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Author Topic: Fat Pad Impingement 8 years and counting – advice please!  (Read 9523 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 #30 on: March 11, 2016, 09:10:07 PM »
I am due my steroid injection for the pes anseurine bursitis only next week, after it has settled I will try and arrange to see Mark Bender, then if after a while that doesn't help I'll try and see Claire.

Though reading Clarkey's post op diary I am wondering if I am better off trying to live with the fat pad impingement rather than get it excised :-\
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 #31 on: March 14, 2016, 04:16:49 PM »
I am sorry if my post-op diary is making you reconsider having fat pad excision! I had medial plica excision in November 2009 and had my fat pad trimmed down caused catching, it was not excised. The plica excision surgery that might be the cause of having to go through AIR surgery in July 2014 to remove excessive scar tissue from scope#1! #

I am more prone to excessive scarring after surgery, I have had PFS since childhood feeling anterior knee pain after running and cycling. I think the fat pad acts like a shock absorber for the knee that can cause problems if it gets trimmed or removed. I might be wrong thinking in this way,  think I read up about it somewhere online.

See Claire 1st before considering any form of surgery, she can advise what would be the best course of action for your Fat Pad Impingement problems. Good luck.

[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 #32 on: March 14, 2016, 05:16:30 PM »
hi

I had my injection into the pes anseuerinus today, spoke to the doctor giving the injection about the fat pad.

He said if the fat pad impingement occurs on its own, then a steroid injection into the fat pad is likely to help, but if it is caused by patella maltracking then it is less likely

The problem is chicken and egg though. I knocked the fat pad first, I am not sure if the quad exercises would lead to the patella tracking normally if the fat pad were not swollen, or if the fat pad were trimmed the pinching/catching would reoccur as the patella would still be maltracking.

Sorry you are still having so many problems with your knee Clarkey it seems a nightmare.

Anyway at this stage I have not been offered a fat pad trim, seems the only thing OS are willing to do is clean out the patella.

I'm going to try Mark Bender first as he was recommended to me by a podiatrist I know, and is also nearer to me and cheaper, but if I really don't make progress there then will definitely look into seeing Claire before agreeing to any surgery, whether fat pad trim, patella debridement or if the TTT offer is back on the table. 

I don't think I would want the fat pad removed altogether  :o though doctor today said some people do have it removed and are fine after...hmmm..
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 #33 on: March 15, 2016, 05:36:07 PM »
Sorry you are not yet seeing any further improvements, know what you are going through. I also had a cortisone injection directly into the fat pad with my previous OS pre-op to scope#1. I did not feel any great benefits apart from numbing the pain slightly. The pain and catching was still there which is why my fat pad was trimmed and medial plica removal.

One becomes more knowledgeable about knee problems when one has a never ending knee problems. It is nice to know that my post-op dairy has a lot of impact on members with similar problems that they know they are not alone with soft tissue injury problems

It might be a nightmare at this present time, one has to remain positive that we can get through it ok in the hope of returning to long distance running again for me personally that I miss greatly. My family and friends think I am bonkers that I wish to return to long distance running if it is still possible and could still happen.

I totally agree with you that that to trim the fat pad is bad enough, to remove it totally is completely bonkers! It makes my ambition more normal and less insane, to hopefully go back to long distance running once again.

You doing the right things right now seeing the UK’s top PT’s and can get the last decision from Claire a PFS specialist, that Vicky has already suggested. Think my right knee problem is no chronic rather than an acute.

Thanks for the good luck message on your other topic, tomorrow will be a big pressure release for me finally I hope?

[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 #34 on: March 19, 2016, 11:28:36 AM »
I understand how frustrated you must be, I don't think you are insane to want to return to long distance running, I just want to be able to run for a bus and be able to walk up stairs, I used to do kick boxing somehow I don't think that will be on the cards in the near future, not that I was very good at it anyway haha.

I can relate to your frustration after seeing your consultant, I hope the second opinion works out better for you, sounds like you have selected a good one.

Have still not made appointment with Bender yet due to upcoming commitments and uncertainty re: work but hope to get an appointment soon before he starts touring with Andy Murray again!

Have had 5 days of no physio/gym to give the steroid a time to work, this co-incided with my having a cold which is probably just as well or the lack of exercise might have driven me up the wall.

Am so fed up of reading in the press that osteoarthritis is caused by being overweight and lack of exercise, I am neither and I would do more exercise if they would fix my fat pad!

Oh also I notice I am developing saddlebags in my old age, I have never had these before, i looked this up and it's caused by weakness in the lateral hip muscles - guess what all the suggested exercises are - deadlifts, squats, lunges, step ups. I can do none of these so I must just wobble about!
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 iwillwalkagain

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #35 on: April 11, 2016, 08:36:31 PM »
Do quad sets and SLRs make your fat pad more inflamed?  This was the case for me.  I had PT for over a year making me do these exercises contributing to chronic inflammation. 

Offline Hipop

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #36 on: April 14, 2016, 01:38:25 PM »
Hi, You mentioned that you are hypermobile. Do your knees hyperextend ? If so, do you weight bear to any extent with them hyperextended ?

Offline Clarkey

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #37 on: April 14, 2016, 03:12:35 PM »
It's hard to say with my right knee problems if it the fat pad causing the problems on top of the inflammation of my patella tendon and possible excessive scarring of the right knee! One leg squats can inflame my knee, also struggle going up and down stairs and steep gradients. Straight away I get anterior knee pain around the tibia region of my right knee.

I do not think I am hypermobile, you will find each person knee problems will be different to the next person’s, one can never really compare with one another. I know how you feel going up the stairs at a slow pace and not being able to run for a bus or train and then end up missing it and having to wait for over 1 hour for the next bus or train. 

Hope you are all able to make progress with your fat pad impingement inflammation, it can be hard to get right again through my own personal experiences know the frustration and stress is causes on your daily lifestyle. Good luck in what ever treatment options you decide to take.

[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 Hipop

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #38 on: April 14, 2016, 05:51:21 PM »
Hi clarky,  I was referring to puffyknee who stated that her osteopath thought the problem might be related to her hypermobility. She (he?) also mentioned doing calf stretches on an incline . I caused pain/?damage to my anterior  medial knee by doing calf stretches and leg extensions with a hyperextended knee . This is why I was querying if she has/used a hyperextended knee with weight.

Offline Puffy the Knee Slayer

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #39 on: April 30, 2016, 06:34:28 PM »
Hi Hipop

I no longer do leg extensions, have not done them for years, though for a while a physio had told me to do them with a theraband

calf stretches on the incline board was meant to increase dorsiflex in my ankles which podiatry said were contributing to my fibula related equinus

i use the leg press, fairly light weight but i make sure i don't hyperextend when i do it

physio had me doing single leg squats and step downs for a time but i had to stop as it made the tugging pain much worse

Hi Clarkey i have yet to see Mark Bender as first when i rang they said they didn't know when he would be there and tried to get me to see one of his colleagues, then said he'd be back end of April possibly, then when I rang later in the month he was fully booked up!

Have orthopaedic appointment next week and still haven't had second opinion from either physio or another ortho
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

Online Vickster

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #40 on: April 30, 2016, 07:18:06 PM »
Could you not see the lady at parkside?

Good luck with your OS appointment
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 #41 on: April 30, 2016, 08:22:32 PM »
Hi Vickster

thanks

I could see her but wanted to get this guy's opinion first, and now i have left it a bit late for either, due to other committments am probably going to have to see either of them after the ortho

though since they seem to have withdrawn the TTT offer that may not matter as much.

How is your shoulder?
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

Online Vickster

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #42 on: April 30, 2016, 09:01:39 PM »
Pretty sore shoulder, well more arm. Had to go back to work after 2.5 weeks (contractor, needed to get back), physio reckons I went back too soon (although 2 weeks was the surgeons recommendation). Pain is the price I'm paying but on the upside my ROM is very good for 6 weeks! Physio for 6 weeks then follow up,with the surgeon. Can drive from week 8 but can't see it happening, at least not any sort of distance. Will take physio advice.
Knees a little grumbly but better than when I'm cycling! ;D

Is this an OS you saw before? I didn't think they were offering much as you say?  I'd go the specialist physio route if there isn't a sensible surgical one
« Last Edit: April 30, 2016, 10:35:46 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 #43 on: May 03, 2016, 11:32:31 AM »
ooh, sorry your shoulder is sore and you had to go back to work even with it hurting. It's difficult isn't it if you can't get the leave. Hope it continues to improve and you'll soon be doing pull ups and TRX, heheh. Hope you have good transport where you are, if you're not able to drive, and are not getting the shoulder squashed on the commute.

The OS, it's the same clinic but the previous consultant has left. They did offer me TTT at the last appt but then the GP letter said I didn't meet the criteria, so I need to check what they are planning now.

Specialist physio, yep am planning to do that anyway before resorting to the knife. Have just been really disorganised with other stuff going on, and Mark Bender not being available, will give it another shot but if he still isn't around (doesn't look likely now with tennis season starting as he's Andy Murray's physio) I will go with Claire at Parkside.
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 #44 on: May 11, 2016, 07:31:43 AM »
Hi all,

So have had further consultation with OS.

It transpires TTT is still a viable option but perhaps not currently the recommended one. I asked about the success rate of TTT for people with maltracking as opposed to patella dislocation and was told it's pretty much 50/50 (as opposed to 80% success for people with dislocation) so to me the odds are not that good for such a drastic op at this stage.

Also was told TTT is purely for pain relief and does not prevent the need for TKR in later life.

I think it was Vickster who mentioned deepening of the patella groove - I asked about this and they said they don't do it, and it isn't done in UK as far as they know.

They also never perform lateral release at this hospital which given what I've read about it is probably just as well.

I have had some improvement with the pes anserine bursitis from the steroid though perhaps not as much as I said in my appointment (was asked percentage wise and as on the spot came out with 50%) but still getting sharp pains on inside of knee, worse in work shoes.

The hospital I am at does not do fat pad trimming because in their opinion this exposes nerve endings and is likely to make things worse. Instead they said apart from TTT the other option is repeated steroids. The OS said eventually the fat pad will give up sending pain signals to the brain, however this would not necessarily mean the fat pad was better!!

The other option they have given me is a relatively new treatment involving injecting botox into the hip muscle. I am undecided on this, there is some info here:

http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_22-2-2016-15-14-26

and here

https://www.fortiusclinic.com/sam-church-lateral-patellar-overload-syndrome

sample size was fairly small but what he says makes sense.

What do people think?

In meantime have opted for another go with steroid into fat pad and will try and see a specialist physio before next OS appointment.

Current OS still opines that it is the maltracking that has led to chronic FPI not other way round, he says without the maltracking the fat pad would have resolved ages ago.

« Last Edit: May 11, 2016, 07:33:15 AM by Puffy the Knee Slayer »
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