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Author Topic: Fat Pad Impingement 8 years and counting – advice please!  (Read 9644 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 #60 on: October 04, 2016, 12:17:05 PM »
Thanks Nick, I will think about it. It may come to that as all the conservative treatment doesn't seem to be doing much and if I leave out straight leg raises for a few days my quads start to disappear. Am I going to be doing SLRs forever!!

It's true I do wonder how the MRI in 2012 showed a meniscal tear and the one last year didn't show it, as these tears do not heal in the posterior third and after a certain age I wonder if they missed it second time round or think I am too old to bother operating on!

I have had my botox injection into the TFL this morning as well as a steriod into the lateral femoral condule.

I have to wait 5 days before doing any physio exercises.

Have tried the foam rollering the week before - it's a bitch. It really really hurts but must mean I am tight and it needs doing.

Will let people know how I get on with it
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 #61 on: October 05, 2016, 08:14:27 AM »
Local anaesthetic wore off mid-afternoon yesterday and have been in terrible pain since, around the site of the steriod injection -  first knee itself and fat pad, and now around the joint where it bends on the outside, and down the outer calf, very stiff and painful.

am hobbling around with a hiking stick, taking paracetamol (i can't take NSAIDs) and sleeping with a hot water bottle under the joint.

The botox site is fine!

I think I am not going to agree to further steroid injections as all they seem to do is cause flare ups and not help. I wish I had just had the botox by itself as if this pain continues it is going to impare my ability to do the physio.

Thought I might at least be able to go to the gym and do upper body work while I wait 5 days to start physio, but can hardly walk without pain and was whimpering like a puppy last night.

Hopefully it will wear off in a few days!!
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 #62 on: October 06, 2016, 07:06:40 PM »
Some of the pain and stiffness has worn off but am getting random shooting pains up the outside of my calf beneath the lateral femoral condyle injection!

It feels like they left the needle in (I know they didn't) and when I move the leg it shoots up it.

I have not had this with any of the previous steroid injections!

What did she dooooooooooooooooooooo? :o

If anyone has had this injection and can let me know if this is normal and how long it takes to pass that would be good, thank you!
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 #63 on: October 06, 2016, 07:17:24 PM »
It's probably taken me a good 48 hours to get over the steroid flare and then maybe another week for the discomfort from having a big needle stuck in the knee!

You say you can't get the fat pad trimmed? Is that just your hospital/surgeon or the NHS generally (mine was done 18 months ago in SW London, albeit privately, along with a lateral meniscus trim)
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 #64 on: October 06, 2016, 07:25:13 PM »
Hi Vickster,

Thanks for your reassurance, I have had post steroid flare before but not as bad as this, hopefull the shooting pains will recede in a week or so then  :)

The NHS hospital I am at does not do fat pad trims. They also do not do lateral release, MPFL tightening or trochleaplasty. Apparently new research is showing that fad pad trims do not resolve the problem and by opening up nerve endings it can make things worse??

I do not know whether this is the case for all NHS hospitals. I thought once I have completed physio regarding the botox into the hip, if they have nothing left to offer me apart from TTT, I might ask my GP to refer me to a different NHS hospital for a second opinion. I don't have insurance and couldn't afford a private op.

My options currently at the hospital I am at are: repeated botox or possible ITB operation, or a TTT or an arthroscopic clean up of the joint, that is it.

Whenever I mention the fat pad they say that if that was the primary problem it would have cleared up with a steroid injection. Well maybe but not after 8 years! They insist the maltracking is causing the problem, all I know is that my MRI initially after injury showed fat pad oedema and my kneecap was normal, now it is tilted several years of impingement later.
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 Daniellezana

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #65 on: October 18, 2016, 07:39:18 PM »
Hello all,

Am new to the thread but sadly not to knee problems.

My issues started about 3.5 years ago now after a long tennis match aged 23, my knee feeling very strange after like it was sinking and generally uncomfortable particularly when straightening my leg. Also much more conscious of the issue when wearing jeans.

I've seen loads of Physios, Osteopaths, Consultants and never got a firm diagnosis. I had 3 MRIs and a CT on the a knee. They would say I do have a slight tracking problem but my symptoms were not typical. I also had scans of my hip, back etc. I got orthotics and used to tape it but got stress fracture in my navicular and so have also had times of complete rest.

Anyway I had an exploratory arthroscopy three weeks ago and was told that they have resected the fat pad and the plica. I'm trying to remain positive but it's still swollen and feels fairly similar at the moment. I'm slightly terrified I may never get rid of this. I'm taking anti inflammatories, icing etc am not in loads of pain but very uncomfortable walking so pretty much all sport is out currently. I used to play sport nationally so really hoping I can find a way through. I delayed moving out of home to sort thing out with Physios and really I'd like an active job so I feel a bit on hold. I know pain can be slightly mental in the end but visibly seeing the shape of my knee at the moment I know that something is wrong. Does anyone have any experience of fat pad /plica resection and time it took to rehabilitate? Appreciate individuals probably vary but if you have any tips that would be great. Pretty much willing to try anything.

Also someone on here posted about TTT. I actually spoke about this to my consultant as I am on the borderline at 18mm. I was basically told by my surgeon that he would never recommend this to someone who wants to be active/ continue to engage in sport as the outcomes are too unpredictable. Have you tried a Kneehab garment along with quads training?

Thanks for your help x
« Last Edit: October 18, 2016, 09:59:38 PM by Daniellezana »

Offline Clarkey

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #66 on: October 19, 2016, 06:01:10 PM »
Hi Daniel,

I have so far had 2 scopes on my right knee, scope #1 was also an exploratory arthroscopy and had my fat pad trimmed and medial plica removed that were both causing restriction in the knee as could fee catching and sharp pain pre-op to scope #1.

I also have maltracking in both kneecaps; this a common problem for many individuals that will also have an impact on their other joints. Orthotics work if you have flat feet and did have some made that did not really make any difference. Three weeks post-op is still early days and had to wait 18 months until I was back to long distance running again only to slip on ice! Since the fall in January 2013 I am no longer able to run and had had to go through scope #2 that turned out to be scar tissue from scope #2. 

I have a long post op-diary of both surgeries and can take a look at parts that might be beneficial to you to know more about the surgery of medial plica excision and fat pad trim. Scope #2 AIR surgery Anterior Interval Release, basically it is surgery to remove excessive scar tissue from scope #1.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=43471.0

I was competitive in long distance running averaging under 6 minutes & 40 seconds mile with a best time of under 6 minutes a mile. I see that you were at play sports at a national level until your knee problems started. I did running long distances as a hobby as I enjoyed it immensely as you did with the sports that you are gifted in to a very high level until your own knee problems started.

My best running session a few days before fall in black ice while walking link below! Gutted as I was going to take part in my local town half marathon and had no option and pulled out as I was not able to run.

https://www.runtastic.com/en/users/nick-clarke-3/sport-sessions/38296072

Never give up hope, need to remain strong & optimistic.

[email protected]
« Last Edit: October 19, 2016, 08:27:50 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 Daniellezana

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #67 on: October 19, 2016, 06:32:27 PM »
Thanks Nick. Will have a browse through? Dd you find anything effective in bringing down the swelling other than the RICE routine?

It's definitely a tough thing all this. Not sure I can bear the thought of 18 months. I'm seeing the surgeon again next week so will be sure to go with my question list. Actually the lack of diagnosis and different opinions has been the most difficult as my MRI scans showed little I was investigated for referred pain and to pain management. So I hope even if its a while that we have a diagnosis. It's also a shame as I think I would have been managed much better conservatively if I'd known about the culprit.

Orthotics I've tried. Actually when I first started with all this I paid a couple of hundred for custom made orthotics and continued to play sport and tape my knee- shortly a navicular stress fracture followed. I was told that also I am very marginally osteopenic that this was biomechanical, but was put on alendronic acid. Then I developed oesophagal ulcers which was particularly unpleasant!

Anyway I really hope your knee improves soon. If there is one thing I've learnt it's to find consultants and Physios that you trust and won't give up on you when it gets tough and confusing. As not to see too many people either however desperate you are to find an answer as you can get lost in the noise!!

Offline Clarkey

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #68 on: October 20, 2016, 03:04:04 PM »
Hi Daniel,

I did not have too much swelling pre-op to both scopes and soon went down post-op by icing and taking anti-inflammatories. I will always have some swelling around the portals that also scar tissue that can be reduced by doing friction massage therapy and having ultrasound with gel around the incisions. It took me longer to recover than expected due to the scar tissue build up! What did seem to help at the time was going through IMS sessions, intramuscular stimulations a form of dry needling. Basically it is the medical version of acupuncture into the quadriceps and thigh muscles. My muscles were super tight and the IMS session loosened the muscles, I was able to run again until I had my fall.

Hopefully your recovery will go quicker with a successful outcome and can compete again at National level, orthotics will help balance your knee alignment. I did not really feel the benefits myself as I am only slightly flat footed; my OS said that I should not waste my money buying custom made orthotics. 

It's true if you can find a good medical team to help and support you it helps to ease the nerves doing all they can to get your physically active again.

[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 #69 on: October 27, 2016, 08:10:58 PM »
Hi Danielle,

I hope your knee is feeling better soon. I had a rubbish pair of "chairside orthotics" for years that did nothing and contributed to what they thought was a medial meniscal tear, but I have a decent pair now that have helped to an extent but not corrected the problem entirely. I have one foot with a collapsed arch following an ankle sprain and the biomechanics of the leg is all wrong.

Re: TTT, I was offered this for the fat pad impingement and maltracking but having researched it decided 50% success rate was not high enough to risk as it is pretty major surgery.

_____________________________________________________

RE: CURRENT TREATMENT FOLLOWING BOTOX

Currently I am having physio following a botox injection (Dysport) into the tensor fascia latae and a steroid injection into the lateral femoral condyle.

After the post steroid flare up wore off I looked up side effects from botox and found a botox support forum which freaked me out as it was full of people who have had terrible long term effects from botox!! I think I will not look there again, I feel fine apart from some headache and flu-like symptoms for a week or two after the injection.

The knee itself still hurts at the front but is not pulling on the laterals as before.

I am definitely noticing a difference when doing the straight leg raises, as the lateral muscles are temporarily switched off, leg raises are really really hard and can feel the inner quads activating.

I used to do 2 sets of 15 finishing with one set of 20, am now doing 3 sets of 10 but sometimes failing on 8, as it is so much harder.

Am hoping this means it is going to work, though it is early days yet, kneecap still clicking and popping and still tilted. 

Foam rollering has left me with bruising down the outside of my thigh. Hmm, not sure that is meant to happen.

I see the physio next week for a follow up, hope the bruising is gone by then.

Some people have more than one botox treatment, I am hoping I will not need another and that this will work, but another 2 months to go.
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 #70 on: November 01, 2016, 05:02:03 PM »
Hi Puffy,

How frustrating that the botox injection into the tensor fascia latae and the steroid injection into the lateral femoral condyle had increased your problems even more. When I had botox injection in September 2013 it was a comical experience ended up at the wrong end of the hospital and was wheeled into the wrong ward after the injection as a precaution.

What was also odd and daunting was having an anaesthetist and anaesthetic machine on standby. Did this happen to you? It could well have been a mix up with another procedure that requires a full anaesthetic.

We all know how frustrating it is not making any progress as you cannot turn back time to pre-op to our Fat Pad Impingement that has made our knee problems worse rather than better.

[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 #71 on: November 02, 2016, 08:09:59 AM »
Hi Nick,

I wouldn't say the botox has made things worse, it has increased the difficulty of the SLRs but that means the inner quads are getting stronger by themselves without also strengthening the laterals.

The steroid I did not like and would not have again, on occasion having pain at the joint, lateral side, and strange sensation of the lower half of leg moving when I do quad stretches.

Am due to see the physio this week for a review, it's only been a month since the injections and 3 weeks since doing the exercises so early days yet.

Wow so when they were doing yours they had anaesthesia ready? wtf. I had a local for it, but I know someone who gets injections for rheumatoid arthritis and he says they don't give him a local when they do it - ouch!!!

Were you on a ward then after your injection? I had mine done in ultrasound and walked home after, felt fine until the local wore off then OWWWWW

Yes I dearly wish I could turn the clock back, its hard to remember life before my knee problems, but what can I do just have to get on with things best I can.
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 #72 on: December 17, 2016, 11:33:32 AM »
So to update on this, have had my final physio review before going back to the OS clinic in the new year.

As I have said in my other thread, the new pain lateral side is still ongoing

 http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=67511.0

With regards to the fat pad, the botox does seem to have helped to an extent although it hasn't got rid of the pain altogether, it seems less frequent and less severe.

However I am still very much reliant on taping, both fat pad unloading and patella taping - without the tape I do get much more pain. Also more pain if not in stability trainers the whole time, even with the orthotics.

The pes anserine bursitis pain has gone altogether but I now have this new lateral side pain which prevents me from doing the upright bike or the cross trainer.

Physio has said in the run up to my OS appointment in the new year I must now try out things I was not doing before the botox treatment to see if things have improved - ie running!!!

So far I have tried this, one minute on and one minute walking, did not manage very long, not because of knee pain but because I am so unfit from years of not running!

It did not hurt at the time, in fact the other knee which compensates was more painful immediately afterwards, but then later and next day the fat pad started.

I am not convinced that running is a good option currently. Although the maltracking seems to have improved a bit, the fat pad is still swollen and I wonder if it is pinching between the knee bones as it is hurting below the kneecap.

In short even if there is not much pain I may be causing damage by running on it. But it is only for a few weeks so they can assess whether the treatment has worked.

Physio has promised me the fat pad will go down eventually. I really want to believe him.

He's said even if the fibrosed portion of fat pad does not go back to normal, if I'm asymptomatic it's not a problem as there are probably people out there with fat pad inflammation who are asymptomatic and don't know they have it. Is this even possible, the fat pad is highly innervated!

But it is about weighing up potential damage to knee and balancing that with trying to get back to normal activities.

Anyway, something to review/discuss when I see the OS next year.

Festive wishes and thanks to all the good people on knee geeks who have supported me through this injury and treatment. xx


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 plant

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #73 on: September 09, 2019, 12:10:04 PM »
Hi, I know this post is from years ago but I've also been struggling with fat pad impingement for years. Probably due to hypermobility - I've done intensive physio for almost a year now, have had 2 injections but still can't walk without pain/catching sensation and progressive swelling.
Am now keen to try surgery, I'm based in London - Vickster do you have any recommendations for the area? Agree that surgeons who specialise in this are hard to come by.
Thanks for the help.

Offline Vickster

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Re: Fat Pad Impingement 8 years and counting – advice please!
« Reply #74 on: September 09, 2019, 01:24:01 PM »
NHS or private?
I’d go to Claire Robertson at Parkside Wimbledon in the first instance. About £200. She’s expert in PF issues.
 Get her advice on surgery (she’s generally for conservative management but does work closely with a team of (mostly private only) surgeons 

https://www.wimbledonclinics.co.uk/consultants

There’s a surgeon who’s who in the learning portfolio under primers, small list of PF specs

Are you under a hypermobility spec? Can they suggest and refer?
« Last Edit: September 09, 2019, 01:37:59 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