Anterior herniation of synovium into Hoffas fat!

[Clarkey]

I would like to know what the following MRI scan report means in plain english. Its a scan of my right knee in August 2003 at the time I got sharp pain in the knee and walked with a limp. Can now walk properly since 2004 have had no treatment but do get pain in both knees at times but not much to worry about. Here are the last 2 paragraphs of the MRI report.

The one feature of note is a small central area of synovial herniation into Hoffas fat anteriorly. The area of synovial herniation extends from the joint line anteriorly in mid line extending towards the inferior pole of the patella over a distance of almost 1.5cm. The patella is rather low in position. The patella height/tendon ratio remains within normal limits but at the low end of normal.

Anterior herniation of synovium into Hoffas fat in normal individuals is an uncommon but encounted phenomenon. Its is usually assumed to be asymptomatic. Whether it is likely to be sympotamatic in a person is I'm afraid very difficult to determine. Obviously if pain is primarily anterior then this potential cause togther with a rather low lying patella. If pain is not specificaly anteriorly located than I think the above findings are best regarded as being incidental findings.

Thats the MRI report from the Consultant Radiologist is it normal to have a low lying patella and anything to be concerned about. I can also move my patella side to side when standing up which I think is normal but worth a mention. Hope someone knows what the report means in plain english, Nick

[Arnoldplum]

I would like to know what the following MRI scan report means in plain english. Its a scan of my right knee in August 2003 at the time I got sharp pain in the knee and walked with a limp. Can now walk properly since 2004 have had no treatment but do get pain in both knees at times but not much to worry about. Here are the last 2 paragraphs of the MRI report.

The one feature of note is a small central area of synovial herniation into Hoffas fat anteriorly. The area of synovial herniation extends from the joint line anteriorly in mid line extending towards the inferior pole of the patella over a distance of almost 1.5cm. The patella is rather low in position. The patella height/tendon ratio remains within normal limits but at the low end of normal.

Anterior herniation of synovium into Hoffas fat in normal individuals is an uncommon but encounted phenomenon. Its is usually assumed to be asymptomatic. Whether it is likely to be sympotamatic in a person is I'm afraid very difficult to determine. Obviously if pain is primarily anterior then this potential cause togther with a rather low lying patella. If pain is not specificaly anteriorly located than I think the above findings are best regarded as being incidental findings.

Thats the MRI report from the Consultant Radiologist is it normal to have a low lying patella and anything to be concerned about. I can also move my patella side to side when standing up which I think is normal but worth a mention. Hope someone knows what the report means in plain english, Nick

[Clarkey]

      Sorry bout that clarky, i was trying to insert a quote from your mri report n sent it out by mistake.. But anyways , this synovial herniation thing... from what i can gather, the synovial fluid is retained in the synoviam < xq's spelling> i believe its a capsule although dont quote me, that baisicly acts a bit like hydrolic suspension in the knee. Herniation of it into the fat pad i think means there is a lesion in that fat pad thats taking in a bit of synovial fluid, lessening the effectiveness of the suspension property. i really dont know enough, to be sure bout all that... just some thoughts

Dont worry about your mistake these things can happen, I decided to insert your quote onto this posting hope you dont mind me doing this. Thanks for your opinion much appreciated.

Nick  {2006}

[Arnoldplum]

         
         No worries
                        But i thought i should add, that ive heard it often said, that one of the main functions of the synovial fluid is that it acts as a lubricant in the joint,and when you have been inactive for a while due to an injurey, it thickens up making joint movement seem more stiff, or so i heard. The idea that it's encapsulation in the synoviam has a function of providing the joint line with a kind of dynamic suspension, is somthing of a creative leap on my part. But in my case it would explain alot about why my knee feels like there is no 'give' in the sense that when i walk it feels like my good leg is walking on grass while the bad leg is walking on concreat, if that makes any sense. So questions to ask are like, is it possible for the synovium to bleed synovial fluid, and is this herniation into the hoffas an example of synovial bleeding. Can the synovium heal itself, and what are the degenerative consequences of not having a properly functioning synovium< or indeed synovectomy >.... again just some ideas, but ive found that asking questions has to be positive and really the best way to learn about ones problem and i hope that would be welcomed by members of the proffession... very sadly thats not always the case.. Personally im just fascinated by it all

[paulgrech]

Clarkey,
There isn't much substance to that report. I think whoever reported it was fishing for something to say. Your patella isn't actually low lying according to the report - it can't be both low lying and normal position as the report seems to say. The herniation into Hoffas pad is an interesting observation but I can't see it is significant-again as indicated in the report. I wouldn't have mentioned either myself.
Paul
www.uk-radiology.co.uk

[Clarkey]

Hi All,

This post is now a few years old and have had a total of 3 heavy falls onto my right knee and the last one was January 25th 2013 thats nearly a month ago and still have swelling and pain at the bottom of my knee.

My 1st fall got away without too many problems my 2nd fall in October 2007 did more damage and had to have an exploratory scope done on my right knee in November 2009 and had my fat pad trimmed and medial plica removed as I was getting pain and some catching and had some swelling at the bottom of my knee.

I am now having similar problems again and was warned by my OS that my medial plica could grow back again and cause the same problem, my concern now is that it’s grown back and is inflamed again.

I was running at a competitive level 4 times a week 9 miles and doing it at an average pace of just under 7 minutes a mile and my best time to date is just under 1 hour 9 miles. I was going to take part in the Droitwich Half Marathon and have had to pull out of it next week Sunday. I can jog at a slow pace and does hurt when I try to run and cannot run very fast as I feel too much pain & discomfort and have swelling at the bottom of my knee.

I had knee pain before fall at the bottom after running so always been delicate and may also be some scar tissue after my scope as I had a slow recovery and took 18 months fully recover again that is a common problem that plica excision takes time to recover from.

Do you think due to my low lying patella I am more inclined to have problems with the bottom of my right knee and if it does not heal by itself and last option was another exploratory scope that it could do more harm then good as I would then have more scar tissue to contend with and could end up worse off!

I hope it does not get to this stage and if it does is it worth the risk if the plica keeps coming back again. I am only 34 and would like to still do competitive long distance running despite my knee problems in the past

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