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Author Topic: Anyone with fat pad impingement and maltracking problems ?  (Read 16440 times)

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Offline Silkncardcrafts

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Anyone with fat pad impingement and maltracking problems ?
« on: November 29, 2011, 08:46:48 AM »
Hi there,

Just got my MRI results over the phone from my physio. Got fat pat impingement suggestive of maltracking.

I am currently on crutches and even painful with that.

What sort of treatment have you had with this condition ?

Seeing my surgeon next Monday.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Stasha83

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #1 on: November 29, 2011, 09:03:33 AM »
Hi

My knee nightmare began with my fat pad being trimmed (which was never the actual problem but hey ho!) and then being put in a brace for 6 weeks. Three surgeries later and a diagnosis of Arthrofibrosis I now have no fat pad at all as the remainder had to be removed in my last surgery.

The fat pad is highly innervated so if it is truly impinging or damaged this can cause extreme pain. Did you have an accident or trauma to the knee to cause this?

I think it's quite a tricky one to treat, my current OS says that he would never surgically touch a fat pad as in his experience, the knee doesn't respond too well. I am his exception to that rule though! On the other hand my original OS was obviously quite happy to fiddle with it so I guess it's down to the opinion of your OS and physio. I also think some OS's will inject the fat pad too as a first option.

My experience has not been a good one but hopefully you will hear from others that have had a better result than me. Good luck with your appointment next week.
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Silkncardcrafts

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #2 on: November 29, 2011, 09:15:38 AM »
Thanks for your input.

I am in extreme pain. Had a mishap at Pilates when I had a bad instructor a few months back and felt the knee twinge.

My surgeon will have to do something as I have been doing conservative treatment for over three months now.

Feel like my patella isn't tracking properly and my tibia is moving too.

Were you in hospital for long ?
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Stasha83

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #3 on: November 29, 2011, 10:23:19 AM »
I think if you have tried the conservative approach for that long it's time to look at other options. Has your physio advised surgery would be a good option?

Have you had it injected? My physio told me about another patient who had an impingement and she recovered after having the fat pad injected and intensive physio to build up the muscle surrounding the knee.

After the first op (the fat pad trim) I woke up in agony and couldn't move, the pain was horrific. I later found out that I had very poor pain management in the hosiptal so I am sure this ould be addressed by a better OS. I was in hospital for 2 nights after that op. I had serious pain and swelling after and because of subsequent problems (AF) I will never fully recover and am in constant pain. But like I said before, my case is a particullarly bad one and i'm sure plenty of others have had good results.

I think as it is so full of nerves it just doesn't like being fiddled with, my OS told me about another OS who performed a scope on himself (for research or something) without any pain relief and he prodded the meniscus, ligaments, tendons etc but when he prodded the fat pad he passed out because of the pain. I think it is totally understandable why you are in so much pain!

June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Driden

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #4 on: November 29, 2011, 01:39:53 PM »
In addition to a steroid injection, ice, and oral or topical NSAIDs, you might google "McConnell patellofemoral taping unload fat pad" and buy on of those Luko(sp?) PF taping kits. The fat pad is likened to biting the inside of the cheek...it keeps getting nicked unless it calms down. So rest is also key. I have read that removal via surgery is often curative, and it sounds quite simple. Of course, it will not fix a root maltracking problem.

Offline nwc07

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #5 on: November 29, 2011, 02:35:35 PM »
I've had 2 cortisone injections directly into my inflamed fat pad.  This has helped reduce the size and inflammation and lessen the impingement.  They can inject it with lidocaine so you dont feel it.  I think the worst I had was a dull ache the day after... 
09/10- left knee subluxation..

Offline nwc07

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #6 on: November 29, 2011, 06:01:10 PM »
I have read that removal via surgery is often curative, and it sounds quite simple.

I have read the same thing but when I questioned this I was told if you remove the fat pad that empty space will just fill up with more scar tissue?  Yet excision of the fat pad is frequently done in arthroplasty ...
09/10- left knee subluxation..

Offline Silkncardcrafts

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #7 on: November 29, 2011, 11:17:56 PM »
Thanks for all your replies.

I have NEVER been in soooo much pain ! The pain is unrelenting.

Can't wait to see what my surgeon says on Monday.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Stasha83

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #8 on: November 30, 2011, 09:01:17 AM »
Having had my fat pad totally removed I too told was told that the 'empty' space will more likely than not fill with scar tissue. Given that I have AF, I think this is very probable indeed!

My problem was that the remainder (it was trimmed in June 2010) of my fat pad had become so scarred and hard it was causing constant pain and inflammation, which in turn, was producing even more scar tissue throughout the knee. It's too early to tell if the removal will help with my ongoing AF battle but in my case, it had to be removed as we had no other options.

Silkncardcrafts: Good luck with your appointment on Monday, I would be interested to hear how you get on.
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Silkncardcrafts

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #9 on: November 30, 2011, 12:32:37 PM »
Thanks for the good luck wishes.

Interesting to hear about your fat pad removal. I have a feeling they will need to remove some of mine.

My knee surgeon and sports physician aren't keen on me using cortisone plus I already take asthma relievers that have cortisone in them.

The worst part is that being on crutches it is putting other joints under pressure.

I see my sports physician in the morning. So, will be interesting see what he says.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline Silkncardcrafts

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #10 on: December 05, 2011, 11:22:45 AM »
Hi All,

Just wanted to update you on how I went with my knee surgeon tonight.

He doesn't want to do anything at the moment. My surgeon wants me to forget physio and clinical pilates but instead do exercise that I enjoy such as cycling, golf and walking.

The MRI shows minor bone edema, patella tendon issues, fat pad issues and grade 2-3 patellofemoral arthritis.

I will give things a few months and if nothing changes I will go back to see him again.

Finding it hard to take in all right now.
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline kapah

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #11 on: January 21, 2012, 02:29:19 PM »
Hi,

I have been battling fat pad issues for almost 3 years now.  Started with a simple running twist at work which didnt flare up for 2 days, then it got worse and worse, especially as the first surgeon said it was a sprain.  Since then it has been 8 ortho surgeons, about 10 physios, 3 Exercise physiologists, a psychologist, a pain doctor, 1 x surgery (possibly another one soon), 2 bone scans, 3 MRIs and dont ask how many pain killers.

Cortisone injection did nothing but flare it up.

Some physio exercises worked to a degree, but only once the flare up had calmed down. I found surgery relieved my pain by 60% in the first day (yes, i was in less pain even immediately after the surgery).  I got back to almost new, and then when I threw myself completely back into full time active work, the pain started the cycle of the quads shutting down and thus muscle wastage and patella maltracking.

When the pain was at its worst........I was on 75mg of Endep per day (anti depressant) which helped calm the intense nerve pain that was mostly at night, and helped get me to sleep.  The only issue is that you become a bit zombie like, and it is hard to wean off as the pain smashed me when i tried getting off it 7 months after surgery....and within 4 days i had to go back on it to stop the pain. 

Currently I am seeing a Chiro/Kinesiologist who is brilliant and kept it going bloody well until the work issue re-irritated it, but he used Kinesio tape, which is so much more effective than the Jenny McConnell taping, and the Kinesio tape doesn't irritate your skin at all compared to the Elastoplast taping.

My advise......if physio and ice helps, then keep up the exercises to target VMO.  If you got as bad as me where laying in bed is impossible without a pillow under your knee, or having to walk the dog with a mobility scooter (I'm 32 and its not a good look), then ask your surgeon whether he has had much to to with fat pads....some dont even recognise it exists.  And above all, the pain is excruciating, and there is no logic to the pain.  You can rest it for 3 days and it will hurt worse, which makes no sense.  Do not let anyone tell you it is in your head.  My surgeon tried to tell me that I had a mental illness, and asked if I had seen a psychologist........I told him that I had been to one, and that it had been her that gave me his name.  That surgeon was shocked at how much improvement there was in 10 days, and finally stopped treating me like I was mad.

Offline nwc07

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #12 on: January 21, 2012, 03:53:54 PM »
  That surgeon was shocked at how much improvement there was in 10 days, and finally stopped treating me like I was mad.

So your improvement came from Kinesio tape? 
09/10- left knee subluxation..

Offline PiotrS

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #13 on: January 21, 2012, 04:18:15 PM »
I also had problems with fat pad impingement when I tripped and twisted my bad knee 2 months after ACLr surgery. Luckily my ACL held up, but I had problems with pain on extension for many weeks after. My muscle weakness following surgery was probably causing patella maltracking, and that was constantly aggravating the fat pad after the initial trip that must have caused it to swell in the first place.

We tried a number of approaches with my physio, but the best solution turned out to be kinesiotaping with a lot of quad strenghtening work to go with it. Before any serious exercise I was doing 100 step ups without full leg extension to get the VMOs to fire before doing any other exercise that could potentially aggravate the fat pad.

After two months of this regime, my patella tracking is now much better, and the problem with the fat pad has all but disappeared.


Offline cmoesle

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Re: Anyone with fat pad impingement and maltracking problems ?
« Reply #14 on: January 24, 2012, 04:11:21 AM »
Hi everyone,

First of all I am amazed to see that there are more people with the same problem that I am having. I felt as though no one understood what I was going through. I'm 19 years old and have currently redshirted my freshman year of college soccer due to the horrible knee problems I've been having. In the past year and a half I have had 2 scopes on my meniscus and have recently had fat pad resection. It's been 4 months and everything has gotten worse since this fat pad resection. Soccer seems completely out of the picture but more importantly I cannot live my day to day life being in this constant pain. I have a great  surgeon, the Indianapolis Colts doctor actually, and I trust that he is a very bright man but he cannot figure out what my next step should be.

Does anyone have any suggestions for me? Is a fat pad removal too drastic for someone my age?
In addition to the extreme pain I have right below my patellar tendon I continue to have the original pain (a stabbing pain between my femur and tibia) where the fat pad was supposedly being impinged.

If anyone had any insight I would be very thankful!