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Author Topic: Fat Pad Resection/Trimming Surgery - Any positive experiences???  (Read 1625 times)

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Offline whoson1irst

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I've now driven myself insane and I'm just over a week before my "exploratory" arthroscopic surgery on my right knee. 3 MRIs have now show increased signal in fat pad beneath the patella. The weird thing is that I had the tightness, cracking and pressure feeling in both knees starting in August 2013 but didn't have a ton of pain. It varied though.  For the first YEAR multiple orthos, pt's and chiros told me not to bother with an MRI because it probably wouldn't show anything (since they did manual tests on my knees and all tendons and ligaments felt strong and healthy). I didn't have health insurance, so I didn't want to pay $500 bucks for one if it was useless.  So they "treated" me for what they guessed was a patellar tracking issue, or quadriceps tightness or patellofemoral syndrome or whatever else they could come up with. 

After a year of this nonsense I finally paid for an MRI out of pocket and it showed fat pad scarring, inflammation and possible impingement.  Meanwhile, I was basically able to run and sprint and jump without a lot of pain (mostly discomfort, pressure, tightness and irritated feeling).  I finally switched insurance and got reevaluated by a knee surgeon recommended to me by another ortho and physical therapist.  He did a new MRI (the 2nd one) and said it confirmed what the first one said but that he was not "excited" to do the surgery. He said you can develop scar tissue, sometimes people don't get better from it etc... He said its nothing dangerous and doesn't lead to anything else so if I can live with it then I should.  Said he would do the surgery if I wanted.  Told me there are no limitations and I could do whatever I wanted and just deal with the discomfort.

3 weeks later, I went to the gym and took the "no limitations" thing to heart. I was doing my first exercise in a could weeks (dumbell split leg squat with leg up on bench) with 35 lbs dumbbells (not extremely heavy but challenging).  It felt uncomfortable as expected and a little bit irritating but nothing too bad.  I noticed later that day, or the day after that I couldn't put impact on that knee without a thin sharp pain.  It soon turned into me not being able to put any weight on the right knee in a bent position.

5 months later (two rounds of physical therapy by two different therapists that I followed religiously, as I always do) and the pain is exactly the same. I'm torn because in some ways Im extremely limited (cannot run but can sort of shuffle if I keep the leg mostly straight, cannot jump at all, cant do bodyweight squat) but I can still walk with basically no pain (up and downstairs are very difficult at times because I have to bear weight with leg bent) and I can even jump rope with basically no limitation (Again because leg is straight).  Unfortunately, I' ma Phys Ed teacher and coach and need to be able to do much more physically in my job and am just not satisfied with this level of ability. 

I recently saw the knee surgeon again and he was much more positive sounding about the surgery this time. Said i can get up and walk around after 2 days and will just want to limit activity for a few weeks and do 6 weeks of PT. He said there's nothing dangerous and sounded hopeful that I"d be back to normal within 6-12 weeks.  HE also said theres a chance of a plica problem but won't know until he goes in.

HAS ANYONE HAD POSITIVE SURGERY EXPERIENCES WITH THESE ISSUES?  I don't have a lot of time to waste but am really scared off by all the negative stories on here.

PS I'm pretty sure I did a cortisone injected a year ago right before I switched insurance. And if I did, I saw no difference.


Thanks
Joe

Offline Clarkey

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Re: Fat Pad Resection/Trimming Surgery - Any positive experiences???
« Reply #1 on: June 16, 2015, 04:24:57 PM »
Hi Joe,

I am sorry to hear about your on-going with your right knee right problems, it that does sound very similar to my right knee problems prior to having an my 1st exploratory scope in November 2009. Before I had the scope done I had the usual conservative methods of treatment and PT that never really helped much at the time.

The cortisone injection pre-op did help ease the knee pain and the same can be said after having to go through a 2nd scope post-op to remove excessive scar tissue caused from having my medial plica removed and fat pad trimmed. My MRI scan pre-op to scope #1 came up fairly normal with some fluid and inflammation around the fat pad!   

I was being hindered by the inflamed fat pad as I could feel it catching at the bottom of the kneecap as if I had torn my meniscus! I was reluctant to have the surgery and maybe could have left it as it was but I was keen to get back to long distance running again. The fat pad impingement was the cause of not being able to run long distance. I took a risk and opted for surgery even though my OS pre-warned me might find nothing wrong once he is inside and might end up worse off!

I do not want to sound negative as you asked for positive outcomes of surgery involving the fat pad and plica excision. When I had my fat pad trimmed and medial plica removed it caused AF that gradually worsened over a period of time. I did however manage to get back into running briefly which was my goal, my surgery was a success for a certain time period. The long distance running I did through pain at times causing bone oedema inside the bone not outside on the MRI scan pre-op to scope #2.

I have read on your post that you are very good at keeping on top of your PT I and are going ahead with an exploratory scope, I would have done the same if I was in your position after opting with all the conservative methods that have failed. I am more prone to excessive scarring of the knee. I admit that I did not really keep on top of my PT and RICE the knee enough in the early stages post-op.

If you stick for 6 weeks post-op religiously to what your OS and PT are asking you to do then you should make a full recovery, do no overdo it by doing too much too soon. Patella mobilisation and keeping the leg elevated should help reduce the chance of forming excessive scar tissue.

Good luck with you surgery, please keep the board posted how your surgery went.

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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