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Author Topic: Fat Pad Impingement 8 years and counting advice please!  (Read 9543 times)

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Offline Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #45 on: June 22, 2016, 10:16:41 PM »
Have had the steroid injection directly into the fat pad. I don't think the doctor could find the precise spot and just put it in generally on the lateral side.

The knee does not like it much. Was told to rest if for 4 days, just tried doing physio today and already my quads have vanished, wtf. Also was getting pain on the medial side directly after injection, think gait altered and putting pressure elsewhere

I think the injection is about 8 years too late anyway.

Have not made the appointment with the Parkside physio yet, i keep meaning to do it then not doing it.

I think I am going to go with the botox.  Can't see what else will help. The injection is supposed to be at its optimum in a couple of weeks but somehow i am not hopeful it is going to work, especially as i cant seem to keep the patella off it even with mconnell tilt glide and rotation taping
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

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #46 on: June 23, 2016, 03:28:15 PM »
Hi Puffy the Knee Slayer,

As you may already know I have also had a steroid injection directly into my fat pad in 2008. It did not really make any difference. I had medical plica excision and fat pad trimming done in November 2010. Do you feeling any catching on the lateral side of your kneecap? I had this problem pre-op to scope #, I thought it might be loose cartilage.

I have also had botox injection into the top of my right thigh muscle to release tightness around the hip. It was contributing to the knee pain pre-op to scope #2 of anterior interval release in September 2013, followed by surgery in July 2014.   

TTT surgery is a big surgery to be going through, it is usually done for patients with regular patella dislocations. For maltracking problems an osteotomy is performed to realign the kneecap into the correct position. 

The patella groove has been mentioned in my right knee OS reports saying the following in one of the paragraphs.

The MRI showed change of signal of the fat pad underneath the patella. Otherwise there were no pathological findings on it. On further evaluation of the MRI one may appreciate a slightly bigger distal pole of the patella with a bone spur which may be affecting the fat pad; however the signal of the tendon is normal. In addition Professor Snow was a little concerned about developing of patella Baja after surgery.

The fat pad can cause other problems, one needs to be careful and cautious about how to go about treating problems with the fat pad! It is a part of the knee that is not very well known by many. They have all heard about cartilage tears and ruptured tendons. I hope you are able to sort it out sooner rather than later, the longer it takes the more paranoid and anxious one becomes.

[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 Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #47 on: June 25, 2016, 12:48:56 PM »
I do feel catching and pinching yes, also pain up the ITB band into the hip. My kneecap is in the wrong position tilted towards the lateral side and the tip is straight instead of towards the hip.

Did the botox help you?

I think the steroid has just aggravated the fat pad, I wish I had not had it and just gone for the botox first  :'(

i don't think it is going to be sorted any time soon, it has been over 8 years already

when i die i will leave my fat pad to medical science :(((((
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

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #48 on: June 27, 2016, 04:10:36 PM »
Hi Puffy the Knee Slayer,

It's is often the case that a cortisone injection can make the knee problems even worse rather than better. The botox injection was to release the tension of the tightened muscles and ITB band, that was contributing to the hip and knee pain. For me it did not really help as I already had scarring inside my right knee that was confirmed in my MRI scan back in March 2014. The botox injection was done in September 2013, followed by AIR surgery in July 2014.

The fat pad is often not really considered to be too much of a concern and problem by many OS's! It can often lead to deterioration of the knee once it has been shaved or removed. 8 years is a long time to be dealing with an on-going knee problems, have you seen another OS for to see what he/she says?

A detailed gait analysis can also be benefit ITB hip pain, a sports PT are better than standard PT's. I did use to see a sports PT until he left the UK to the Middle East. Since he has left have found it hard to find a half descent PT. The one's I have seen made my right knee injury worse rather than better.   

Good luck in trying to sort out your fat pad problems.

[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 Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #49 on: July 09, 2016, 10:56:37 PM »
Hi Clarkey,

The pain from the injection has died down now and just gone back to the normal pain. I am still eating like a pig though and gaining weight so not happy, I didn't think this would happen with an injection, is this normal?? Do steroid injections into the joint increase appetite?? So now I have gained weight feel too embarassed to go and see the sports physio in case she decides my weight has caused my knee problems  :'(

No I haven't seen another OS as only got referred to this one recently and havent gone through all the options. For years I had a very useless muscular skeletal consultant who denied I even had fat pad syndrome and dismissed my medial knee pain as an ache and pain we all get sometimes.

Sorry the botox did not work for you. I don't think I have scarring so maybe it will help me.

I will try and make an appointment for the physio when my distended stomach has gone down :(
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 Vickster

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #50 on: July 09, 2016, 11:39:21 PM »
Why do you need to wait to see the Physio?
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

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #51 on: July 11, 2016, 06:56:05 PM »
Hi Puffy the Knee Slayer,

Cortisone/steroid injections did not give me any negative side effects and certainly never increased my appetite. Anxiety and stress levels will affect each individual in different ways. We can over indulge by comfort eating or not eat enough during the day. It is very challenging to keep your weight at a healthy level if your cannot do any physical activities on a daily basis.

Swimming is not in the same league as long distance running for me personally, I miss my running as it was not just good for my physical health but also good for me socially. When I was a active member at my local running club I was starting to make new friends, staying for a drink after a run or attended social evenings.

Due to my Asperger's I find it harder to interact and socialise, at the running club I found it a lot easier to chat and get to know other members. Who knows if I was able to run I might have found a potential girlfriend or future wife. This is why I am so determined and eager to try and get my right knee sorted our asap. January 2013 was the last time I was able to run and missing it greatly.

It will not do any harm trying out botox, it can help give some pain relief that is always beneficial if you are able to reduce some of the knee pain and discomfort.

Vicky is right that you should be able to see an NHS PT at fairly swiftly usually within 2 to 3 weeks. I had to wait 8 weeks to see the Head PT at the Hospital as my PT regime is specialised in chronic patella tendonitis, followed by ESWT sessions.

Never give up hope, one day both of us will be physically active once again, need to convince an OS that willing to happy to take a risk doing procedures that are not often used in the operating theatre. Patella decompression surgery is not done very often, if you can find the right OS for your specific knee problem he/she should be able to sort it out with a successful surgery and recovery programme.

[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 Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #52 on: July 16, 2016, 10:40:23 AM »
Why do you need to wait to see the Physio?

because i have gained a lot of weight in a short space of time and currently resemble Jabba the Hut  :'(. Going on diet in time for OS appt in August.

Not an NHS physio, have given up with them, i meant the private one.
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 Vickster

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #53 on: July 16, 2016, 01:59:26 PM »
I can't see why it matters? I'm overweight/now obese following a lack of exercise and too much eating post shoulder surgery (probably gained 10 kilos this year).  I've been like this for years, no medical professional has ever judged me. The only time I discussed it with my knee surgeon was because I brought it up to get his opinion

Obviously being a good weight is better for knees, but I certainly wouldn't delay treatment due to it!
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 Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #54 on: September 03, 2016, 06:23:44 PM »
Hi Vickster, I'm not overweight I just gained weight recently.

I've now been back to the OS and agreed to have the botox injection into the hip muscle, but am freaking out a bit after reading that people can have health issues later on due to botulism. The OS said they've not seen any negative effects, though sometimes the injection does not work.

Anyway this is the last ditch NHS attempt as after this my only NHS options are a clean-up arthroscopy or TTT! They don't do fat pad trims or trochleaplasty and I really don't think repeated steroid injections are going to do owt.

Am holding off seeing the Parkside private physio for now as I will get an NHS physio to assess me before the botox and give me exercises to do after, it's a 3 month treatment period. If it fails then I will see the private one as there is not much else left for me on the NHS.

I have had to stop the fat pad unloading and patella tilt/glide taping as due to the hot weather my skin was reacting badly to the tape. I noticed the muscles were quite weak after I removed it so maybe it's better to keep it off for a while. Havent noticed much difference in pain without it, except it feels like my kneecap is sometimes digging into or tugging on something, not sure if that's the fat pad or the patella tendon.

Anyway am due to see the NHS physio at the end of the month for pre-botox assessment so will discuss with him.
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

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #55 on: September 13, 2016, 03:20:52 PM »
Hi Puffy the Knee Slayer,

I am not overweight and have a slim build, I still had problems with my fat pad! I went through a botox injection 3 years ago in September 2013 that did not make much difference. July 2014 I had scope#2 of RK AIR. As you already fully aware reading through my never ending post op diary it has made the right knee worse than it was pre-op to scope#1 and #2. Three cortisone injections last year works for some patients but not for me and many others.

I feel that with all the NHS cutbacks and a limited budget, high demand plus the junior doctor's strikes that unless your knee is completely warn out or have a large meniscus tear they will try ways to try and make you change your mind about considering gambling with a diagnostic arthroscopy. Saying the worst case scenarios that are unlikely to happen, to cover themselves in case the worse did happen.

The NHS PT'S I have seen so far all reassure me that there nothing to worry about as the knee looks ok, ending up with 2 scopes. Private PT's think in a similar way; I would advise you to go on what your knee is telling you with the pain, discomfort and limitations it is having on your daily life.

I am really missing not being able to do any long distance running since January 2013, I know that you also feel the same as I do with your knee injury.

[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 Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #56 on: September 28, 2016, 05:10:43 PM »
Hi Clarkey,

Yes I think you may be right about the cuts influencing their treatment decisions. A previous MRI had shown a meniscus tear but the last MRI didn't show it so they said I don't have one.

I've now been seen by the NHS physio and am due for the botox next week. I've been given a few extra exercises including foam rolling the ITB which is OUCH! and he says because the ITB is so tight the botox has a good chance of success. He mentioned ITB lengthening op if necessary.

He does not seem to think my fat pad is the problem but rather my tilted kneecap. I don't really agree with this but for now am going along with it.

Anyway I will see how it goes, maybe it will help. If they have nothing more to offer I may try a second opinion on the NHS as maybe elsewhere does different ops other than just TTT.

Yes they have warned me that a lot of people feel after an arthroscopy that their knee never felt the same again...but as they don't do fat pad trims or MPFL anyway, probably not much point in having one.

Of course I know they say not much is wrong, and it is still affecting our daily life, pain and discomfort and limitation of activities daily, but then they act like we are making a fuss about nothing. They seem to be taking me seriously for now, will just have to see what happens.

Did you mean I ought to push for a diagnostic scope?
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 naedoc94

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #57 on: September 29, 2016, 12:29:04 AM »
Puffy you are like a butterfly that I have seen outside my house in the garden. I hope you have better conditions with your knee so you can have butterflies in your garden too.

Offline Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #58 on: October 02, 2016, 08:00:57 PM »
Puffy you are like a butterfly that I have seen outside my house in the garden. I hope you have better conditions with your knee so you can have butterflies in your garden too.

Thanks for your kind words
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

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  • Neil TheElephant knee packed up carrying his trunk
Re: Fat Pad Impingement 8 years and counting advice please!
« Reply #59 on: October 03, 2016, 04:46:48 PM »
Hi Puffy,

If you feel that having a diagnostic arthroscopy would be a risk worth taking then you have the rights to go head. The OS will tell you it extremely risky and may end up with your knee becoming worse rather than improving.

You are the one giving your consent, no one else that you are willing to take a risk and gamble by going ahead with surgery. If you are in pain and discomfort and not able to take part in sporting activities that been going on for a while then you have the rights to ask for a diagnostic arthroscopy.

When I had scope #1 my OS did pre-warn me that he may not find any problems once he looked inside my right knee. The fat pad was inflamed and my medial plica was removed as it was restricting movement in my right knee. Scope #2 was lucky that I had a positive MRI scan showing unusual bone bruising that looked like wear and tear! Turned out to be excessive scar tissue.

Despite what many OS say that MRI scans are very accurate, I think they are not that great if you have soft tissue injuries or scarring inside the knee! This will give a false MRI scan reading making out that the knee is perfectly ok when it is not. I often read on KG bulletin board that large cartilage tears have been missed out on the MRI scan.

The best and most accurate way to diagnoses a long term knee problem is a diagnostic arthroscopy under the expert eyes of the OS. Think they are just being super paranoid and cautious in case they get sued if the patient knee ends up a lot worse than it was pre-op.

Good luck in getting the right sort of care and treatment that you deserve.

[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