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Author Topic: Fat Pad Inflammation Hoffa's Syndrome  (Read 462 times)

Offline Christine10S

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Fat Pad Inflammation Hoffa's Syndrome
« on: January 16, 2018, 02:54:51 AM »
Hi- Has anyone had any success with treating fat pad inflammation or impingement?  I sprained both knees doing a squatting exercise 4 1/2 months ago...lots of pain but no real swelling, just in the middle of the kneecaps and pain below the knee.  PT did not think it was Patellar Tendinitis but rather fat pad irritation & inflammation along with maltracking issues.  I try to do PT exercises & stretches faithfully, but I have one week of no pain & then the next I'm almost crying.  Walking up & down stairs is fine, & no pain while sleeping.  Ice them every night.  I was even jogging at one point in early November.  Pain also around the area of the kneecap.  I live in the US so an MRI takes 4ever to get...until that is approved- Can anyone give me any advice as to what can treat this successfully?  I'm starting to lose my mind here...I'm pretty healthy at 49, never had an injury quite like this.  Any advice would be so much appreciated!

Offline reflex_nl

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #1 on: January 16, 2018, 12:34:55 PM »
It could also be cartilage damage, get it checked soon; MRI's will do the trick, but it has to be grade 3 or 4 in order to see it. I hope the cartilage is ok.
RK Patella Luxation in 2000
RK Scope grade 2 damage to patella
RK PT for 4 mths, recovered 90% after 4 years
LK Patella Luxation in Oct'16
LK Scope to remove loose bodies (grade 4) to patella Nov'16
LK Lateral Release + MPFL Reefing + MCIC in the UK Dec'17

Offline Christine10S

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #2 on: January 16, 2018, 03:03:21 PM »
Thank you ...
Worst case scenario if my cartilage is damaged at level 2 or 3?
Or 4?  What can I expect?

Offline Vickster

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #3 on: January 16, 2018, 03:20:51 PM »
Unfortunately patella cartilage is pretty difficult to fix, it can be managed with the right level and type of activity (not squatting, lunging, running probably though). Once it's worn away, it's pretty much gone. There are techniques to repair if a small focal hole, but these are usually more for younger patients (and very expensive). On the patella though because of the forces when bending and straightening

Has your PT taped the patella away from the fat pad to reduce the impingement? It's a good diagnostic to confirm that is the issue and should help with pain. The fat pad is chock full of nerves which is why it hurts when pinched

Have you seen a knee specialist? Is it your insurance that means you have to wait ages for an MRI, can you pay to speed up the process if a specialist thinks it's needed. note an MRI isn't infallible, it's a diagnostic not an indicator of treatment ultimately. All sorts of things can show up that have no influence on pain and function and other things can be dismissed as minor but are actually the source of troubles.

Good luck :)
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 Christine10S

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #4 on: January 16, 2018, 04:50:49 PM »
Hi Vickster-
I was hoping to hear from you as I see you give lots of great advice to others.  I should be getting an MRI in the next few weeks.  You need either a letter from God or be bleeding to death to get one here.  Of course the last 2 days have been fine, no pain at all, so weird.  Been doing lots of step ups and step downs, SLR's (front & back), 5 min on the bike...
If it is a tracking issue, does that involve cartilage damage?  Pain is really only on the front of my kneecap (the outer edges) and right below...sometimes near the meniscus area too, but very little... is 4 months long enough to do serious damage?  I know you can only speculate as best you can, just looking for some window of hope in my bleak tennis future..
Thank you again!

Offline Vickster

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #5 on: January 16, 2018, 09:10:17 PM »
You might find some info of interest in here on fat pad syndrome, patellofemoral syndrome and patella arthritis. Unfortunately, at 49 if you've been active (or even not)  it wouldn't be unusual for there to be wear and tear in the knee joint, which may have only become symptomatic when you aggravated and inflamed it in the gym

http://www.kneeguru.co.uk/KNEEnotes/primers/patella
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 Christine10S

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #6 on: January 17, 2018, 12:27:20 AM »
Yes, Iím sure from 15 years of tennis- started when I was about 30...that there iscwear & year.  Before that I was a swimmer & liked to run here & there.  But Iíve never had any knee pain of any kind, I thought I was taking pretty good care of them.  Hopefully they arenít too bad... maybe someone will post about a fat pad success story.  Iím
Obviously optimistic😀👍🏼

Offline Bondodgykneecurrie

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #7 on: February 05, 2018, 08:12:08 AM »
I had 90% of mine surgically removed last year (fat pad).

Offline Christine10S

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #8 on: February 08, 2018, 03:57:57 AM »
Hi! Thanks for the response- how are you feeling now? Any better?
And can you tell me what your symptoms were & for how long?
Sorry we all have these issues on this site-
-Chris

Offline Clarkey

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #9 on: February 10, 2018, 11:47:00 AM »
I have had my fair share of right knee injury problems for over a decade and started with catching in the knee and when I had my very 1st every consultation in 2003 the MRI scan came back negative and my OS thought it might be plica syndrome. A few years later had an updated MRI scan showing inflammation of the fat pad tried to use safer conservative methods of treatment with physiotherapy to build up the quads stronger in the hope it will stop the kneecap inflaming the fat pad. I then had a cortisone injection using an ultrasound machine to pinpoint where the fluid and inflammation had built up followed by a cortisone injection. It did not reduce the inflammation leading to scope#1 in November 2009.

While my OS was scoping my knee he spotted her performed medial plica excision and trimmed the fat pad. I would be wary and cautious how much is removed 90% is a large chunk to take out with the fat pad close to nerves risky removing nearly all of the fat pad! Anterior knee pain is closely linked to the fat pad. plica and patella tendon that have all been the main cause of my knee problems.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Christine10S

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #10 on: February 10, 2018, 04:29:05 PM »
I really appreciate your feedback.  What were symptoms before your surgery?
I donít have any swelling & can do most light activities...but then by the evening Iím in pain & back with the ice packs before bed.   Stairs & recumbent bicycle are fine too...
But the pain also happens randomly throughout the day- not in one particular spot either...mostly around the kneecap & off to the sides of the patellar tendon (but the tendon seems fine).  Iím trying to build up my VMO & quads & hamstrings too...
Itís a long slow process I guess...
Thanks again!

Offline Clarkey

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #11 on: February 11, 2018, 07:10:30 PM »
It was at the start of the millennium when my knee problems started that gradually got worse mid too late 00s. Anterior knee pain to start off with that my OS thought might be the plica. I then had a fall while jogging tripping over my shoelace that became untied think it was 2007 just after I purchased my 1st 1 bed flat. Fell onto my right knee that must have caused the fat pad to become inflamed. Then felt catching inside the knee on the lateral side with some slight swelling at the bottom of the kneecap.

I really appreciate your feedback.  What were symptoms before your surgery?
I donít have any swelling & can do most light activities...but then by the evening Iím in pain & back with the ice packs before bed.   Stairs & recumbent bicycle are fine too...
But the pain also happens randomly throughout the day- not in one particular spot either...mostly around the kneecap & off to the sides of the patellar tendon (but the tendon seems fine).  Iím trying to build up my VMO & quads & hamstrings too...
Itís a long slow process I guess...
Thanks again!

I did not feel too much pain at the start of the injury and made a fateful mistake to carry on running after the fall that causing extra trauma to the knee with an increase in swelling the next day and was not able to run anymore properly felt pain and pressure while running at the bottom of the kneecap. Had my scope#1 out of 3 in November 2009 after no success with conservative methods of treatment options opting to go for a diagnostic arthroscopy.

[email protected] 
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Christine10S

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #12 on: February 15, 2018, 04:12:37 AM »
Wow...did I see you just had another procedure done? How are you feeling now?
The OS (physician assistant) also said he now thinks itís more Patellar Tendinitis 😰
Iíve been Going to the gym & doing all the VMO & hamstring building that I can. 
Also doing 10 minutes on stationary bike...,
Any thoughts for that?

Offline Clarkey

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Re: Fat Pad Inflammation Hoffa's Syndrome
« Reply #13 on: February 15, 2018, 06:36:27 PM »
Hi Chris,

Everyone knee reacts differently, you may have had 2 of the same knee problems I have had Fat Pad Impingement and Patella Tendonitis with Arthrofibrosis of the knee being the main problem causing inflammation of the fat pad and patella tendon. Scar tissue inside the knee and anterior release surgery is not a common surgical procedure. Decompression of the patella tendon is rarely done with conservative treatment methods usually successful. 

Wow...did I see you just had another procedure done? How are you feeling now?
The OS (physician assistant) also said he now thinks itís more Patellar Tendinitis 😰
Iíve been Going to the gym & doing all the VMO & hamstring building that I can. 
Also doing 10 minutes on stationary bike...,
Any thoughts for that?

Link to one of my topics posted a year ago Treatment Options for Patella Tendonitis

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=67713.0

I wouldnít do anything without the supervision or at least blessing of your Physio

Iíd avoid any machines that cause you to  extend your leg while lifting weight, extreme pressure on kneecap and attached structures. You donít want to exacerbate the condition. So check everything with your PT first

I would have said the same as Vicky suggested to check what exercises you can and cannot do with your physiotherapist even pool exercises need to take care not kicking your legs too much while doing breaststroke the kicking action can aggravate patella tendonitis a mistake that I made thinking I was doing the right thing!

A fairly new link from last year August with a paragraph going through pool exercises for patella tendonitis.

https://www.livestrong.com/article/428400-swimming-exercises-for-tendonitis/

Good luck, it takes a lot of time to make progress need to be extremely patient that can be hard to stick to. Please do not worry too much that your Fat Pad Impingement and Patella Tendonitis will end up like mine has. As I said at the start of my post our bodies react differently to similar knee condition no two are exactly the same.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

 















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