Advertisement - Hide this advert





Author Topic: Fat Pad Impingement Surgery - Any Advice  (Read 6834 times)

0 Members and 1 Guest are viewing this topic.

Offline Xeract

  • MICROgeek (<20 posts)
  • *
  • Posts: 16
  • Liked: 0
Fat Pad Impingement Surgery - Any Advice
« on: September 20, 2010, 08:54:14 AM »
I've been struggling with fat pad scar tissue and impingement for about a year now - since I had an arthroscopy (both knees) about a year ago. I've been trying to get an appointment with a clinic that does alcohol ablation but doctor is refusing to give a referral. I've tried a cortisone injection in both knees and it didn't really help either, so surgery seems to be my only option.

Anyone had any experience with surgery for fat pad impingement? What was the recovery time? Did you get back to full fitness? How can I tell whether my OS is the right one for the job? I'm in the UK so recommendations would be good.

Thanks

Offline Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4183
  • Liked: 75
  • Neil TheElephant knee packed up carrying his trunk
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #1 on: September 20, 2010, 04:36:26 PM »
Hi There,

I had my fat pad trimmed and medial plica removed in November 2009 and like yourself having problems with scar tissue and think its more from the medial plica removal then the fat pad trim as I get most of the pain around the incision area on the medial side. I also get alot of swelling and pain at the bottom of the kneecap and hurts to kneel and squat and still cannot run which was one of the reasons for the surgery. The catching on the lateral side has gone since my surgery but my knee feels worse of now then it did pre op.

I managed to find an old post from KG about this alcohol ablation you are talking about from a member who knows a Pain Clinic in London, where the Dr does alcohol based injections.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=14629.0

Hello to Anyone out there with fat pad irritation/impingement:

Dr. David Connell at the London Pain Center uses a new alcohol ablation technique for Hoffa's Disease (infrapatellar fat pad irritation/impingment syndrome).  He is a radiologist with the Department of Radiology, Royal National Orthopaedic Hospital and Kingston Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex HA7 4LP, United Kingdom.  He presented this at the Radiologist convention in Brussels.  Here is a link to the study: 
http://linkinghub.elsevier.com/retrieve/pii/S0009926007002735  (copy and paste).

This is in lieu of surgery.  It is alcohol (ethanol and analgesic bupivicaine) injected directly into the fat pad guided by ultrasound so that it is direct.  You will need to contact Dr Connell, Consultant Musculoskeletal Radiologist on 02073172790.  You can speak to Carolyn.

Hope this helps!

Nick :) {2010} :)
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 itdoesntbend

  • MICROgeek (<20 posts)
  • *
  • Posts: 3
  • Liked: 0
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #2 on: September 20, 2010, 06:22:49 PM »
I had surgery to treat fat pad impingement and medial plica about 10 weeks ago - and am not seeing much progress. I still can't bend my knee. I find out more on Wednesday - they keep saying it is still MCL damage, and the MRI doesn't show impingement, but then it didn't the first time around - and they only found it when they did an arthroscopy.
From what I gather it's not the easiest thing to recover - given the number of nerve endings in the site.  Good luck... I am trying cortisone injection for the first time this week.

Offline Xeract

  • MICROgeek (<20 posts)
  • *
  • Posts: 16
  • Liked: 0
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #3 on: September 21, 2010, 02:59:10 PM »
Hi guys, managed to get an appointment to see whether I'm suitable for alcohol ablation in a few weeks, so will let you know how it goes. Fingers crossed!

itdoesntbend, I'd be interested to hear how your cortisone injection goes and whether it makes a difference, as it's possible I may have to have another in the future.

Offline Garywake6511

  • MICROgeek (<20 posts)
  • *
  • Posts: 2
  • Liked: 0
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #4 on: October 29, 2016, 10:27:52 PM »
Afternoon all,

I had my fat pad and police surgery 5 weeks ago and having the exact same post operative symptoms like your self.
Desperately been trying to get hold of my surgeon to which I have had no luck and keep getting told wait until your follow up which is a week and a half away so a total of 9 weeks since my operation.
Unfortunately the operation was carried out by the NHS to which I regret everyday!
Can you advise on how you are all now after your recovery and any tips on getting back to normal. I am still on both crutches, unable to apply weight on operated knee nor straighten out or fully bend with out having large amounts of pain.
Your advice and comments will be most welcome
Regards
Gary

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4687
  • Liked: 379
  • Neelie knee!
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #5 on: October 29, 2016, 10:40:34 PM »
Have you seen your GP? Or a physiotherapist, either NHS or privately?

I'm not sure what you mean about the NHS as most consultant surgeons who operate privately also have an NHS practice

Are you icing, elevating? Doing basic physio exercises for extension, flexion, to avoid muscle atrophy and to reduce swelling? The other thing you should always avoid is putting a pillow below the knee when elevating, only under calf and ankle

What do you mean by police surgery? Plica?

When was the op as 5 weeks plus 1.5 isn't 9?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Nobbly-knee

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 2
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #6 on: October 31, 2016, 01:06:35 PM »
Xeract

I think I have one or a combination of fat pad impingement/scar tissue/patella tendinopathy.  Following a recommendation by Vickster I have an appointment with Claire Robertson at the Wimbledon Clinic on 3 Nov.  Have a look at her website http://www.wimbledonclinics.co.uk/consultants/ms-claire-robertson/ as she specialises in anterior knee pain and might be able to give you some other non-invasive options to try first.  I will update this post after I've seen her. 

Alex
ACL rupture & recon and medial menisectomy 2008; lat menisectomy 2008
Steroid injections into portal scar tissue  2010/11
ASTYM 2011
Surgery x2 to remove infrapatellar branch of saphenous nerve 2012
Massage, taping, patella tendon strapping
Ongoing anterior knee pain

Offline Nobbly-knee

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 2
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #7 on: October 31, 2016, 01:12:00 PM »
PS just realised that Xeract's post was 6 years old!  Never mind, others might find my feedback re Claire Roberston useful!
ACL rupture & recon and medial menisectomy 2008; lat menisectomy 2008
Steroid injections into portal scar tissue  2010/11
ASTYM 2011
Surgery x2 to remove infrapatellar branch of saphenous nerve 2012
Massage, taping, patella tendon strapping
Ongoing anterior knee pain

Online Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • Posts: 4687
  • Liked: 379
  • Neelie knee!
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #8 on: October 31, 2016, 01:14:46 PM »
Hope it works out. Report back :)

@Puffythekneeslayer might be interested in your feedback for example
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Nobbly-knee

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 2
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #9 on: October 31, 2016, 05:44:16 PM »
Thanks, will do.
ACL rupture & recon and medial menisectomy 2008; lat menisectomy 2008
Steroid injections into portal scar tissue  2010/11
ASTYM 2011
Surgery x2 to remove infrapatellar branch of saphenous nerve 2012
Massage, taping, patella tendon strapping
Ongoing anterior knee pain

Offline Puffy the Knee Slayer

  • Regular Poster
  • ***
  • Posts: 97
  • Liked: 14
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #10 on: November 01, 2016, 08:47:22 AM »
Thanks Nobbly knee, yes indeed Puffy the Knee Slayer would be interested in how you get on!

I may see Claire Robertson if current treatment (Botox into the tensor fascia lata plus physio, on NHS) is not successful.

Ta
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

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4183
  • Liked: 75
  • Neil TheElephant knee packed up carrying his trunk
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #11 on: November 01, 2016, 05:16:07 PM »
Hi All,

It is good to share our own personal experiences with Fat Pad Impingement Surgery with all the setbacks post-op. Claire Robertson seems to be a good option if you live in the London and the south east region of the UK, and can afford the fees or have medical insurance cover.

[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 Nobbly-knee

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 2
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #12 on: November 04, 2016, 03:37:28 PM »
Quick update following my visit to Claire Robertson in Wimbledon yesterday.  Before the appointment I sent her a 4 page summary of my knee history with photos.  She took the trouble to read this carefully before seeing me making my hour with her very efficient. 

Of the many OSs and therapists I've seen she is the first to have a really good knowledge of each of the physiological, neurological and psychological aspects of knee pain and, crucially, how these inter-link.  I expect most people with chronic knee pain will recognise the logic of this holistic approach, however I wish I'd seen her before my pain became chronic.   

In short she thinks my residual pain is from fat pad damage (but not tendinopathy) from four operations exacerbated by 'hypervigilance' and complex regional pain syndrome, which cause excessive muscle tone (sub-conscious brain-imposed tightness as opposed to short muscles) in muscles/fascia connecting the patella (VMO, ITB, hip flexor, psoas, etc) which then create more pressure from the patella down into the fat pad and so on in a vicious cycle. 

She has recommended ongoing taping, stretching upper leg against resistance and heat wheat bag to reduce tone, and will refer me to Richmond Stace, www.specialistpainphysio.com for pain management and 'reprogramming' of the brain's neural map (I didn't catch the precise jargon!).  My muscle strength is ok as I've been able to stay active so she has given me a target of increasing my cycling miles while finding tricks to reduce the pain ('pain-gating') before I start a ride.  I'll add more detail if relevant when I get the letter. 

At 175 for the first hour (90 per subsequent 1/2 hour though she thinks I may not need another appt. with her) it is not cheap but it's also far more thorough and holistic than a regular physio appt.  For instance it was very refreshing to hear her instantly recognise and diagnose from symptoms which others had been baffled by such as extreme sensitivity to wearing trousers, purple discolouration after exercise, etc.

Many thanks to Vickster for the recommendation. 



ACL rupture & recon and medial menisectomy 2008; lat menisectomy 2008
Steroid injections into portal scar tissue  2010/11
ASTYM 2011
Surgery x2 to remove infrapatellar branch of saphenous nerve 2012
Massage, taping, patella tendon strapping
Ongoing anterior knee pain

Offline Daniellezana

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Fat Pad Impingement Surgery - Any Advice
« Reply #13 on: February 09, 2017, 12:00:54 AM »
Hello,

Like all of you not having fun with fat pads.

After 3.5 years of no diagnosis, I had a exploratory arthroscopy in September where they found I had a bulky fat pad that they trimmed and medial plica. I was told by my consultant at follow up that the knee looked to him to be better (despite me still feeling it was swollen) and so was referred onto pain management. However on going here, the pain consultant asked for another scan that showed an inflamed fat pad, pre patellar bursa and some minor patellar tendon damage. Scans before this had never mentioned the bursa and the tendon and actually the fat pad was not reported on scans immediately before my arthroscopy (it was on the first scan I had back in 2013). Given this report the pain specialist sent me straight back to the knee surgeon, and I've basically had to beg him to try an injection as he feels the only path for me now is drugs.

I'm going to have the injection as is low risk before going down pain management route but am not sure whether to get another opinion on the knee first. The pain person I was referred to only suggested drugs but because of the scan didn't seem that convinced whether this was the right path.

Is there anything else people can recommend - alcohol ablation?

Interested in Nobbly Knees post as I too have an issue with trousers, jeans, tight and leggings. Not sure if it is the swelling or a nervy thing coming from fat pad or elsewhere. I am nt sensitive to someone touching my knee though at all- it's very odd and lots of people look at me like I've lost it when I mention. It was an immediate symptom of this injury. I've also had all nerve tests - with exception of infrapatellar nerve which every person I see refuses to test.

Would be interested to know of the pain physio is helpful. Am a bit worried about going on pain drugs so wonder if this may work instead/ in addition to the drugs? Has anyone else tried these? I am finding Licodaine patches helpful for the trouser issue but only when they are on - ie no lasting benefit. Also considering alternative therapies too.

Symptomatically I'd describe my knee as uncomfortable not painful but every time I extend the knee- so walking is a problem. Worsened by trousers, tights, clingy materials, there is occasional feelings of catching in kneecap and feel it looks very slightly swollen always. I don't seem to fluctuate but don't get any better with rest.

Let me know of any thoughts/advice xz