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Author Topic: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery  (Read 2192 times)

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Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #15 on: January 28, 2021, 10:17:43 AM »
Hi Vickster,

I have not considered that and that is a very good point. Yeah I will stop icing for a bit and see how it goes. If I do continue, I will do it for no more than 20 minutes at a time.

I haven't bought any new footwear but I am back in the office 4-5 days a week now, and wear my work shoes with orthotics. My work boots have a bit of a heel, which I heard helps take pressure off the fat pad.

No not the ITB, its the one the runs down the lower part of the leg. I don't even know if it's a tendon, maybe it's just a muscle. It's basically the muscle/tendon that runs down that blue arrow in the photo.

I don't do any stretching but maybe I should start? Yeah I work as a web developer, so I literally sit all day. I try to get up every hour and go for a 5 minute walk but still have to do a lot of sitting. I have a sit/stand desk at work but I feel like a lot of time on my feet might flare up my knee.

Ryan

Edit: Attached are shoes, left are ones I wear to work, right are ones I try and wear casually
« Last Edit: January 30, 2021, 11:40:13 AM by RyanC, Reason: add shoe picture »
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #16 on: January 28, 2021, 01:34:27 PM »
Iím not sure why standing would aggravate a knee that has kneecap issues...itís better for posture and body not to sit too much!  If youíve to sit, you should try to keep your leg up and straight, especially as you have kneecap soreness.

Sitting also tightens and shortens calf muscles, which why stretching is helpful as well as strengthening. Can you go back to your physio to get some tips about general conditioning and not just the knee. The muscle you say is sore is I think tibialis anterior

https://www.torbayandsouthdevon.nhs.uk/uploads/25345.pdf

Youíll also need to work on the rear calf muscles (gastroc and soleus) and also hamstrings, glutes. Maybe get back into Yoga or Pilates?

Perhaps go get a good deep tissue massage of lower back and legs...a good sports massage therapist can tell you how to stretch effectively and safely too

You do have rather slender and even slightly bowed legs, although could be the photo. Perhaps some strengthening and stretching may help...speak to physio (maybe find a new one for a fresh pair of eyes)
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #17 on: January 30, 2021, 11:36:20 AM »
Hmmm I think you're right, and I know work has some of those mats people stand on which makes it easier on the knees for standing. There are some people that just don't sit down at work at all. Maybe I'll try and stand for 1-2 hours a day and sit the rest and see how that goes. I normally spend the first hour at work checking emails, getting back to people etc, might be a good time to do it.

I really want to get back into yoga, but I don't feel like my knees could handle it at the moment. Quite a few of the poses require me to be in a lunge position, and my knee gets pretty aggravated when bent and load bearing. I have started to stretch a bit more every day as I have been told by many people that my calf muscles are extremely tight.

I am going to get a deep tissue massage, that is a great idea. They're not cheap though, looks like its about AUD $60, which is about £35 for half an hour. I think I'll do it anyway.

Yes I have very bowed legs (I'll add a photo) and my knees don't touch when I put my feet together. When I got orthotics, I was treated for my foot rolling out, not in which the podiatrist said was uncommon. I think my bowed legs used to be worse when I was a kid but have gotten better as I grew up. They never used to cause me any trouble and am not sure if they bow made me more susceptible to this kind of injury.

In terms of strength and flexibility, I just found out there is a public pool near my house, and on the way to work for me. They do Yoga on Wednesday mornings and Aquarobics a few days a week. I think I'll hold off from the Yoga at this stage but the Aquarobics sounds interesting. I have been looking for something to get my heart rate up but easy on the knees. I have hurt my ribs (trying to jump over a fence - dont ask!) so I am nursing that back to recovery at the moment, but will get into it soon!
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #18 on: January 30, 2021, 11:49:43 AM »
If you want a proper cardio workout, assuming you can, why not try swimming? Do the exercises yourself before, after and during. While the pools were open here, I was doing the exercises hydrotherapy physios had showed me and swimming as much as my ankle would take.
Hoping the pools open again soon (currently under full lockdown) so I can get back in for fitness, ankle rehab and knee prefab before my scope (assuming okayed by surgeon and physio)

I pay £35 for a sports massage, I think itís good value, youíre paying a trained professional. Have an hour for the first one, as they may have quite a lot of work to do on both legs, glutes and your lower back

Maybe look at Pilates rather than yoga
« Last Edit: January 30, 2021, 11:54:11 AM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #19 on: February 08, 2021, 10:26:03 AM »
Hey Vickster,

I have been thinking about doing some swimming. I was going to go on Saturday but I saw my physio on Friday and he recommended I sign up for a gym and start using some of the machines with light weights as part of my rehab. I also like the idea of the gym as this gym does yoga and pilates classes which I am going to attend.

Cheers
Ryan
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #20 on: February 08, 2021, 10:43:48 AM »
Week Nine

Week nine was slightly better in some ways but worse in others. The first 4 days of the week went well but then I had another flare up of my knee but this time no as bad as previous flare ups. It was quite bad for about 1.5 days but started to settle. I was going to go to a gig on the Friday night with a couple of friends but I had to cancel to rest my knee. I did manage to get out on a couple of bike rides which was nice and good for the knee, but other than that, especially on the weekend I did not do much.

I have been continuing to take the anti-inflammatories that the surgeon gave me, though I am taking them more 'as required' rather than twice per day.

I don't have much more to add for this week, I am writing this a week late and have just started full time work so really exhausted/can't remember much of this week. I will add more information to week 10 which I will write now.

TL;DR:
Slightly better than the previous week. Had 4 good days but flared up over the weekend. Continuing to take anti-inflammatories.
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #21 on: February 08, 2021, 11:05:51 AM »
Week Ten

I started full time work this week. I was a little bit worried as I had to go into the office everyday which meant I would have to do 6-7k steps just during the day (a bit of a walk to and from the car park, then going to meetings, everyday activities at home etc.) Things did seem to be fine and as the week went on, my knee was feeling better and better

Even though the knee was feeling stronger, I could see that I was losing a bit of weight. I have been a little lazy with rehab the last week or so and I think my right quad got a little smaller. It was noticeably smaller than my left (good knee leg). I saw my physio on Thursday (I think I said Friday in a previous post) and he recommended that I join a gym so I can start using some of the leg exercise machines. He also recommended getting on the cross trainer and maybe even doing some yoga/pilates if the gym offered it.

On Friday, I went to a local gym and did a trial. I jumped on the cross trainer for 15 minutes (which was the first time I had broken a sweat exercising in a long time), and did some of the leg extension exercises and the seated squat things (ones where your sitting down with your legs almost in the air and push up on a board with weights). The exercises didn't feel great, I just felt this pain in my right knee on the lateral side when my knee was bent at about 45 degrees. I was convinced that I would wake up the next day and the knee would feel terrible but it didn't. It felted a little unstable but nothing too bad. Two days later I did a trial at another gym, this time for a week. I did a similar thing, cross trainer for 15 minutes, extensions and seated squats. I also just did some arm exercises and a few chin ups while I was there. Again didn't feel great with the leg exercises and pulled up a little more sore the following day. My knee did feel a little inflamed the following day, and I did go to a BBQ where it hurt a little to stand up for a long period but it was OK. The following day (today) my knee felt pretty good back at work. I went back to the same gym and did the same exercises plus some stretching at the end of the session.

This is the first time in quite a number of weeks that I feel my knee is starting to improve. I feel like my knee is less irritable and I am able to push through some exercises that would have flared up my knee for a week or two if I did them 1.5 months ago. It is definitely not anywhere near perfect but it is looking kind of promising. At the same time I don't want to get my hopes up as I have felt like this before and then just come crashing down when my knee has a big flare up.


TL;DR:
Started full time work in the office so I am up and about a bit more. Saw the physio who recommended joining a gym and doing some leg exercises as well as going on thee cross trainer and doing some Yoga/Pilates. Knee has handled the gym quite well so I will continue. First time in a while that I feel like my knee is starting to improve, but don't want to get my hopes up too much
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline vickster

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #22 on: February 08, 2021, 11:28:33 AM »
With any new resistance programme, low weight, high reps is much better and continue to fatigue not pain. And donít forget to stretch after your workout (and light icing if inflamed) :)
Leg extensions can be unfriendly to the PFJ, did the physio specifically mention doing those?
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffaís fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #23 on: February 28, 2021, 08:34:54 AM »
Week Eleven, Twelve & Thirteen

Hi all, apologies, I have been quite lazy with the posting. I will write for week eleven, twelve and thirteen all in one post.

I think part of the reason why I haven't been posting is because my knee was getting better, so I was starting to get on with my life. That is until I had another major flare up.

Last post I mentioned that I felt like my knee was really improving and I think it really was. I believe one of the reasons why it was improving was because I was starting to use it more, but not too much. I was doing about 6k steps per day when I went into the office, which was 5 days a week. I was also bike riding quite a bit and have joined a gym where I get on the cross trainer. One of the reasons why I go to the gym is because the physio recommended it. This is because there are leg machines that I could do as he is concerned with the strength of my quads. The first couple of times I went to the gym, I did the leg extension exercises and the seated squat things. It didn't make my knee feel great but it didn't really flare it up. My knee got to the point where I felt like I could return to rock climbing and felt like I could probably go on a beach walk with some friends. Last Saturday, so about 8 days ago, I went to the gym and did 20 minutes on the gross trainer and was feeling good. I then jumped on the leg extension machine on the lowest possible weight. I did one set of leg extensions and again, they were not feeling great but I continued to a second set. On the second set, I had done about 6 reps already, and on the seventh, as I was lifting my leg up, I felt a sharp pain under my knee cap on the right hand side, exactly where I get all my pain. I knew instantly that I had hurt myself and stopped the exercise. I didn't know that I had flared my knee up quite badly until that night. I was meeting some friends in the city for a drink at a pub and then planned on going into the fringe festival that is currently on in my city. My knee was feeling pretty average walking to the pub, and when it was time to go to the festival, I knew that I just needed to go home. The next day it was obvious I had hurt it quite badly. I don't think it has been this flared up for months. I am so disappointed and I am pretty down about it. It has been 8 days since the flare up and it still feels pretty bad. It has improved slightly but its still pretty painful and just generally unstable/sore.

I don't really know what to think right now. Part of me thinks my knee is just buggered and it will never get better. The other part of me knows that it has only been 3 months since the surgery and that it generally takes about 6-9 months to recover. There is also another part of me that doubts whether this is actually a fat pad injury or something else is going on. In saying that I do have pretty typical symptoms of fat pad impingement, the only weird thing is that my symptoms are on the lateral side of my right knee.

Anyway, I plan on just resting again. I have to go into work but I will be spending a lot of time at home.


TL;DR:
Knee was feeling pretty good and I thought things were getting better and I was starting to move on with my life. I then flared my knee up quite badly at the gym doing a leg extension. Now feels like it felt 1 month post operation. Super frustrated with it but what can I do..

Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline silver_maple

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #24 on: February 28, 2021, 08:36:57 PM »
Ryan,

Thanks for the update. I re-read your The Injury post. You had a traumatic accident. While it's possible this could lead to fat pad impingement, there could well be something more than that. I am skeptical the sharp pain you felt at the time of the accident is a suddenly sprung up fat pad impingement. I had impingement in the very same spot but it developed gradually through overuse (running).

I realize you had an MRI and your knee was scoped and nothing more was found. That's of course good but like you I wonder if something was missed. Good scoping can go beyond the MRI so not sure what to recommend. Any scope can cause tissue damage so I am reluctant to call for a second exploratory scope. Maybe a second, more powerful, MRI with a different radiologist. There are various advanced MRI techniques, including quantitative MRI, use of contrast agents, etc. We need to rule out ligament or lateral meniscus tear.

Age is on your side. For many of us here this knee club is like Hotel California. Hope you'll be one of the few who can check out.
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; 5mm focal chondral lesion (LK); degenerate meniscus tear (RK)
2020 - PRP x3 in RK
2021 - PRP x3 in RK, PRP x1 in LK

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #25 on: March 02, 2021, 08:35:42 AM »
Gday silver_maple,

Thanks for taking the time to reply.

From what my surgeon has told me, there seems to be multiple ways to irritate/pinch your fat pad. I think many people have an overuse type injury but I have also read online hyperextension/direct blows are really common ways to pinch your fat pad. I am also skeptical that there is something else going on but the surgeon has gone in there with the scope, looked all around, has pictures of my perfect meniscus etc.

I am 99% sure that there is nothing wrong with my meniscus but skeptical about the ligaments. However, when I did pinch my fat pad, I did feel it on the right hand side under the kneecap and then the pain sort of gradually moved to the outer lateral side.

How are you going with your fat pad impingement? When did you injury yours and what type of treatment have you had?
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline silver_maple

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #26 on: March 03, 2021, 12:45:19 AM »
Ryan,

There are three fat pads. I developed a supra-patellar fat pad impingement in the right knee only due to overuse (running and long walking). The fat pads are quite innervated and can be a source of sharp pain if impinged/inflamed. When the pain hit me I tried rest, ice and activity modification (stopped running). That worked to reduce the pain dramatically. Eventually saw a doc after even walking more than 8-10 km inflamed the area. By the time I had the MRI, as I had reduced walking to ~ 6 km a day max, the impingement had eased and was diagnosed as "mild". But if I were to increase the walking distance it would flair up.

Inflammation is not good for the knee as it sets degenerative processes in motion, mostly re cartilage.

In your case, I wonder if the doc recommended more conservative treatments before surgery. Yes, surgery can be indicated for impingement but only after less aggressive modalities have failed. As some fat pad appears to have been removed, you may experience some kinetic changes in the knee, like you describe in Week Seven.

Another poster, kneegeek2020, was so upset part of his fat pad was removed that he tried fat injections in order to restore it.

The default solution is to wait the six months post op and see if you heal. The good thing is you appear to have no other structural issues and only an "irritable knee". Please keep us posted from time to time. Best.
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; 5mm focal chondral lesion (LK); degenerate meniscus tear (RK)
2020 - PRP x3 in RK
2021 - PRP x3 in RK, PRP x1 in LK

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #27 on: March 07, 2021, 12:42:31 AM »
Hey silver_maple,

I did try a number of conservative treatments pre operation but had little to no success with these. These included seeing two physiotherapists, doing all the strengthening exercises, getting orthotics, rest and doing yoga for about 3 months. I found that my symptoms were just getting worse and that is when I decided to see the surgeon, as recommended by my second physio.

Yeah I am basically just going to wait until 6-9 months post operation and see how things are going. That seems to be the general timeline for these things to settle. I do have faith as my knee has settled a bit before but then I have aggravated it, so I think I just need to take it easy, which is really hard for me to do as I am 29 and just want to get back into life!

Ill keep you updated.

Ryan
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #28 on: March 07, 2021, 01:25:05 AM »
Week Fourteen

My knee has started to settle after the flare up that I had 2 weeks ago and I am starting to see a bit of a pattern. When I flare my knee up, it generally STARTS to settle about 1.5 weeks after the flare up. So there are some positive signs but it is still certainly inflamed. I am back to the point where I can walk on flat surfaces with good shoes on without much trouble if I take it easy, in other situations, like walking flat footed, or on uneven surfaces, my knee doesn't feel great. I have been taking ant-inflammatories, celecoxib, twice a day, morning and night and I think that is helping a bit.

I saw my physio on Wednesday. There was not much he could do but recommended that I pull back from the rehab exercises for the next couple of weeks but continue bike riding as much as I could. This seems to be the only exercise that never flares my knee up. I think I have just been so concerned about my quads and how much weaker my right is from my left. I think I have wanted to get my right quad back to what my left is like too quickly. I think the reality is that my right quad is going to be a lot weaker than my left for a long time, and that it is not realistic that in 3 months time my right left will be as strong as my left. I think I need to just continue to do what I can on my right, i.e. bike riding, the cross trainer at the gym etc until my knee completely settles. I also think that when my knee does settle again, I just need to take it easy and continue doing the exercises that I know don't irritate my knee and avoid that ones that do.

This all sounds like the logical thing to do but I guess when my knee is starting to feel good and strong again, I just want to get back into my normal life again and start pushing it harder because I think I can.

Maybe this is too much information for an online forum but whatever. My now ex girlfriend and I broke up in June last year. I feel like I have not only been trying to deal with a knee injury/surgery but also a break up which has been incredibly difficult. The first 6 months of break ups are always pretty hard, and it is still hard, but the last couple of months I have been keen to try and move on and meet someone else. I have just been desperate to just get back into life, start meeting people, do different things etc but I feel like this knee injury/surgery is just holding me back. Realistically, I would have done the typical get back into shape thing that a lot of people do post break up. I would have been running, playing hockey, netball, and just generally going out more and doing different things. Instead I haven't been able to play any sport, no running, many times I have had to turn down social events/going out, it just sucks!!!!! I have been talking to a girl recently that I met that didn't eventuate to anything in the end but I think part of the reason why it didn't is because I wasn't able to do some things that she wanted to do. She is really into hiking, camping, running and wanted to do some of those things with me but I just couldn't, and am unsure when I will be able to do those things again, if ever!

Anyway that's enough for this week, I'll try and check back in for week fifteen.

Ryan.



TL;DR:
Knee starting to settle after the flare up 2 weeks ago. Seems to take 1.5 weeks to start to settle after a flare up. Really need to accept that its going to take a long time for my right leg to be as strong as my left and when my knee does settle, I need to continue doing exercises that definitely don't aggravate my knee and leave the more intense knee strengthening exercises until much later in the recovery.

There is also a bit of an emotional rant in there about wanting to get back into life, especially post break up.
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #29 on: March 15, 2021, 10:05:14 AM »
Week Fifteen

Hi All,

I haven't seen much improvement in my knee this week but it hasn't gotten any worse. It is still no where near as good as it was 3 weeks ago before I flared it up. It's getting closer to four months post op now, and it has been a significant time since the surgery. I am really sceptical as to whether this knee is going to get better and whether the surgery has done anything, or whether it has made it worse. Right now, my knee is significantly worse than what it was pre operation. I am just playing this waiting game and I don't know how long post operation it has to be to determine that the surgery has failed and this is how my knee is now. My surgeon says sometimes it takes 3-5 months, others on the internet say 6 months. I think 6 months is about when I'll know but I guess its just not really looking promising.

One thing that does seem to help is wearing shoes with a bit of a heel. I think it takes the load off the fat pad a bit. About 6 months ago, I bought a pair of RM williams boots which have a fair heel on them. I wear them to the office and my knee seems to feel the best when I am at work. I recently bought some adidas sports shoes to wear on the weekend and casually as I got a bit sick of wearing these big hiking boots everywhere. I was wearing them on the weekend and they just don't feel great on the knee which is annoying. I have bought an old but in good condition second hand pair of RM williams boots off ebay. They cost $600 a pair but I got this second hand pair for $200. I got them from a shoe repair shop who has repaired them etc. I am going to try and wear my good pair to work and this second hand pair on the weekends. I like wearing shorts so they will look a little funny but oh well, if it helps my knee then its all good.

That's all for this week, not much has changed since last week. I'll check back in next week.

TL;DR:

Not much has changed, not worse but knee still not as good as 3 weeks ago before I flared it up. Kind of losing hope that this knee will get better. Ordered a pair of boots that have a heel as that seems to help.
Ryan from Adelaide, South Australia
23/11/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up