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Author Topic: Fat Pad Impingment and Mal-Tracking of Patella  (Read 313 times)

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Offline Strongknees

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Fat Pad Impingment and Mal-Tracking of Patella
« on: September 10, 2018, 01:14:34 PM »
Hi everyone,

After 16 months of PT for "anterior knee pain" with little to zero improvements, I saw a different specialist who suggested I have fat pad impingement as well as mal-tracking of the patella. My worst symptom is pain while standing still. I also have occasional pinch (very painful) while walking. Any exercise is out of the question.
I had a MRI in November 2017 but the radiologist did not see (or mention in his report) any issue in the fat pad.
The new specialist gave me a much more conservative program than the one I used to follow: just ice and limited ROM quad and VMO exercises.

I am worried my inflammation is now chronic and might need more invasive treatments.

1. Should I get another MRI to confirm the diagnosis of fat pad impingement?

2. Can anyone suggest a surgeon in the UK who is super expert with fat pad injuries so I can get some additional advise while I continue the conservative approach?

Thanks for reading this and I would appreciate any suggestion.

I am 35yo and I want my life back.

Offline Vickster

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #1 on: September 10, 2018, 01:41:09 PM »
Try to see Claire Robertson who is a consultant Physio and recognised as an expert in PFS and fat pad injuries. Private only (£195 not covered by insurance) practising at Parkside in Wimbledon. CV here (scroll down)

https://www.wimbledonclinics.co.uk/consultants

 Her website is Clare patella, here’s her fatpad blog

http://clairepatella.com/the-infrapatellar-hoffas-fat-pad-explained/

If you need surgery (not usually advised or needed for fat pad impingement, scarring is an issue), she’d be well placed to advise if there is no other option

I’m not sure another MRI scan will show much, any knee specialist should be able to tell if there’s impingement. However if there’s true mechanical misalignment, I believe most patella experts would do a CT if felt surgical realignment needed (like a PF osteotomy)
« Last Edit: September 10, 2018, 02:30:01 PM by Vickster »
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 Vickster

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #2 on: September 10, 2018, 03:59:59 PM »
There’s a list of PF surgeons here.

http://www.kneeguru.co.uk/KNEEnotes/primers/whos-who-knee-surgery/whos-who-patellofemoral-surgery

Doubt fatpad specifically is an area of expertise as it’s usually a symptom of maltracking or, as Claire told me, OA (also more common if valgus and/or overweight). They’re more likely to deal with anatomical issues like recurrent dislocation and the causes / effects thereof

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 Strongknees

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #3 on: September 11, 2018, 02:25:07 PM »
Thanks Vickster.

I actually saw Claire Robertson 2 weeks ago and she was the one finally diagnosing me properly. I am now following her advice. Good to hear other people have seen her and trust her.

Thanks again.

Offline Vickster

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #4 on: September 11, 2018, 03:28:55 PM »
Ah is she the specialist you saw?
What did she say/suggest?
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 Strongknees

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #5 on: September 11, 2018, 04:14:20 PM »
Yes, I saw her in Wimbledon.

Ice and limited ROM VMO exercises to start with. Claire wasn't too concerned about my fat pad - that was a relief. However the pain is still very debilitating for me.


Offline Vickster

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #6 on: September 11, 2018, 04:24:15 PM »
Are you in London or did you travel?

Did she think muscle imbalance the culprit? If not the fatpad? Did your MRI show anything of note?

Can you get relief from ice, heat, meds?
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 Strongknees

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #7 on: September 11, 2018, 04:32:29 PM »
The MRI didn't show anything clear.

I think I had an injury a 16 months ago. Because of that lost a lot of muscles. The VMO became weak causing incorrect tracking of the patella which then started to irritate the fat pad.

This is from a combination of what Claire told me and my history and evolution of symptoms.

Does it make sense to you?

Offline Vickster

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #8 on: September 12, 2018, 10:52:13 AM »
Yes makes sense. Muscle imbalance seems a culprit for PFS and fatpad impingement. Do you plan to see her again after following her suggestions for a while?
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 Strongknees

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #9 on: September 13, 2018, 10:26:12 AM »
Yes definitely. I am also seeing an osteopath who has applied taping and give some insoles as my right foot wasn't properly aligned. I hope the combinations of these 2 specialists will help my recover.

Offline James NZ

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #10 on: September 15, 2018, 03:16:27 PM »
Hi mate, I'm 33 and in the same boat. I just want my life back!
I wouldn't get another MRI. I would get another radiologist to get their opinion. I've had three totally different opinions from one MRI!
I've also sent you a pm

Offline Strongknees

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #11 on: September 17, 2018, 04:53:31 PM »
Hi James, for some reasons I ma not able to reply to your PM. Claire is definitely knowledgeable and she will give you good advice. I think at the end of the day you (and I ) need to find what work for us. Each of us is different. I am struggling with thin injury but hopefully one day I will fully recover. How are your quads and VMO?

Offline Vickster

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #12 on: September 17, 2018, 05:06:10 PM »
You need 20 posts to PM (to stop spammers)

You can up your count in the games room area :)
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 James NZ

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #13 on: September 17, 2018, 05:30:48 PM »
Yes,  it's just so frustrating that even a small walk can agrivate it! My VMO and quads have all but disappeared following surgery. I'm trying to rebuild them with estims but can't stay in my painfree envelope. So depressing, but we must carry on!

Offline Strongknees

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Re: Fat Pad Impingment and Mal-Tracking of Patella
« Reply #14 on: September 17, 2018, 05:53:33 PM »
I am not sure if you have read the post on fat pad from Mike Ryan Sports Medicine? There is a LOT of good advice there... Ice, ice, Ice.. VMO strengthening, potentially looking at insoles to correct foot positioning? I am sure you are not walking properly (I am not either!).















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