Banner - Hide this banner





Author Topic: Questions about fat pad impingement  (Read 184 times)

0 Members and 1 Guest are viewing this topic.

Offline RyanC

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 0
  • On a mission to get better knees
Questions about fat pad impingement
« on: January 01, 2021, 02:44:49 PM »
Hi all,

For context, here is my situation:
I have been suffering from knee pain for about 10 months now. I originally injured it playing field hockey when I felt a pinch below my knee cap where (I think) my knee was in flexion and landing on the grass. Six weeks ago, after doing physiotherapy (physical therapy), going to the podiatrist and getting orthotics, and even doing yoga for 3 months, I had a knee arthroscopy to see what was wrong with my knee. My surgeon found nothing structurally wrong with my knee but did find that I had a fat pad impingement which was on the outer side of the bottom of the patella. He trimmed it down and said I should be good to go in 2-3 weeks... 6 weeks on and things seem to be better in some ways and worse in others. 3.5 weeks after the surgery my knee felt really really good. I was able to walk around my neighbourhood without much pain at all and my knee felt quite stable. After a few days of doing over 10,000 steps, my knee seemed to flare up with similar symptoms to what I have pre-operation. It did settle a bit so I started to get more confident on it and then it flared up again. The weird thing was though that the first time it flared up I rested it for 1.5 weeks and it seemed to settle a bit, but the second time it flared up I went for a bike ride and was on my feet all night (new years eve) and that seemed to calm my knee down...

These are the questions that I have:
  • First of all about my symptoms. The surgeon found a fat pad impingement, but I seem to get my pain on the lateral side of my knee, just above that bone that sticks out on the outside of the knee (even though the original pinch was below my kneecap). From what I have read online, fat pad impingement causes pain anteriorly and not laterally? Is that right or can it cause lateral pain as well. I don't seem to have any anterior pain.
  • My second question is regarding these flare ups of the knee. It doesn't make sense that my knee could be flared up and then a bike ride and a night on my feet would settle it? I am now thinking that maybe there was some scar tissue in my knee that was causing the pain and the ride/night on feet cleared it up? Any thoughts on this are much appreciated.
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4890
  • Liked: 411
  • Neelie knee!
Re: Questions about fat pad impingement
« Reply #1 on: January 01, 2021, 02:52:49 PM »
Perhaps go to the physio and get reassessed for muscle imbalance, and muscle or other tightness, eg IT band?

If you get pain doing something, donít do it or modify it. 10000 steps is really a lot so soon after surgery.  Keep icing every day too to manage inflammation which will still be present even if the knee doesnít look swollen.

Whatever the surgeon said about recovery times, 6 weeks is still very soon after knee surgery, itís traumatic to the joint and the general health and strength of your leg. 

If you can, get into a pool and do some hydrotherapy, ask your physio for exercises to do.

Good luck
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 RyanC

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 0
  • On a mission to get better knees
Re: Questions about fat pad impingement
« Reply #2 on: January 01, 2021, 11:42:46 PM »
Hi Vickster,

Thanks for taking the time to respond.

I will have a chat to the physio next time I see him about the things you mentioned. I am pretty sure that I don't have ITB syndrome as I have previously had this and foam rolling and some ITB stretches helped a lot. I did an insane amount of foam rolling and was stretching my ITB heaps (with pigeon pose in yoga) for a few months prior to surgery and it had no effect in alleviating my symptoms.

Yeah I do agree that 6 weeks is not a long time, its just that the knee felt great 3.5 weeks after and now its all over the place! But yes I do need to give it some more time.

I am going to look into this hydrotherapy!!

Cheers
Ryan
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 0
  • On a mission to get better knees
Re: Questions about fat pad impingement
« Reply #3 on: January 06, 2021, 11:55:26 AM »
I thought I might just post this article here. I have been doing quite a bit of research on fat pad impingement and the outcomes of the surgery to trim the fat pad. All I could find was people saying how much they regret getting the surgery or that the surgery made things worse. I then found this useful article saying that 30 out of 34 people who had the surgery improved and returned to their pre-injury status. Gives me a little hope!!!

https://www.arthroscopyjournal.org/article/S0749-8063(07)00590-7/fulltext#back-bib4
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4890
  • Liked: 411
  • Neelie knee!
Re: Questions about fat pad impingement
« Reply #4 on: January 06, 2021, 12:03:01 PM »
I had my right fat pad trimmed 6 years ago (plus a meniscus tidy), no ill effects (just as well as Iím NWB following left ankle surgery and need the right to get around the house!)

People are far more likely to post online if they need support / advice following a poorer outcome than if they have an uneventful recovery and good outcomes
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 RyanC

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 0
  • On a mission to get better knees
Re: Questions about fat pad impingement
« Reply #5 on: January 06, 2021, 01:25:05 PM »
Yeah I totally agree. I think I went down a bit of a rabbit hole there for a day or two and was thinking the worst. It all started when I was reading about Clarkeys story and how it took him 18 months to recover.

Do you have post op diary entries Vickster? I am very interested as I seemed to have had the same surgery as you. My surgeon did the fat pad plus a tiny bit of meniscus tidy up.

I have read that you were back biking 6 weeks after and were fully recovered after 6 months? When did you really start to see improvements with your knee? Glad it went well for you 😊
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4890
  • Liked: 411
  • Neelie knee!
Re: Questions about fat pad impingement
« Reply #6 on: January 06, 2021, 02:00:13 PM »
Three months seems to be a milestone for me. Itís hard for me to assess that knee really as the other is shot, but I have no swelling, full ROM and good strength (compared to other)

Iíve never done a post op diary.
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 RyanC

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 0
  • On a mission to get better knees
Re: Questions about fat pad impingement
« Reply #7 on: January 07, 2021, 02:41:21 AM »
Ok thanks for getting back to me on that one. Sorry to hear your other knee is shot  :(

I understand that it is very much that I need to rest and let things settle which will take a few more months but is there anything else you did that you felt helped the recovery? I have heard of many things that can be done. Fat pad massage, ice massage, patella taping, cortisone injections, just icing it etc.

I asked my physio briefly at the end of my last session and he said there is little evidence to support patella taping, and said we could give the massage a go. My surgeon is against a cortisone injection at this stage and has just given me some anti-inflammatories to take. Any other advice/help is much appreciated   :D
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4890
  • Liked: 411
  • Neelie knee!
Re: Questions about fat pad impingement
« Reply #8 on: January 07, 2021, 08:51:16 AM »
I had a steroid injection before that arthroscopy didnít help.
Donít think I did anything specific back then apart from the physio exercises, ice for a few weeks, painkillers if needed... Just takes time. I donít know how old you are (I was about 43 when that op was done)

I did get a bit of soreness probably from over doing it, itís since been discovered that I have a congenital bone spur on the fibula which irritates the tissues around it and need to avoid specific massage to that area. 

I did have a proper physio led bike fit too to check that cycling wasnít irritating the knee.

I can also have very tight muscles especially calves so do find sports massage and stretching beneficial.

Itís just time really. I wouldnít ever have steroid unless there is clear
inflammation, so swelling and heat in the joint.
I find voltaren gel can be helpful, massaged in once or twice a day (my rheumatologist is a fan of 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 RyanC

  • MINIgeek (20-50 posts)
  • **
  • Posts: 20
  • Liked: 0
  • On a mission to get better knees
Re: Questions about fat pad impingement
« Reply #9 on: January 07, 2021, 12:27:16 PM »
Thanks Vickster.

Yeah I am going to keep the physio exercise up, keep icing it multiple times a day and am taking some anti inflammatories (I think itís celecobix or something?). Also, I am 29 years old.

So you found the bike OK and it didnít aggravate things too much? Iím a big cyclist, well ever since I did my knee Iím a big cyclist, and would love it get on some beach rides again! I am also going to do some stretches. I did about 2.5 months of yoga pre op so I am pretty flexible but my calves have terrible flexibility.

In terms of the injection, my knee is inflamed and hot right now, but I think thatís because I really pushed it over New Years. I am going see if it settles, which it normally does, to try and avoid an injection.

Thanks again for taking the time to help/listen. Iím sure Iíll have some more questions over the next few months!
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

  • Administrator
  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 4890
  • Liked: 411
  • Neelie knee!
Re: Questions about fat pad impingement
« Reply #10 on: January 07, 2021, 02:42:42 PM »
If youíre taking NSAIDs for more than a day or two, be sure to take a PPI like omeprazole to protect your stomach.

Iím not a massive distance cyclist, rarely more than 50km in a day now, and even before I crashed in August, more like 20-30

At 29, you want to avoid steroid injections as it can damage the articular cartilage (you donít want arthritis).
You could try PRP injections as a steroid free anti inflammatory if those are available to you. But regular icing should help too and not overdoing 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















support