Bad Case of Fat Pad Impingement...

[lilayZee]

Hey everyone,

This is a long story that has been spanning over the course of 6 months with little to no improvement. I have been on this site constantly looking for answers during my whole ordeal trying to learn as much as possible and I've finally decided to post my story on here hoping to get a reply from someone going through something similar to myself or just to put it out there if there is anyone else who is looking for answers and is going through the same thing as I am. I would love to hear from all you fellow geeks out there.

On May 13th this year i slipped in indoor soccer while turning and heard about 5 pops which ended up being a large bucket handle tear in my right knee which was first misdiagnosed as two small tears. I had a second MRI taken at the 13th week mark which showed it was a large bucket handle tear with floaters and i got told by my surgeon that it was obvious from the first MRI that it was a bucket handle tear. I lived in complete agony for 13 weeks before i had the partial meniscectomy, but i was to stubborn to get the surgery done as I'm a massive believer in the bodies own ability to heal itself. I eat extremely well, look after myself, very fit, and am a very spiritual and grounded person. During this time i could not stand, walk, or do anything really, i quit my job and was basically sitting down for 15 hours a day being cared constantly trying to let my body recover.

I'm from Adelaide, South Australia and had my partial meniscectomy done mid august by Dr Roger Paterson who is one of the better surgeons and got told i would be back to running within 4 weeks. After the surgery my OS told me he removed about 70% of my medial meniscus and that my fat pad just a bit swollen but besides that my knee looked perfect. So he said all my anterior knee pain was probably coming from the fat pad because the displaced piece of my meniscus was in a position where it was irritating it constantly. He said the fat pad would settle after a month or so and everything would be good. After the surgery my knee was extremely swollen and it took about 2-3 weeks for the swelling to go down. After the surgery i lost the pinchy feeling below my kneecap that i had been dying from for 3 months prior and was optimistic. But after my knee swelling started disappearing the pinch became more and more painful up to the point where its basically only the bottom of my kneecap that has swelling, i have a little residual swelling around elsewhere. I have no pain anywhere in my knee besides the pinch that never goes away, i wake up and its there and its there till i close my eyes at night. I also have on and off swelling in my calf and foot which is massive. My os says I've been hit with a very bad case of fat pad impingement but he was suprised because my fat pad was only slightly swollen when he did the scope. He doesnt believe i have scar tissue formation since its the exact same pain i had before the surgery and its so localised.

Since the surgery i still cant walk or do anything without pain. If i go for 10 minute walks around my block the pinch just slams me and I'm in 11/10 pain for days and it takes 2-3 weeks to settle so i had to stop all my walking all together. I was trying to do the physio exercises but it just did the same thing, any exercise i would do from shallow wall squats, glute bridges, leg raises just to name a few would get me in 11/10 pain for days. All i do is sit for 15 hours a day and have been essentially doing this for 5-6 months. I cant do anything because any slight activity i do puts me out for weeks, Ive been resting my knee completely for a month now not doing anything with it and its still not going away. im running out of options, Ive been doing acupuncture twice a week for 3 months, am perfect with my diet, using fat pad offloading with tape, tried hydrotherapy, cycling, walking, physio exercises, PEFT therapy, chiro, mobic, herbs, topical creams, foam rolling, stretching. I cant even pick up a book and read it or play my playstation because when i move my hands and hold something the pain in my knee worsens straight away too. So all i basically do is sit and watch tv. I am going to try cortisone at my next OS appointment in a few weeks but feel that is my last option before a revision surgery to trim the fat pad, which from the other threads doesnt sound like is a good idea due to the scar tissue formation. Because my right knee hasnt been functioning for 6 months now i've got pains in my left knee all time, tight muscles everywhere, tight itb's, neck and shoulder pain from overusing arms, sore back from sitting too much, achilles tendinopathy on my left leg, developing pressure sores from sitting down all day (have to sit on a roho wheel chair cushion at all times otherwise extremely painful), have bursitis under my sit bone. I'm only 24 years old and i was an extremely fit person playing indoor soccer for 2 comps and outdoor soccer and now i feel like im a living zombie not being able to do anything.

Has anyone had a case of fat pad impingement as serious as this. Has anyone gotten over a bad stint of fat pad impingement? I really feel like im the only person on the planet who has it this bad, ive read lots of forums and never come across anyone who is in pain like me.

[Scubagrl4]

Hi lilay,
I am so sorry to hear of your knee troubles. I do not have the exact problem that you do, but I did want to let you know that you are not alone in your frustration with a knee that won't behave. I too was very active before my knee injury 7 months ago, and I understand how hard this all is. I really hope that this cortisone injection works for you. Have you had another MRI since your surgery? If not, it sounds like it is about time you had some more testing done...especially to rule out arthrofibrosis and rsd. With the amount of pain you are having, it just sounds like you really need to know what is going on. If your doctor doesn't seem to want to find out what is going on, I would get a new doctor if I were you.
I hope you start feeling better soon. (((Hugs)))

[lilayZee]

Thanks for the kind words. Am getting another MRI done to take into the next os appointment. os is pretty certain its just the fat pad because i had this exact same pain for months before the surgery and when he went in he said my knee was perfect besides the fat pad and meniscus. and the pain is no where near the meniscus area. just a never ending pinch right underneath my patella towards the bottom of it.
Sounds like you have had a tough last 7 months...hopefully you are getting some sort of improvement in your recovery.

[Scubagrl4]

Thank you lilay,
I hope so too, but it's too soon to tell at this point.
Keep us posted on your MRI results. I really hope it is something that can be fixed without more surgery.

[Clarkey]

Hi Lilay,

Sorry for the late reply, after having read through what you have been through so far your knee problems sounds very much like how my knee was pre op before I having exploratory scope #1 four years ago in November 2009.

Pre op to scope #1 I was getting anterior knee pain with pain and swelling only at the bottom of my right knee and was also experiencing pinching and catching inside the knee. At 1st I thought it must be a torn cartilage and had an MRI done that surprisingly turned out to be clear with just signs of swelling and fluid around the fat pad.

I had a cortisone injection into the fat pad in the hope that it would reduce the pain and swelling as it was not just the catching and pain causing me problems I was not able to run due to the knee pain while trying to attempt to run. I also had the usual routine of PT and ultra sound therapy that made no difference! I had no option left in the end but to go for an exploratory scope.

My OS did pre warn me and even said are you sure you still want to go ahead still with the exploratory surgery when I signed the consent form as he may go inside my knee for nothing before going into theatre. I of course signed the consent from as I would do anything to stop the catching and being able to run again at a competitive level.

When my OS was looking inside my right knee he had to remove my medial plica that was large and inflamed and so was my fat pad that he trimmed and did not remove the fat pad completely. When I woke up despite the strong pain killers given could feel pain around the portals at the bottom of the kneecap.

It took 18 months till I was able to run again at a competitive rate and had to go to the pain clinic as I was still getting pain and swelling at the bottom of my kneecap and was given another cortisone injection into the medial portal that was the area that was most painful. Also had IMS dry needling done that did help for a while only!

I was ok again for a further 18 months and was running long distance again at a good rate and managed to run 9 miles in just under 1 hour. In was pre training to take part in my very 1st ever half marathon in March 2013 and had just joined a running club and was already one of the top club runners.

The good old British weather managed to ruin my training and hard work when I slipped on black ice in January 2013 while I was walking as running would have been irresponsible. I also slipped before I had exploratory scope #1 in October 2007 when I slipped over on an untied shoelace while I was running falling hard onto my right knee. I managed to do the same again falling onto my right knee with momentum. This was 6 weeks before the half marathon and was gutted when I had to pull out.

Since then all down hill and not been able to run again and went through PT and even had a Botox injections into tensor fascia lata as my OS thought it was my tightness around IT band causing PFS. Again was not really doing much and once again opted to have another exploratory scope #2.

This is when my OS did anterior interval release surgery and removed an excessive amount of scar tissue inside my right knee that was caused from scope #1 when the medial plica was removed and fat pad was trimmed! I had AIR surgery in July of this year and I am just over 4 months post op.

I hate sounding negative as I am only be honest! My right knee pain is worse now than it was pre-op with more intense pain and swelling at the bottom of my kneecap with the main pain and tightness around the medial portal. I am certain AF has returned again!

I apologies for such a long post hence the late reply as I have not had the time until now to give a reply back again. I hope what I have had to go through so far will give you a better understand towards 'Fat Pad Impingement' and 'AF' of the knee.

Good luck trying to get your knee sorted that is going to be a long stressful process to go through, you will have good and bad knee days, It is also ok and normal to get upset at times and feel frustrated. I am glad I have KG for moral support and guidance.

It is good to be able to share our own personal experiences and being able to help and guide one another through our ongoing knee problems!

[email protected]

[pelin]

Hi Lilay,

I came across with your post in this forum and wanted to know what happened with your injury afterwards. This post is 5 years old and hope that you feel ok by now. Please update us with your news.

I am also having a fat pad impingement injury myself. Although mine is not as bad as yours but still affecting my life big time. Knowing that this will all go away one day will really cheer me up right now tbh.

Looking forward to your reply.

Thanks.

Pelin


-----------------------------------------------------------------------------------------------------------

Hey everyone,

This is a long story that has been spanning over the course of 6 months with little to no improvement. I have been on this site constantly looking for answers during my whole ordeal trying to learn as much as possible and I've finally decided to post my story on here hoping to get a reply from someone going through something similar to myself or just to put it out there if there is anyone else who is looking for answers and is going through the same thing as I am. I would love to hear from all you fellow geeks out there.

On May 13th this year i slipped in indoor soccer while turning and heard about 5 pops which ended up being a large bucket handle tear in my right knee which was first misdiagnosed as two small tears. I had a second MRI taken at the 13th week mark which showed it was a large bucket handle tear with floaters and i got told by my surgeon that it was obvious from the first MRI that it was a bucket handle tear. I lived in complete agony for 13 weeks before i had the partial meniscectomy, but i was to stubborn to get the surgery done as I'm a massive believer in the bodies own ability to heal itself. I eat extremely well, look after myself, very fit, and am a very spiritual and grounded person. During this time i could not stand, walk, or do anything really, i quit my job and was basically sitting down for 15 hours a day being cared constantly trying to let my body recover.

I'm from Adelaide, South Australia and had my partial meniscectomy done mid august by Dr Roger Paterson who is one of the better surgeons and got told i would be back to running within 4 weeks. After the surgery my OS told me he removed about 70% of my medial meniscus and that my fat pad just a bit swollen but besides that my knee looked perfect. So he said all my anterior knee pain was probably coming from the fat pad because the displaced piece of my meniscus was in a position where it was irritating it constantly. He said the fat pad would settle after a month or so and everything would be good. After the surgery my knee was extremely swollen and it took about 2-3 weeks for the swelling to go down. After the surgery i lost the pinchy feeling below my kneecap that i had been dying from for 3 months prior and was optimistic. But after my knee swelling started disappearing the pinch became more and more painful up to the point where its basically only the bottom of my kneecap that has swelling, i have a little residual swelling around elsewhere. I have no pain anywhere in my knee besides the pinch that never goes away, i wake up and its there and its there till i close my eyes at night. I also have on and off swelling in my calf and foot which is massive. My os says I've been hit with a very bad case of fat pad impingement but he was suprised because my fat pad was only slightly swollen when he did the scope. He doesnt believe i have scar tissue formation since its the exact same pain i had before the surgery and its so localised.

Since the surgery i still cant walk or do anything without pain. If i go for 10 minute walks around my block the pinch just slams me and I'm in 11/10 pain for days and it takes 2-3 weeks to settle so i had to stop all my walking all together. I was trying to do the physio exercises but it just did the same thing, any exercise i would do from shallow wall squats, glute bridges, leg raises just to name a few would get me in 11/10 pain for days. All i do is sit for 15 hours a day and have been essentially doing this for 5-6 months. I cant do anything because any slight activity i do puts me out for weeks, Ive been resting my knee completely for a month now not doing anything with it and its still not going away. im running out of options, Ive been doing acupuncture twice a week for 3 months, am perfect with my diet, using fat pad offloading with tape, tried hydrotherapy, cycling, walking, physio exercises, PEFT therapy, chiro, mobic, herbs, topical creams, foam rolling, stretching. I cant even pick up a book and read it or play my playstation because when i move my hands and hold something the pain in my knee worsens straight away too. So all i basically do is sit and watch tv. I am going to try cortisone at my next OS appointment in a few weeks but feel that is my last option before a revision surgery to trim the fat pad, which from the other threads doesnt sound like is a good idea due to the scar tissue formation. Because my right knee hasnt been functioning for 6 months now i've got pains in my left knee all time, tight muscles everywhere, tight itb's, neck and shoulder pain from overusing arms, sore back from sitting too much, achilles tendinopathy on my left leg, developing pressure sores from sitting down all day (have to sit on a roho wheel chair cushion at all times otherwise extremely painful), have bursitis under my sit bone. I'm only 24 years old and i was an extremely fit person playing indoor soccer for 2 comps and outdoor soccer and now i feel like im a living zombie not being able to do anything.

Has anyone had a case of fat pad impingement as serious as this. Has anyone gotten over a bad stint of fat pad impingement? I really feel like im the only person on the planet who has it this bad, ive read lots of forums and never come across anyone who is in pain like me.

Hey everyone,

This is a long story that has been spanning over the course of 6 months with little to no improvement. I have been on this site constantly looking for answers during my whole ordeal trying to learn as much as possible and I've finally decided to post my story on here hoping to get a reply from someone going through something similar to myself or just to put it out there if there is anyone else who is looking for answers and is going through the same thing as I am. I would love to hear from all you fellow geeks out there.

On May 13th this year i slipped in indoor soccer while turning and heard about 5 pops which ended up being a large bucket handle tear in my right knee which was first misdiagnosed as two small tears. I had a second MRI taken at the 13th week mark which showed it was a large bucket handle tear with floaters and i got told by my surgeon that it was obvious from the first MRI that it was a bucket handle tear. I lived in complete agony for 13 weeks before i had the partial meniscectomy, but i was to stubborn to get the surgery done as I'm a massive believer in the bodies own ability to heal itself. I eat extremely well, look after myself, very fit, and am a very spiritual and grounded person. During this time i could not stand, walk, or do anything really, i quit my job and was basically sitting down for 15 hours a day being cared constantly trying to let my body recover.

I'm from Adelaide, South Australia and had my partial meniscectomy done mid august by Dr Roger Paterson who is one of the better surgeons and got told i would be back to running within 4 weeks. After the surgery my OS told me he removed about 70% of my medial meniscus and that my fat pad just a bit swollen but besides that my knee looked perfect. So he said all my anterior knee pain was probably coming from the fat pad because the displaced piece of my meniscus was in a position where it was irritating it constantly. He said the fat pad would settle after a month or so and everything would be good. After the surgery my knee was extremely swollen and it took about 2-3 weeks for the swelling to go down. After the surgery i lost the pinchy feeling below my kneecap that i had been dying from for 3 months prior and was optimistic. But after my knee swelling started disappearing the pinch became more and more painful up to the point where its basically only the bottom of my kneecap that has swelling, i have a little residual swelling around elsewhere. I have no pain anywhere in my knee besides the pinch that never goes away, i wake up and its there and its there till i close my eyes at night. I also have on and off swelling in my calf and foot which is massive. My os says I've been hit with a very bad case of fat pad impingement but he was suprised because my fat pad was only slightly swollen when he did the scope. He doesnt believe i have scar tissue formation since its the exact same pain i had before the surgery and its so localised.

Since the surgery i still cant walk or do anything without pain. If i go for 10 minute walks around my block the pinch just slams me and I'm in 11/10 pain for days and it takes 2-3 weeks to settle so i had to stop all my walking all together. I was trying to do the physio exercises but it just did the same thing, any exercise i would do from shallow wall squats, glute bridges, leg raises just to name a few would get me in 11/10 pain for days. All i do is sit for 15 hours a day and have been essentially doing this for 5-6 months. I cant do anything because any slight activity i do puts me out for weeks, Ive been resting my knee completely for a month now not doing anything with it and its still not going away. im running out of options, Ive been doing acupuncture twice a week for 3 months, am perfect with my diet, using fat pad offloading with tape, tried hydrotherapy, cycling, walking, physio exercises, PEFT therapy, chiro, mobic, herbs, topical creams, foam rolling, stretching. I cant even pick up a book and read it or play my playstation because when i move my hands and hold something the pain in my knee worsens straight away too. So all i basically do is sit and watch tv. I am going to try cortisone at my next OS appointment in a few weeks but feel that is my last option before a revision surgery to trim the fat pad, which from the other threads doesnt sound like is a good idea due to the scar tissue formation. Because my right knee hasnt been functioning for 6 months now i've got pains in my left knee all time, tight muscles everywhere, tight itb's, neck and shoulder pain from overusing arms, sore back from sitting too much, achilles tendinopathy on my left leg, developing pressure sores from sitting down all day (have to sit on a roho wheel chair cushion at all times otherwise extremely painful), have bursitis under my sit bone. I'm only 24 years old and i was an extremely fit person playing indoor soccer for 2 comps and outdoor soccer and now i feel like im a living zombie not being able to do anything.

Has anyone had a case of fat pad impingement as serious as this. Has anyone gotten over a bad stint of fat pad impingement? I really feel like im the only person on the planet who has it this bad, ive read lots of forums and never come across anyone who is in pain like me.

[Robitgeern]

Thanks for the info

[plant]

Hi lilayZee/ Pelin
I also have this issue - did anyone get surgery in the end? I had it 3 months ago and am still very much in the healing phase. Just looking to see if anyone has had a similar experience!

[RyanC]

Hi LilayZee,

I am really interested to see how you came along since you posted this in 2014. I am also from Adelaide, South Australia and my surgeon was also Dr. Roger Paterson out of SportsMed in Stepney. When I read it I couldn't believe the coincidence!

I am in somewhat of a similar position. I had my arthroscopy and there was nothing wrong except for a fat pad impingement that was trimmed back. I am having similar issue where I am having pain and discomfort after the surgery.

Cheers
Ryan

[phillyhScotland]

Hi Lilayzee et al.,

I’ve been struggling with hoffa’s for 5 years, last 3 years on crutches. had surgery 2 years ago and regret it. Made things worse. I saw another consultant after that but he looked incredulous about the whole shaving idea. Seems that not all consultants approve of it! He told me to just walk, should get better, did for a while then deteriorated again, nightmare. Will try an injection again, 3 times injections did nothing but one time worked well, has to be in the right place. Anyway, I hope you all manage better with this than I have. Hopefully it can be fixed.
Kind regards
Philip

[amy]

Hi all,

I too have been struggling with fat pad problems in my left knee and have decided to post in hope to get some advice on course of action and hear some positive recovery stories! 33yo female, was semi professional horse rider :-(

My problems started 15months ago in Jan 202 when I opted to have a partial meniscectomy (before did have bad pain sometimes but lived a normal active life just had to be careful and rest and ice it for a few days at a time sometimes when pain was very bad)- have been getting worse and worse and now have been on crutches for the past 3 months. (3months post op I was able to ride a little again and walk to do daily activities but by end of day knee was very painful, too much walking or standing made it worse quickly) 3 months post op i crouched in shower and had immediate intense pain this is where my problems really got worse and I was unable to weight bear much from this point on.
I've not been able to stand or walk at all, other than absolute essentials to get tot eh loo or to bed, into a car etc. Its very debilitating. Just wondered how any of you are doing now? I have pain in that area all of the time from the moment I wake until when and if I can get to sleep. I also have a very intense constant nerve pain as well now on the outside of my knee that is even worse at night and often wakes me up. Putting my leg into full extension or flexion really aggravates even more but is possible although painful to do. Currently taping, going to hydrotherapy once or twice a week (have been doing so since May last year) have had various nerve tests but it was in June last year before the constant outside pain came.

Had 2 weeks of progress in pain and small improvement in ability to walk in house and sleep with a lot less pain in August last year but things have progressively got worse since August, at that point I could do the recumbent bike for 10-15 mins a day without it making things worse and didn't hurt to actually do it too much.  Because I have been so immobile despite trying to keep the leg moving rolling a soft ball under the foot whilst seated etc and seated marching.. I have lost a lot of muscle so knee cap is not tracking completely straight how they used to when I was strong. (Was a full time horse rider, self employed competing and breeding horses , enjoyed skiing, tennis etc) 

I'm also 33 week pregnant so cant use any pain meds (was using lidocaine patches before that did help)

Any advice welcome! I feel totally lost and like i'll never be pain free or able to walk to do daily activities in the house or go to a shop pain free ever again. Going to try Gabapentin and lidocaine patches as soon as safe to do and get another MRI

Keen to know how I get I diagnosis for the constant burning/electric/squeezing neve pain on the outside of my knee, just below (peroneal nerve?) Any thoughts?   I can not lay on it in bed as it hates any pressure. But I can touch the knee okay and no colour changes or swelling... The pain is more intense if the leg gets cold. Or maybe its all radiating out from the very unhappy fat pad? Pain is always lateral fat pad and tendon a sore when pressed. I can feel and hear crepitus under the knee cap (MRI last July reported 'Evidence of quite marked oedema within the superolateral aspect of the apex of the infrapatellar fat pad, and there is some minor oedema in relation to the most lateral aspect of the proximal patella tendon, with a trace of signal increase within it, giving the impression of local friction syndrome here. )

I'm now so weary of having a fat pad trim after this surgery and reading posts from  others on here. Have tried steroid injection into fat pad in April last year that made it a lot worse and into the joint in Oct that didn't help either.. have not tried PRP yet?

Now unsure if the knee tilt due to lack of muscle is creating the ongoing pinch laterally and chronic inflammation or if that will remain even if I do somehow manage to get strong again. Certain PT quad sets make the pain worse, So i suppose at the moment I am just trying not to lose any further muscle by going to hydrotherapy twice a week. My left quad and calf is visible smaller than my right, same for my left glute and weaker hip.

Really appreciate anyone input. Thank you :-)

Amy