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Author Topic: Fat Pad Impingement 8 years and counting – advice please!  (Read 9721 times)

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Offline Vickster

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #15 on: January 23, 2016, 06:05:09 PM »
Maybe not if your kneecap is malaligned especially as you've had the issues for a number of years. As Nick says, a CT scan is the best way for the surgeon to assess the true location of the different bony bits

There's info here which may answer some questions http://www.kneeguru.co.uk/KNEEnotes/primers/patella-primer

And if you choose to go the second opinion route, there might be some names here to start you off

http://www.kneeguru.co.uk/KNEEnotes/whos-who-knee-surgery/whos-who-patellofemoral-surgery
« Last Edit: January 23, 2016, 06:10:22 PM by Vickster »
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 #16 on: January 24, 2016, 09:19:48 AM »
yeah this is what I don't get, I don't have dislocation, though the kneecap does move to the wrong place, ie lateral side, I can sort of push it back into position using a technique a sports podiatrist taught me but it doesn't last, in spite of endless quad/VMO exercises - which I thought was because of the swollen fat pad preventing it from sitting correctly.

They told me 8 out of 10 people are happy with the outcome of surgery - but I assume those will be people who have dislocation, not just maltracking!

I don't get why they are not suggesting lateral release instead, I will have to ask them next time. Also would prefer they trimmed the fat pad first, though I gather from yours and other people's experiences this is no guarantee either. But if they don't do something, the osteoarthritis will get worse!

I haven't had a CT scan only X-ray and MRI.

Been reading your post-op diary, sounds like you have been through the mill, I'm really sorry you're still suffering so much after all this time :(
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 Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #17 on: January 24, 2016, 09:23:33 AM »
Thanks Vickster for the info
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 #18 on: January 24, 2016, 10:05:41 AM »
Is it possible that your trochlea right grove is too narrow, the wrong shape or similar? Hence why the kneecap doesn't sit properly. A CT scan would give more detail, an MRI doesn't necessarily

There's quite a lot on this board about lateral eleven, my understanding is its indicated where the kneecap is stable but tilted with no cartilage damage. There's a link to the right >>> as well as further info in tne learning hub. I know after I had my scope to trim fat pad, meniscus and tidy my tatty patella, my physio said she was very glad the surgeon hadn't done a lateral release as they often cause more issues than they solve (not that he had ever mentioned the possibility)

That said I'm not sure my pain at that time was solely due to these issues in the knee, as I still have leg pain which the surgeon now thinks is down to a 9mm bone spur on my fibula irritating everything around it. Looks quite impressive (and ouchy)on my recent CT!

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 #19 on: January 24, 2016, 10:26:40 AM »
Thanks Vickster that is helpful. Next time I go I will ask for a CT scan. Have been reading the patella primer and it does say lateral release is not for people with a mishapen patella so maybe that's why they haven't suggested it.

MRI says trochlear groove appears subjectively shallow and with chondral degeneration of the trochleal groove cartilege.

It must be difficult for them to know what is causing what since it has all gone on for so long and things have developed since the initial injury.

Ooh bone spur sounds really painful, can they do anything about that?
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 #20 on: January 24, 2016, 10:34:26 AM »
The bone spur can be removed, but it's in a tricky position as there's a big nerve in tne way, so there are risks. I need to have a shoulder op in mid March so tne leg is taking a back seat. I'm not keen (risky and a biggish incision needed) and I'm not sure the surgeon is either, although it's been paining me for over a year (mostly when I'm not doing anything) so if it doesn't settle, I may not have a choice. It's uncomfortable rather than downright painful, achy and burny. Tramadol takes the edge off at night, paracetamol and ibuprofen don't do a lot

It does sound like your groove and patella are the issue, which is scraping at the trochlea. Problem is deepening the groove is a big and painful op by all accounts and few surgeons do the op. Jonathan Eldridge in Bristol is a name that comes up on these boards. Not local to London obviously but might be worth seeking his opinion privately even if that's all you do. At least you'll have the opinion of an expert

CT scan is normally only done to inform the best course surgically so I'm not sure the NHS will fund if there isn't a surgical plan in place. That's the reason I had one done, so the surgeon knows the detaild situatiin before going in
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 #21 on: January 25, 2016, 03:54:58 PM »
Lateral release surgery can go either way it usually a surgery that can make the knee problem even worse rather than better. Plica excision is also a hit and miss surgery! It can work out ok for some patients with success stories that have been posted by members of the bulletin board. I also read unsuccessful plica, fat pad trimming and LR surgery.

I am just unlucky that I am more prone to excessive scarring or bleeding inside the knee straight after surgery plus maltracking problems and PFS. Not being able to run is not just physically demanding it also get to you mentally if you suddenly are not able to run anymore at a young age.

Worst case scenario would be an open surgery to sort out the shallow trochlear groove that sounds similar to patella realignment surgery or 'Osteotomy' that can be a great success despite it being a major knee surgery!

Link to a post-op diary success story proving that the surgery can be a great success.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=49136.0

My long on-going knee problem is also proving difficult to get it right again for the orthopaedic team at the hospital I had both scopes and various other types of treatments.

[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 #22 on: January 27, 2016, 09:26:24 AM »
Good luck with your shoulder op Vickster, sounds like you have a lot going on. It's difficult to weigh up the costs and benefits, sometimes I wonder if the current pain is better than the risk of things getting worse. Chronic pain must be very difficult though, I think tramadol is quite heavy duty so sounds like the pain is bad. I can't take ibuprofen myself which probably hasn't helped things.

Thanks for the info regarding Jonathan Eldridge, I will have to email about the costs.

Clarkey, thanks for the link to a success story, I have been freaking out a bit at all the potential complications - read that I could end up with bone fractures, am likely to have neuropathy in the shin, a bit of bone that hurts on kneeling etc.

The registrar did not mention deepening the trochlear groove, only moving the kneecap. In fact he did not mention the bone work I only found that's part of TTT when I looked online.

Will have to ask how experienced this surgeon is - impossible to find out anything online as there is no info about him, I think he has only recently reached Consultant status.
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 Aly0108

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #23 on: January 28, 2016, 12:35:41 AM »
Anybody cured Fat pad impingement with PRP, Stem Cell, Ozone, Prolo, etc.

Offline Clarkey

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #24 on: January 31, 2016, 03:20:46 PM »
Good luck Vicky with your shoulder surgery in mid March, its at the same time when I will have another consultation what to do next with my right knee! I am now such a regular patient that I have a hot beverages hospital loyalty at the café.

I have been searching and also like to ask the same question? Would a PRP injection be beneficial for fat pad inflammation and chronic patella tendonitis! I remember Vicky in my post-op diary mentioned trying PRP injection.

http://www.prptreatments.org/sports-medicine/patellar-tendonitis-tendinosis/prp-treatment-for-patellar-tendnosis/

Does the NHS provide PRP injection, would I be eligible as I have had 3 cortisone injection last year without feeling any benefits. I hope if I print out the above link to show my OS that he would be ok about me suggesting it.

It makes sense at this stage of my hard to fix inflamed patella tendon problems to try out PRP injections, this would be better than having another cortisone injection. It is not really benefitting my right knee problems ending up making my knee worse having too many cortisone shots in a short space of time.

Is PRP injections less risky that does not weaken the articulate cartilage!

[email protected]
« Last Edit: February 01, 2016, 03:34:47 PM by Clarkey »
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 Vickster

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #25 on: January 31, 2016, 04:54:53 PM »
I think you'll struggle to get PRP in the NHS but you can but ask. I am not aware of specific risks as its derived from your own blood (plasma, so minus the red cells)

Multiple shots of Cortisone is are to be avoided if possible, they can be effective and are cheap. The equipment for PRP is expensive on the other hand. You may also need multiple injections

Your surgeon cites PRP as an area of research interest on his website bio so I'm sure he'll be willing to discuss even if he can't offer it to you on the NHS

http://www.sportinjuriesclinic.co.uk/surgeon/
« Last Edit: January 31, 2016, 05:09:31 PM by Vickster »
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 #26 on: February 18, 2016, 09:44:06 AM »
Hi, so before I have even got a second opinion regarding the TTT, received the letter to my GP from orthopaedics.

Seems they have now changed their minds and letter states I am not a candidate for TTT as "TT-TG is 12mm and this distance is still within normal limits - up to 15mm for females".

Instead they say they may offer me "arthroscopic debridement of patellar femoral joint to stop further fissuring and slow down progression of degenerative changes".

So a complete u-turn, no idea why, probably funding.

They are now claiming my anterior knee pain is most likely due to degenerative changes....errr...no I had this pain since I fell in 08 and injured the fat pad!!!

Am fed up with the whole thing. What is the point of them going in and cleaning up the joint if they are not going to do anything about the fat pad???!!!! It will still be pinching aftewards!!

Am considering going to see John Hardy. I've read a lot of his posts on Runners World and he seems to have a good understanding of FPI and the relationship between FPI and PF OA.

Just totally fed up with NHS, if they had done their job properly in 2008 (they did x-ray not MRI) I might not have OA now.  >:(
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 #27 on: February 18, 2016, 10:38:04 AM »
My cycling Physio recommended I see a consultant Physio at Parkside in Wimbledon, Claire Robertson, who is expert in PFS

Link here. Not cheap if self paying but might be of value.

 http://www.wimbledonclinics.co.uk/consultants/ms-claire-robertson/

Not heard of John Hardy so can't comment

Good luck
« Last Edit: February 18, 2016, 10:39:57 AM by Vickster »
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 #28 on: February 20, 2016, 09:24:29 AM »
Thanks for the info Vickster. The fee is OUCH! :o

Well I might pay her a visit as well.

Have been recommended Mark Bender as a physio by the podiatry clinic, will probably see him first (he's a tad less expensive) and then if that doesn't help maybe I will try Claire. Seeing as they are not offering me an op I guess I have the rest of my life to try out different specialists eh!  ::)
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 #29 on: February 20, 2016, 09:30:13 AM »
The fee is less than seeing an ortho privately. I guess if you get some answers it helps lessen the blow. I'm very glad I have Bupa, costs me a lot a month (about the same as a consultant Physio appointment) but I get my money's worth! My shoulder op in March would be well over 4K self funded

Never heard of Mark Bender. Physio recommended Claire to me as a PFS specialist
« Last Edit: February 20, 2016, 09:33:59 AM by Vickster »
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