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Author Topic: Fat Pad Impingement Surgery and Recovery  (Read 82 times)

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Offline RyanC

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Fat Pad Impingement Surgery and Recovery
« on: January 13, 2021, 11:25:56 AM »
Introduction

Hi,

My name is Ryan, I am 29 years old and I am from Adelaide, South Australia. I am a former tour guide/bar tender but now work as a web developer here in Adelaide. I have done heaps of travelling through South America and Europe and have always been a really active person, playing Basketball, Cricket, Football, Hockey and Netball through my teenage years and into my 20's (not all at the same time).

I am currently 7 weeks post operation for a fat pad impingement so I am a little late to be starting post op diaries but better late than never. I plan on firstly recounting the last 7 weeks week by week, and then continuing to update on my progress every week or so.

I am writing this to both track my recovery progress but also to help others who also have had similar surgeries.
« Last Edit: January 13, 2021, 11:48:14 AM by RyanC »
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #1 on: January 13, 2021, 11:36:17 AM »
The Injury

In March 2020, I decided to go and try out for a new field hockey club. I had sprained my ankle badly in June 2019 playing social netball and had not done much running/exercise since. Everything was going fine during the training session until about 2/3rds of the way through when I landed, with my leg at full extension where I felt a sharp pinching sensation below my knee cap. I had no idea what it was but I went off. I did come back on the last 5 minutes of the training session where it started to hurt again.

I didn't know what I had done. I tried running on my knee 3 days later and it felt terrible. I left it for a few weeks to see if it got better but it did not. I later saw a physiotherapist where I saw him for about 10 weeks. He gave me a whole bunch of exercises to do but nothing was helping my knee. I was then referred onto a podiatrist who got me orthotics. This also didn't help so I decided to do 3 months of yoga. When this didn't help I got really frustrated and got an MRI scan. The scan came back saying there was nothing wrong so the doctor referred me to another physiotherapist. When I saw the physio, he thought that I potentially had some meniscus damage and that I should go see a surgeon. I saw the surgeon once, where he said there was some abnormalities around my lateral meniscus and he recommended surgery.
« Last Edit: January 13, 2021, 11:44:59 AM by RyanC »
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #2 on: January 13, 2021, 11:44:37 AM »
The Surgery

The surgery was an arthroscopy. It took place on the 23rd of November, 2020. Initially it was cancelled because my state went into a COVID-19 lockdown but it was later put back on. I didn't know that I had a fat pad impingement prior to surgery, I thought that I was having my meniscus repaired.

The surgery took about 30 minutes. After it was done, the surgeon told me it was a fat pad impingement and that I should be all good in 2-3 weeks, I now know that is a ridiculous timeline for a recovery from a surgery like this, especially on a fat pad. I stayed overnight in the hospital.
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #3 on: January 13, 2021, 12:02:49 PM »
Week One

I could walk on my leg only hours after my surgery, although it was just me hobbling to the toilet and back. The hospital staff gave me regular pain medication and about 12 hours after the surgery they gave me an ice pack. I had three incisions, all of which had bandages on them and they put a waterproof film over the top. I stayed in hospital overnight and was sent home in the morning with a script for some pain meds and some basic physio exercises. The exercises included:
  • Sitting down and bending my leg towards my chest
  • Sitting down and lifting my straightened leg
  • Lying down with a towel under my knee and straightening my knee

The first three days I did not do much at all. I followed the doctors advice just to take it as easy as possible and kept my leg elevated. My knee was just achy and sore and I couldn't do much at all.

On day four, I decided to give driving a go. Even though my knee was sore, I felt as if I could perform the emergency brake if I needed to. I jumped in my car and drove around the block and it was fine.

I spent most of this week just on the couch. After driving and walking a little bit on day 5 my knee was so sore, just really achy. Basically after week 1, the swelling in my knee did start to subside a little but it was still very much in the early stages and was still very sore. I changed the dressing on my incisions multiple times and was performing the physio exercises multiple times a day, even they were quite painful to do
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #4 on: January 14, 2021, 09:04:40 AM »
Week Two

I did quite a bit more walking this week. Not so much because I went for walks around the block, just because I started to get back on my feet more. I moved back into my house after staying with my parents for the first week. This meant that I had to be on my feet to cook, clean etc. I have a supermarket only about 50 metres away from my house, I started walking there and back to get supplies. Looking back on my fitbit, I was doing an average of 6000 steps per day. My knee did get sore though, not the pain I used to get from the impingement, just like an inflamed and achy pain, especially if I had been on my feet for an hour or so.

I do remember one of those days later during week two that my knee was feeling quite good. I walked around the block and couldn't believe that it felt so good so soon after surgery. I got pretty confident and asked my friend if he wanted to go for a short beach walk and get dinner that night. That was a really bad idea, about 1 minutes into walking along the beach I knew I should be resting my knee, it didnt feel as good as it did earlier in the day. I remember that night it felt really achy and painful and knew I still very much had to take it easy. I was a little disappointed as the surgeon told me 2-3 weeks and I'd be fine.
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #5 on: January 14, 2021, 09:39:30 AM »
Side Note - Recovery Time

I really wish my surgeon told me realistic expectations for the recovery period. When I first came out of the surgery, the surgeon told me that I should be good to go in 2-3 weeks. I now know that that is an absolutely ridiculous timeline. When I saw him for the 2 week post op appointment, he told me to give it another 4 weeks to settle. At the 6 week post op appointment, he told me that these things take 3-5 months. I didn't really know what to believe so I started doing some research online. From what I can see, fat pads can be a pain, and many people go through 'cycles' where the knee starts to feel better, they start using it more and then it flares up, which can go on for months. From what it looks like, a fat pad surgery generally takes 6 months to full recovery, where the first 2-3 month being the worst. I have seen cases where it took 18 months to recover but none where it was 6 weeks or less. But yes I am sure the surgeon knew that recovery could take this long and I wish I knew the realistic expectations going into the recovery so I wasn't so devastated every time a milestone came around where I thought I should be better and running again.
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #6 on: January 15, 2021, 09:02:53 AM »
Week Three

Two and a bit weeks after the surgery, I saw my surgeon for the routine 2 week post op appointment. There he removed my bandages and checked up on how I was going. I told him things were going OK but things were very much still inflamed. At this point, I was expecting to feel close to 100% better as he told me I should be good to go in 2-3 weeks. At this point, he told me to give it another 4 weeks and check back in.

That week I saw a lot of improvements. I started to walk more, mainly around the block a few times a day and early in the week I was doing about 8k steps per day. I had a Christmas work function where I dressed up and put my no so cushiony RM Williams boots on. I did limp around a little that day, and it didn't help that I had to go up and down a few times. I woke up the next morning and my knee felt fine to my surprise. I then got a bit more confident and had a day where I did 14k steps and the knee felt fine. I couldn't believe it, maybe the surgeon was right about the 2-3 week timeline. I even rang my parents, almost in tears, telling them that my knee was going to be fine! The following day I did another 12k steps. I woke up the next day and my knee was a bit sore. I didn't think too much of it and had another big day on my feet. It was becoming obvious throughout that day and the day after that I had pushed my knee way too hard. At the time of writing this (7.5 weeks post op), my knee hasn't felt as good as it did at the 3 weeks post op mark. At 3 weeks, I actually got to the point where I was thinking, 'well if this is as good as my knee gets then I am satisfied with it'. I could just live my day to day without pain. I felt like I wouldn't be able to run but I was in no pain (and taking no painkillers at the time).

So yeah, I had pushed it too hard and I had my first flare up of the knee. I'll leave the 'trying to get the flare up under control' part for next week as most of that happened in week 4.

Added note: I also saw the physio for the first time post op (my physio and not the physio that comes and sees you after the surgery). He said he had seen many fat pat impingement surgeries and we needed to have a focus on building quad strength (and other muscles). The exercises he gave me were:
  • Seated on a table with my leg dangling and a 2kg weight on it, extend my leg into full extension - repeat 3 times for 60 seconds
  • Sitting on the floor against the wall with my good leg bent and bad on extended, lift my bad leg up and down with 2kg weight - repeat 3 times for 30 seconds
  • Ones where I am on my side, and lift extended leg with 2kg weight - repeat 3 times for 30 seconds
  • Ones where I hold a slightly deflated soccer ball between my legs - repeat 3 times for 30 seconds
« Last Edit: January 15, 2021, 10:15:34 AM by RyanC, Reason: add physio information »
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #7 on: January 15, 2021, 09:08:32 AM »
Week Four

So as mentioned I had flared up my knee. My knee was visually more swollen, it was hot and just really agitated. I got to a point where I had to limp around a bit which I hadn't done for weeks. I knew that I just had to take it easy so thats what I did. I spent most of the week on the couch watching TV, icing it as much as possible and just generally resting. There isn't much more to report for this week other than I just rested. It took a solid week for it to begin to start to settle. By the end of this week, it was still nowhere near what it was at 3.5 weeks and I was starting to get pretty down about it, especially as 1 week prior I thought my knee was a couple of weeks away from starting to run again.

Note: I am trying to recount what happened as best as possible, but I am writing this as of 7.5 weeks post op. Some of the end of week three actually happened in week 4 I think. I believe it was about 3.5 weeks, so in week 4, that my knee started to feel really good and I had my first flare up.
« Last Edit: January 15, 2021, 09:38:13 AM by RyanC, Reason: Add note »
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #8 on: January 15, 2021, 09:33:45 AM »
Week Five

At the start of this week my knee was still a bit agitated but getting better. I think it really started to feel significantly better about half way through this week, but still nowhere near as good as 3.5 weeks post op. I started walking around the block again and things were feeling OK. Again I started to get quite confident on my knee again. I actually went to a party one night and ended up doing 17k steps in one night, at one stage I was dancing on the dance floor. My knee was feeling OK but by the end of the night it was really sore, just achy and swollen. I woke up the next day and it didn't feel too bad but not quite right. That week I had also started going for bike rides. My physio had advised me that I should only do rides for 30 or so minutes but I was going for hour and a half rides. Basically this is when my second flare up happened! I have only got myself to blame as I was going so hard. On New Years Eve I had already planned a bike ride with a friend and then was having some people over my house for some drinks and celebrations. I basically planned to just try and get through that night and rest my knee in the new year.

The weirdest thing happened though, after going for a big bike ride and being on my feet all night my knee felt really good.. I woke up on New Years Day and my knee felt great. I couldn't really work this out as I had pushed it so hard. This is the end of this week but Ill continue for week 6!
Ryan from Adelaide, South Australia
23/12/2020 - Right knee arthroscopy: Fat pad impingement trimmed and minor chondral breakdown tidied up

Offline RyanC

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Re: Fat Pad Impingement Surgery and Recovery
« Reply #9 on: January 15, 2021, 10:07:16 AM »
Week Six

I still can't really work out why my knee felt so good after new year, I have a feeling I might have 'loosened' the scar tissue up a bit and warmed it up so it felt OK. I did end up taking it easy for the next couple of days and thats when it became obvious I was going through another flare up. Again, my knee was agitated, hot and achy. I was seeing both my physio and surgeon on the same day early this week. I saw the physio first, he could sense my frustration. He said that the surgeon might opt for a cortisone injection to help calm things down. He gave me a few extra exercises to do this time he gave me:
  • Glute bridges where my heels started on a chair
  • These exersises where I put one foot forward and the other foot on a chair behind me. With the front foot slightly bent, I moved a weight from side to side

I asked my physio about fat pad taping and fat pad massage. He seemed to be against both but said we could give the massage a go next time.

I also saw the surgeon. I went in and explained to him what had gone on. He seemed a bit disinterested and didn't have any answers or suggestions for me. I asked about the cortisone injection but he said he didn't recommend it and that it wouldn't shorten the recovery time at all. He then told me that these things take 3 to 5 months to recover and that most people see a 50% improvement in their original symptoms and that I just had an 'irritable' knee that I would have to live with. He ended up giving me some anti inflammatories (Celecoxib - I have a sensitive stomach) and told me to take them 'when required'. I was starting to get pretty annoyed in the appointment, especially as he told me that I should be good to go in 2-3 weeks. I asked him what happens if my knee is still no good in 5 months time? Do I just have to live with a crappy knee for my entire life? He responded by saying that if my knee was not good in 6 months time, that he could do the surgery again, but he would 'alter the healing process' basically by using cortisone injections during the recovery period. I was not happy to hear this.

I left the surgeons office pretty upset. I ended up calling my mum and just broke down crying saying that my knee was no good and I would essentially be disabled for life. Everywhere that I read, arthroscopies take 6 weeks to recover from. I felt like I just just left with a knee that was worst that before the operation.

That is when I started to go down a bit of a rabbit hole on the internet about fat pad impingements. From what I could see, the surgeries were rarely successful and that many people ended up with worse knees post op and wished they'd never got the surgery. After I read Clarkeys post op discussion, I felt kind of depressed. He said it took about 18 months to get back into running. At this point I was 1.5 months post op... so did that mean I had another 16.5 months of recovery to go? I felt super down and depressed for a couple of days.

After doing some more research I found this article. Its from a medical journal and it tracked the recover of 34 patients that had a resection of their fat pad.

https://www.arthroscopyjournal.org/article/S0749-8063(07)00590-7/fulltext#back-bib4

It said that 30 out of 34 people recovered to their pre-injury status. I couldn't believe it as I felt like this surgery almost always failed. I then started finding a bit more information on realistic timelines. It looks recovery periods for fat pad impingements are around 6 months, where the first 3 or so months they are pretty irritable. This gave me some relief that all that money I spent and pain I am going through might be worth it!

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















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