Banner - Hide this banner





Author Topic: DESPERATE FOR HELP - Knee fat pad impingement  (Read 3717 times)

0 Members and 1 Guest are viewing this topic.

Offline MrsV

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
DESPERATE FOR HELP - Knee fat pad impingement
« on: August 12, 2014, 02:59:42 PM »
Hi. I wonder if anyone is able to offer advice or help. My daughter is 36 and is having excruciating pain for the last 3 months.
After 2 months We paid to have a private MRI as her GP support was lacklustre and conventional treatment of ice, rest, physio was not making any difference. The private professor we saw was very strange indeed, however after he finally managed to get his PC working he said it was a fat pad infringement and would get better eventually. And that was about it.

She can barely walk at all without excruciating pain - yesterday she was seeing stars it was so bad. She was sick with pain which appears to be relentless. She had to sit down on a pavement last week and her knee felt burning.
Her GP has referred her to an Orthaepedic Surgeon but has warned it could take at least 3 months then they probably won't do anything. He then kindly offered her anti depressants as she seemed to be "stressed"!!

She is a self employed single mother trying everything she can to keep herself together but is beginning to lose hope of any end to this.
Physiotherapists haveve said there are other treatments available such as cortisone injections and as a last resort surgery but no one seems to be interested at all.

We are at the end of our tether now - she is doing as little as possible with her knee, having physio and gentle exercise but with the best will in the world she has to walk even if it's only to go to the loo!

Has anyone any advice please???

Offline laxknee

  • MICROgeek (<20 posts)
  • *
  • Posts: 10
  • Liked: 0
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #1 on: August 12, 2014, 08:11:42 PM »
I don't have fat pad impingement, but I do have extensive scarring in the fat pad (due to a recent ACL reconstruction surgery). Walking isn't challenging, but every time I extend & bend the knee, I have excruciating pain. Stairs are my own personal nightmare - I usually use my "good leg" to go up & down stairs.

Based on my limited experience with this (and closeness in age to your daughter - I'm 30), I will share what's worked for me (so far):

1. Massage therapy: Painful but helps move things around and reduces pain. The clinic I would go to has laser treatment, EMF & massage therapy. It helped reduce the pain (although it never really went away).

2. Knee taping: This was a Godsend. If done just the right way, it took away 60-70% of the pain - at least for me.

3. I recently went through 4 surgeon interviews about the Hoffa's fat pad scarring that I have. I do not want to go under the knife for a second surgery. 3/4 recommended surgery, while 1 (Dr. Scott Dye) was completely against it. He put in a steroid shot and is helping me bring back extension (post op ACL surgery complication). He believes if there is less stress on the fat pad, the pain can be managed.

4. Custom orthotics: A part of my issue is pronotion post op. This means that my fat pad is being irritated because I have lost muscle strength and the knee is now titling, causing weird posture. I received these 10 days ago and the results are still TBD.

5. Change of physical therapists. I have just started going to a new PT. He recommends "trying" to strengthen muscles around the knee so that there is less stress on the knee, and in turn, on the fat pad. He plans on getting to this through posture correction.

I don't know how helpful this is, since my issue is slightly different, but I wanted to throw some recommendations out there, just in case they can help. The ultimate decision for your daughter would be to have surgery, of course. I have suffered post op complications (I make up 5-10% of the people that do), so I am especially wary of surgery. Just my 2 cents :)

Hope she feels better soon!


Offline MrsV

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #2 on: August 12, 2014, 09:21:26 PM »
Thank you for that. It's definitely food for thought. We were hoping a cortisone injection might be helpful but need to find someone to actually put themselves out to help.

She has had her knee taped which hasn't helped so now waiting to see a consultant.
I'll keep you posted.

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 405
  • Neelie knee!
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #3 on: August 12, 2014, 09:28:29 PM »
Could she see a consultant privately again (and potentially transfer to the NHS list if required)? Maybe a different one?  Where are you in the UK, there's a list of knee specialist in the information hub


Good luck :)
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 MrsV

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #4 on: August 13, 2014, 10:06:05 AM »
We're in the Newcastle area. We've another appt privately on 1 September just worried they won't be very helpful either. Sort of lost faith a bit but we'll see.

I never thought that 3 months down the line she would still be hobbling, and crying with pain. Fingers crossed.

Thanks

Offline Vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4844
  • Liked: 405
  • Neelie knee!
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #5 on: August 13, 2014, 10:23:33 AM »
Hope it all goes well.  Go armed with lots of questions, make sure he listens to your story, understands your daughters situations and concerns. Say that you've tried everything conservative and now is the time for a more definitive intervention you believe. 

Unfortunately, often with soft tissue issues it is just a matter of time, but a steroid injection might help.  The fat pad is full of nerves, hence it's so painful.  There is at least a clear diagnosis from the MRI to address, not always the case

Good luck
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 Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4190
  • Liked: 75
  • Neil TheElephant knee packed up carrying his trunk
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #6 on: August 13, 2014, 04:10:38 PM »
Hi There,

Laxknee has given some useful advice and guidance that covered most must of my suggestion. I can tell you from my own personal experience of fat pad impingement in my right knee that is is a long and frustrating and painful process to sort out.

Soft tissue injuries inside the knee joint can be extremely painful and restrictive causing chronic knee pain. It always best to try out all the conservative options 1st before going for an exploratory scope as the fat pad region can be sensitive if any surgery is performed on the fat pad.

I tried physio 1st as I have maltracking problems in both my knees and my right kneecap is lower then it should be and hoped that PT would help lift the kneecap slightly by building up the muscle around the kneecap. This would hopefully stop the fat pad impinging the kneecap, it made no difference with my fat pad issues.

Soft tissue injures to the knee can take a while to recover from fully and a wise decision to go private as this is what I did I saw my OS privately and then for further treatment saw him the NHS saving valuable time. It was £170 well spent to jump up the NHS waiting list.

I had ultra sound, friction massage therapy, custom made orthotics and a cortisone injection all treatments failed. I had no other option left and went ahead with an exploratory arthroscopy. My OS removed my medial plica and trimmed my fat pad that caused the pinching and sharp pain at the bottom of my right kneecap.

Warning caution if your daughter did require surgery to reduce the fat pad it a fairly invasive surgery and can cause excessive amount of fibrous scar tissue to build up around the fat pad that can restrict the knee movement.

I am more prone to scarring and some are less prone and just had my post op pre op appointment with my OS this afternoon and said when he was inside my right knee was lots of scarring around the fat pad that was restricting movement inside the kneecap.

I am 36 in December and think I read up and maybe wrong that fat pad impingement is more of a common problem with females and less of a knee problem found in males. I was just unlucky that I more prone to scarring that can be hard to get right again if you overdo it post op as it can return again.

Good luck with your daughters appointment with a private OS, surely can see him/her sooner then 1st September. When I saw my OS at a private hospital saw him within 10 days after my GP referral. Maybe you could call the OSís Secretary to try and fit your daughter in earlier this month ideally as we not even half way through yet August yet!

[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 MrsV

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #7 on: August 13, 2014, 07:29:21 PM »
Thanks for that advice Clarkey. Surgery is definitely the last resort!
The recommended OS is on holiday at the moment which is why there's a bit of a wait. After seeing the first private "knee specialist" we definitely need a second opinion. Both he and her own GP just seem to take the view it will get better eventually and don't do anything to aggravate it. As walking a short distance aggravates it this is a bit difficult.
She has had physio, massage, exercises, acupuncture, taping, icing the knee constantly, painkillers, gel - her physio will no longer treat her as its not helping and has recommended she sees a consultant. Nothing helps at all. As you can imagine she's really struggling and the constant pain is having a detrimental effect on her overall.

Well we'll keep on going. 

Offline Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4190
  • Liked: 75
  • Neil TheElephant knee packed up carrying his trunk
Re: DESPERATE FOR HELP - Knee fat pad impingement
« Reply #8 on: August 15, 2014, 04:34:21 PM »
It is worth waiting to see a recommended OS that is still a quicker appointment then seeing an OS on the NHS despite him being on a well deserved holiday.

Also worth considering are Sports Medicine Physician that are more experienced then your standard PT and do not do surgical procedures that an OS might consider doing if all other options have failed!

[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