the thigh muscle on my right leg in the hope it would reduce my muscles that were super tight, it did help release some of the tightness. The knee pain remained, I then had the AIR surgery when it looked like a microfracture surgery on the one positive MRI scan out of five.

Extended Scope Practitioners (ESP) are specialist Physiotherapists or Occupational Therapists who work in an extended role alongside a Medical Consultant. If you are referred to an orthopaedic clinic you may be seen by an ESP instead of the Consultant or their Registrar.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=42784.0

I had the Botulinum Injection done by a 'specialist consultant musculoskeletal radiologist' who also reviewed my last two MRI scans that did not show up anything majorly wrong. A ESP must get a briefing from an OS and radiologist with the results rather than them going through the images alone.

It gets to a point when you accept anything that is being offered to you even surgery that many say avoid like the plague! If you have not tried you will never know if it will go the other way and be a success rather than a failure! This is what is getting to me right now. We are the ones that makes the final decision and gamble. If I was offered a diagnostic arthroscopy at my next consultation without asking first I would accept with never ending post-op none recovery.

I am sure you are now at the same stage as me contemplating on going ahead with a diagnostic arthroscopy surgery with some reservations of course, this is normal if you going through any type of surgery. It is not a pleasant experience to endure but when you desperate to make some progress you tempted to go ahead with it.

[email protected]
« Last Edit: February 22, 2017, 11:26:52 PM by Clarkey »
RK: PFPS, Arthrofibrosis & Tendinopathy
16/01/18
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-Hip - FAI 04/04/17  RK 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09

Offline Puffy the Knee Slayer

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Re: Pain under knee, lateral side above fibula?
« Reply #23 on: February 23, 2017, 12:53:05 PM »
I am not convinced surgery is the right way forward, I think they would just do a scope and say nothing is wrong or do one of those fake sham ops to shut me up!

Physio said the remaining FPI is no more than you might find on any person who is asymptomatic, but I am still experiencing pinching at the front of my knee.

My kneecap tilt has improved greatly with the botox but the rotation is still wrong, it is very obvious compared to the other knee.

This sharp pain on the lateral side is worse than all of that, heaven knows what they did, maybe when they gave me the steroid into the lateral femoral condyle the needle went in too far and hit a nerve or caused a bone bruise or the steroid weakened the cartiledge.

Anyway I will try another botox by the time they review me maybe if it is the lateral meniscus tear causing the pain it will have improved. I am not going to go on accepting botox forever though, will probably ask for a second opinion if this next treatment does not improve things.

I do not think their MRI scans are that accurate as they already told me I did not have a medial meniscus tear when a previous MRI from somewhere else showed that I did.
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Offline Puffy the Knee Slayer

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Re: Pain under knee, lateral side above fibula?
« Reply #24 on: March 07, 2017, 11:35:30 AM »
OK having collected the MRI report I am thinking the physio downplayed things considerably?

Here is what it says:

"Intercondylar region: the ACL and PCL are in tact

Medial compartment: The medial meniscus appears intact. There is mild chondral thinning;there is no significant subchondral marrow oedema. The MCL is intact. There is minor pes anserinus paratendinosis.

Lateral compartment: There is a focal undisplaced short segment lateral meniscus tear involving the posterolateral horn, extending to the tibial surface, with the mild posterolateral gutter synovitis. There is mild chondral thinning. There is no significant subchondral marrow oedema. The LCL and conjoint tendon are intact. The popliteus tendon and remainder of posterolateral corner structures are unremarkable. The ITB is intact and does not appear to be significantly thickened.

Patellofemoral compartment: There is minor lateral patellar subluxation and overhang. There is an impression of borderline patella alta, with a shallow femoral trochlea demonstrating a truncated medial surface, as well as a dysplastic patella displaying a hunter's cap deformity. A TT-TG distance of 12mm is noted. The patellar tendon is lateralised, with significant underlying Hoffa's fat pad impingement. The quadriceps tendon is intact. The MPFL and lateral retinacular fibres are intact.

Other findings: There is a minor knee joint effusion. The popliteal fossa structures appear within normal limits.

Conclusion: Evidence of a subtle focal oblique tear of the lateral meniscus posterolaterally. Evidence of patellofemoral dysplasia, with suggestion of borderline patella alta. Significant superolateral Hoffa's fat pad impingement."


So I still have the pes bursitis, and the FPI and patella maltracking, and now a meniscus tear to add to my arsenal!

I would think the lateral tear could well be the cause of my lateral pain?? I don't mind if they can get it better by physio, but if it needs a trim I hope they are not trying to avoid offering me an op due to cost!
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Online Vickster

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Re: Pain under knee, lateral side above fibula?
« Reply #25 on: March 07, 2017, 12:41:45 PM »
Sounds like a second opinion is called for, all those relatively minor things could be leading to accumulated pain, or referring pain around the joint, upsetting muscle balance and all sorts.  See if your GP will refer you (or pay to see a surgeon privately who could then move you to his NHS list?)

Unfortunately, degenerate meniscus tears tend to reoccur once they've been trimmed - if it's not causing locking or buckling, it's as well to leave alone (even insurance Co's are reluctant to fund menisectomies without biomechanical issues)

A lot of the things seem patella related, I'd still find a good physio (yours sounds a bit crap tbh - physios don't generally downplay pain and effect on QoL, that's what doctors / surgeons are there for ;) )
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline Puffy the Knee Slayer

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Re: Pain under knee, lateral side above fibula?
« Reply #26 on: March 07, 2017, 01:12:31 PM »
I think you could well be right. The letters I got copied from the hospital to the GP have inaccuracies in them, eg claiming that my last steroid was into the fat pad - it wasn't, it was into the lateral femoral condyle; also stating I said my new lateral pain was an ache - no I told them it was a sharp knifelike twisting pain.

Physio letter states there is no demonstrable explanation for patient's pain - erm???? As only new MRI finding is the lateral tear I would surmise that may well be causing the pain! But then they might have to admit the steroid did some damage?

I don't know if it is degenerative or not, maybe it was acute after the injection?

Anyway yes, definite plan to see private physio, will have to look into OS referral. There was one surgeon who looked promising and also has NHS clinic  - Mr Wills-Owen? - so maybe him.
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Online Vickster

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Re: Pain under knee, lateral side above fibula?
« Reply #27 on: March 07, 2017, 01:17:55 PM »
My surgeon is a top bloke, I'll PM details (NHS practice too)

Never heard of Willis-Owen myself
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
LK New MRI shows lat & medial meniscus tear & other stuff
RK MRI lat meniscus tear
8/1/15 RK Steroid jab,
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation

Offline Puffy the Knee Slayer

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Re: Pain under knee, lateral side above fibula?
« Reply #28 on: March 07, 2017, 01:50:01 PM »
Thank you very much, Vickster  :)
06/07 ankle sprain - collapsed arch
01/08 fall doing physio
06/09 MRI fat pad impingement
01/13 MRI medial meniscal tear
03/15 - decent orthotics
01/15 MRI - pes anseurine bursitis, SPL fat pad impingement, PFMaltracking
Cortisone 04/15; 03/16; 06/16; 08/15 Cortisone+Duralane; 10/16 Cortisone+Botox

Offline Clarkey

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Re: Pain under knee, lateral side above fibula?
« Reply #29 on: March 07, 2017, 06:34:42 PM »
I was going to see Mr Charles Willis Owen myself for a private consultation, he specialises in patella tendonitis that has had himself. He told me that ESWT has a high success rate that did nothing for my patella tendonitis.

http://www.kneeguru.co.uk/KNEEnotes/courses/lower-limb-overuse-injury-series-charles-willis-owen-frcs/tendinitis/patellar-tendinitis

He is also very much into long distant cycling as you can see on his YouTube account.

https://www.youtube.com/channel/UCyAbl6TaE2U9W9jIakz-U3Q

I read that he was based in London and moved down to Bournemouth on the south coast so he commutes less so he can spend more time with his wife and kids.

[email protected]
RK: PFPS, Arthrofibrosis & Tendinopathy
16/01/18
18/07/14 Anterior interval release  
16/11/09 Medial plica excision & fat pad trim
Cortisone injections: R-Hip - FAI 04/04/17  RK 23/12/15, 22/10/15, 13/05/15, 30/03/10, 23/04/09