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Author Topic: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery  (Read 1396 times)

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Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #45 on: June 05, 2021, 11:08:46 AM »
Hi silver_maple,

I have actually found my first MRI that I had on the 13/07/2020. This one was done at with the same company that did my second one. I have also posted the full results of the second MRI as well.

This is the report for the first MRI:

Coronal and sagittal alignment of the knee joint is normal. There is a small joint effusion present decompressed into the suprapatellar fossa. There is a minimal amount of synovitis here and in the intercondylar region. There is no large intra-articular body visualised. There is no infiltrative marrow lesion demonstrated. There is no Baker's cyst.

Patellofemoral Compartment: The Insall-Salvati ratio measures 0.96 which is within normal limits. Femoral trochlear morphology is normal. The medial and lateral retinacula are intact. There is some minimal chondral oedema about the medial patellar facet articular cartilage but no full thickness chondral defect is seen here. There is no subchondral change. There is some chronic fibrocartilaginous repair with some minimal subchondral oedematous change at the troclear groove articular cartilage with no other chondral defect or subchondral change seen about the femoral throchlea. The quadriceps and patellar tendons are intact. The quadriceps, prefemoral and Hoffa's fat pad appear unremarkable. Small amount of fluid in the deep infrapatellar bursa. No evidence of prepatellar buritis.

Intercondylar Region: Both cruciate ligaments are intact. Some minimal subcortical oedema is seen at the posterior tibial spine which may be possibly traction related to the posterior cruciate ligament.

Medial compartment: No tear of the medial meniscus is demonstrated. The medial collateral ligament is intact and unremarkable. The meniscofemoral and meniscotibial ligaments are normal. There is no chondral abnormality or subchondral change visualised.

Lateral compartment: The lateral meniscus is intact. The lateral collateral ligament is intact and unremarkable. The popliteus tendon and other posterolatereal corner structures appear unremarkable. There is no chondral defect or subchondral change seen throughout.

Conclusion: There is no acute internal deragement. No high grade chondral abnormality seen.






For reference, here is the full copy of the MRI results from the one I had on the 24/04/2021:

Intercondylar Region: ACL and PCL intact.

Medial compartment: MCL intact. No meniscus tear identified. Articular cartilage is intact. No subchondral oedema.

Lateral compartment: LCL complex is intact. No features to suggest ITB friction syndrome. Popliteus is intact. No meniscal tear identified. Articular cartilage is intact. No subchondral oedema. Small effusion is noted arising from the posterior aspect of the proximal tibiofibular joint with mild associated synovitis however no underlying degenerative change. Normal apperance to the fibular origin of the soleus.

Patellofemoral compartment: Small knee joint effusion is noted. Patellar retinacula are intact. Quadriceps and patellar tendons are intact. There is a small near full thickness chondral defect involving the inferolateral patella with subtle subchondral oedema. remaining patellar cartilage well preserved. Single full thickness dark chondral fissure troclear groove with subchondral cyst formation however this is a stable funding. Remaining trochlear cartilage well preserved. Scarring is evident involving the supereolateral aspect of Hoffa's fat pad in keeping with debridement. No features of Hoffa's fat pad impingement.

Other findings: No Baker's cyst. No features of pes anserine bursitis.

Conclusion: Small near full thickness chondral defect with sub chondral oedema inferolateral patellar facet. Mild proximal tibiofibular effusion without significant underlying degenerative change. No meniscal tear.
« Last Edit: June 05, 2021, 02:28:00 PM by RyanC »
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 #46 on: June 05, 2021, 03:47:31 PM »
Ryan,

Thanks for posting the full MRI reports. The first one looks reasonably benign. To operate on the basis of such report simply on the suspicion of a fat pad impingement looks like an aggressive modality to me. No use crying over spilled milk. You have no alignment issues. That your doc would suggest patellar tendon shortening is beyond me. Frankly I have no confidence in this doc.

While the second MRI is fresh I'd recommend seeking a 2nd opinion from a different doc. The question is what to do with the cartilage defects, you've got one in the troclear groove as well. Your body has managed some fibro repair already (per the 1st MRI report). Maybe you can manage that again but fibrocartilage is less durable. Why our body would not attempt genuine repair with hyaline cartilage I don't know. This fact is behind the proliferation of various chrondroplasty techniques. The snapping you get could be the plica - if you can replicate it in front of your GP, he/she may confirm that. It could go away after a few weeks.
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; another 5mm focal lesion; degenerate meniscus tear (right knee)
2020 - PRP x3 in right knee
2021 - PRP x2 in right knee

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #47 on: June 06, 2021, 01:47:51 AM »
Hi silver_maple,

Yeah I couldn't believe when the doc recommended patellar tendon shortening, seemed a bit ridiculous. This particular surgeon has seemed pretty disinterested every time I go in.

In terms of the original surgery, I guess I was pretty desperate. My knee symptoms seemed to be getting worse and I had not responded to physio, yoga or orthotics. When I went into this original surgeon, he said something like 'you seem to have an abnormality around your meniscus, the only way to know what's going on in there to do an arthroscopy and see what is going on'. That's when I had the surgery and he found the fat pad impingement that he trimmed back. I'll add a photo to this post of the image of the impingement and what it looked like after trimming.

I think I will make an appointment to see another doctor and work out my options. From what it sounds like, these chondral defects can be the source of a lot of pain and might be what is causing it and the fat pad is fine.

It's just hard to know what to do right now. I am 6.5 months post operation which seems to be a long time but I also read some places that sometimes the knee needs longer than that to settle after any surgery. I have this chondral defect on my patellar which has seemed to pop out of no where and have no idea whether that is causing my pain or the fat pad is still trying to settle after the surgery. It is also hard as the inferolateral patellar chondral defect is almost in the same spot as the fat pad impingement surgery and that is always where I get my pain, I never get pain on the medial side of my knee.

Also, my knee does seem to give me these snippets of hope, where it is feeling really good and feeling like I can run, then it just throws me back down. It's hard to say if my knee is better than before surgery. I never used to have a couple of days where my knee was feeling good pre-surgery, there was always an ache or pain in there whenever I walked. I am sometimes now able to walk pain free but my knee seems to 'flare up' much easier than before. Anyway enough of that rant!

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 #48 on: June 06, 2021, 08:16:50 AM »
Week twenty-seven

Hi all,

There has been a bit of discussion back and forth since last week. Basically I now know that I have a small amount of cartilage damage on the under side of my kneecap on the bottom on the outside. There is also some damage in my trochlea groove. I was a bit disappointed as my surgeon failed to mention this to me a month back when I got my MRI results. I have been freaking out a bit the last couple of days, I've had some really positive days but the last two my knee has been really achy. I guess I just think that I am almost 7 months post operation and things have not gotten back to normal. I also went down a bit of a rabbit hole as to how chondral defects are treated and that really freaked me out i.e. the process and recovery with treatments like microfractures and ACI, MACI etc. I even watched a video of a MACI operation and just burst into tears.

In terms of the week, I have had some pretty good days, especially the first 5 days. I clocked up about 70,000 steps this week as I was out walking around the block, climbing etc. On day 6 of this week though, my knee was just getting a bit sore. I played golf (and hired a cart) yesterday and things were OK but it was pushing it. I was meant to go out yesterday for some karaoke and just couldn't as my knee was just sore and I didn't think I could handle it.

I don't know why but when my knee started to hurt later in the week, I really started to get a bit depressed about it. I think this is because it has been over 6 months since the surgery and I feel like I am still so far off running properly/living a normal life. I seem to get glimmers of hope, then I just get thrown back down. I have had some time to think about what my next plan of attack with this is as I refuse to believe that this is just how my knee is and this is how I have to live from now on.

I have been doing some reading on chondral defects and a lot of people do respond to physio and strengthening the muscles around the knee. My muscles in my legs have certainly gotten stronger since doing rehab but I think they are still way weaker than they normally are. I haven't been super super consistent with the rehab either. I was doing the really light at home ones for about 3 months post op. I did have weeks where I did not do the exercises, and at one stage, I didn't do any for about 3-4 weeks. I then was pretty consistent with the gym rehab for about 2 months but for some reason, about 1 month ago, I started working out my upper body a lot more and the leg exercises only at the end if I had time. I recently posted a photo of my legs and how I have put on some muscle, I think I have actually lost some of that since posting. I also think that my job is really not helping with the rehab. I just sit all day and that is making my legs (and just body in general) weaker. I think if I do two rehab sessions a week, that only counteracts the sitting all day and doesn't have a positive gain on my muscles.

Side note: My dad has was diagnosed with chondromalacia in both knees under the knee cap when he was about my age (maybe a bit younger). He has never had surgery and the pain went away when he stopped playing football (aussie rules). He hasn't had any pain since.

Basically what I am getting to is my next plan of attack for this knee. I know there is no way I am having another surgery until at least 1 year after this one. Also, I know that the muscles in my legs are just weaker than what they usually are. I think I need to start getting really serious about this knee rehab and try to build the muscles in my legs as much as I can without flaring my knee up. If I can spend the next 2-3 months doing that, I think I will be in a better position to come up with a plan from there, knowing that my legs are strong but I am still getting/not getting pain.

Thats all for this week, I will check back in next week!

Ryan


TL;DR:

Now know that I had cartilage damage on the inside of my patellar, which my surgeon seemed to fail to mention to me. Overall knee has been good but sore at the end of the week, has gotten me a bit down. Basically know that I will not have another surgery until at least 1 year post op, so only option is to strengthen the muscles around the knee and see what happens with that. Will then be in a better position to make a decision about what action to take next
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 #49 on: June 06, 2021, 10:08:42 AM »
Perhaps you are overdoing it and not having rest days or days where you stick to only gentle non weight bearing type exercise, a gentle flat cycle just to get the knees moving or a gentle swim, some pool walking perhaps. Followed by ice and heat and feet up :) Avoid deep squatting lunging, weights for a bit, give the knee a rest. You want to avoid inflammation as that causes damage to cartilage.

It’s very easy to overthink what might be going on especially when receiving a detailed MRI report. As my surgeons various have explained many times, radiologists are expected to report any and all findings, however many might be on little or no clinical consequence. It’s down to the expert specialist to correlate with history, clinical examination and discussion of symptoms with patient.

I would doubt a tiny defect without painful crepitus, swelling, loss of ROM is the cause of your knee soreness, and certainly not in need of major surgery :)

I went down the whole MACI thing in 2010, big traumatic weight bearing defect on lateral femur (which as noted had filled with fibro), even had the harvest scope after a long fight with private insurer but being mildly knock kneed and having some other wear, the surgeon (an expert in cartilage repair) wouldn’t do it (without straightening the joint first).
I’m very glad actually, yes my knee is a bit of a mess now (I’ve just had a scope and 3 patches of micro fracture to grade 4 bits). Notably that WB defect fibro seems to be holding up ok, but one of the micro fractures was to the same bone, but a different bit (other were WB medial femur, trochlea and chondroplasty to patella)

Stick with physio, the gym, pool, but don’t overdo it, walking 10k steps every day is probably too much for your knee, you need to find the right balance between weight bearing activity, non impact and most importantly rest (a couple of days a week). Perhaps give yoga or Pilates a go on the rest days, make sure your core is good and all the leg muscles firing properly (plus hips, glutes, lower back) and everything supple.
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, Hoffa’s 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 #50 on: June 07, 2021, 09:36:54 AM »
Hi Vickster,

I probably am overdoing it a bit. 10k steps per day is probably too much, I am just really keen to get back to my normal self and when the knee is feeling good, I just start using it. I have/am pulling it back and will see how it goes. I think I need to stop the icing for a bit, I think my skin is starting to burn a bit! I also don't think the taping is doing anything, so I might stop that also.

Also I agree with you with the radiologist thing. I think most of the stuff on the MRI is just because they have to report everything. Also thanks for the info about your MACI, that sounds like an absolute last resort for me and something to think about in 6 months to a year when all else has failed.

I have also been considering having a cortisone injection. I seem to have problems with inflammation and my knee getting a bit angry so maybe I am a good candidate for it?  I feel like there is no harm in trying??

And yep that is the plan, sticking with the physio, gym etc. I haven't yet tried the pool but it is winter where I am and most are closed. There are some indoor ones but its a bit of a hassle to get down there. I've been indoor bouldering quite often which is surprisingly OK for the knee, especially if I do certain types of climbs and take it easy.

Cheers,

Ryan
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 #51 on: June 07, 2021, 10:47:08 AM »
Cortisone (or any injected steroid) can damage cartilage so unless your knee is very inflamed (swollen, hot) and nothing else helps (eg anti inflammatory gels, or oral medication), best not to go there if it just feels a bit sore (especially if it’s transient following activity, better to moderate activity and have proper rest days). You could ask your specialist about hyaluronic acid injections (like Synvisc or other brand) or Platelet rich plasma (PRP), they are natural and can help lubricate the joint and reduce inflammation.  Although again they’re more for moderate to severe symptoms really (not least due to the cost).

In terms of icing, you should never apply ice directly to skin, wrap in a cloth (or if doing massage to fat pad, put olive oil on the skin and keep the icecube moving always). Have you tried heat on the joint too, especially to warm it up before exercise?

It is possible your knee will never feel exactly as it did as you’ve had surgery. All surgery will cause changes in the joint, as scar tissue is unavoidable, so it may just be a matter of accepting that and moving forwards with your different knee.

MACI and other cartilage repair modalities are often a poor option for defects in the patella/trochlea due to the forces with bending and straightening so again you’d really only want to consider if severe pain and functional impairment :)

Have you considered mindfulness or CBT as a way of managing the psychological impact (rather than looking for invasive treatments?) Might be worth looking into
« Last Edit: June 07, 2021, 03:38:21 PM 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, Hoffa’s 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 #52 on: June 09, 2021, 09:35:45 AM »
Hi Vickster,

OK I will avoid steroid injections for now. I have actually booked in to see a new surgeon. As mentioned before, I am not looking to get another surgery done any time soon, well at least not for the next 6-12 months, but it would be interesting to see his interpretation of the MRI results and just get some advice from him. I will discuss my options around those injections you mentioned with him.

Regarding icing, I always put olive oil on my skin before applying ice. I have not tried heat to the joint before exercise, I mainly use ice before exercise. I could give this a go and see if it makes any difference.

I understand that my knee will never be the same, and am happy to accept that I will never play competitive sport again. To be honest, I think I would also be able to get past the fact that I couldn't run again, I just don't seem to be able to live a life where I can live normally and go on one walk a day without it flaring up after a couple of days. I also get into situations where I can just hang out with friends because my knee is hurting so much.

Ryan
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 #53 on: June 09, 2021, 10:47:53 AM »
If using a static ice pack, you should wrap it in a cloth not just oil the skin (the oil is for ice massage where you are using an ice cube on a small area eg the fatpad)

What pain relief have you tried when it’s sore? What sort of pain is it?
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, Hoffa’s 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 #54 on: June 09, 2021, 12:04:29 PM »
Hi Vickster,

I haven't been using ice packs, only the ice massage for a couple of minutes a couple of times a day. I always put olive oil on my skin before hand.

In terms of pain relief, I still have some celebobix. I haven't actually taken any for this recent flare up as I have recently started taking some medication for something unrelated and read that it slightly increases your chances of developing GI tract bleeding if taken together. I might take some ibuprofen as apparently it is slightly better for this. I might also start taking some paracetamol as well to see if it helps.

In terms of the pain, I seem to get the exact same symptoms every 'flare up'. There isn't a specific spot where it hurts, it just aches and is 'angry' on the lateral side, right where the fat pad is, under the patella. But I also seem to get pain that kind of shoots up and down my leg. So my IBT will be sore, like an achy swollen pain, as well as the tendon that runs below the knee on the lateral side. Even reecetly I have this achyish pain in my glutes. Even the muscles behind my knee kind of ache. I feel like it all originates from my knee. Last night, I was getting these 'shooting' pains on and off coming from the bottom right (of my right knee) part of my knee cap.

The pain I got pre surgery was so much more 'localised', but now when it flares up, I get the symptoms of above.

Cheers,
Ryan

Edit: I also seem to get more 'popping' and 'clicking' in my knee when it is flared up, and that seems to settle when my knee is OK.
« Last Edit: June 09, 2021, 12:08:53 PM by RyanC »
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 #55 on: June 09, 2021, 12:25:13 PM »
If it’s more muscular ache or tightness that doesn’t relieve with focused stretching and rest, have you tried sports massage? Of glutes, hamstrings, quads, calves, even lower back? Anything awry can cause stiffness and knee pain. Do you use a foam roller, tennis ball etc as part of your gym workout ?
Presumably a physio has done a thorough assessment of all your muscles and gait?
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, Hoffa’s 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 #56 on: June 13, 2021, 09:11:52 AM »
Nah its not muscle tightness, I definitely know that feeling. The achy pains in my legs are most pronounced closest to my knee, and only come up when my knee is really irritable and achy, so its definitely to do with that. I do use a foam roller and tennis ball quite regularly as part of my workout.

The physio hasnt done a gait analysis but I went to a podiatrist and got one done and wear orthotics, so I think that is all good. Also, I have tried getting a sports massage. It was OK but it was $60 and can't really afford to get one too often!

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 #57 on: June 13, 2021, 10:25:07 AM »
Week twenty-eight

Hi All,

This week has been the worst week in a while. As mentioned in week twenty-seven, I pushed my knee too much with 70k steps for the week. At the beginning of this week, I tried to push through it a bit, thinking it was just some general soreness. I had pulled back on the walking but I was still doing the gym exercises (leg extensions, hamstrings etc). It got to a point where it was just soo painful, even to the point where I was limping around the house. It wasn't really that painful when I was doing the exercises at the gym, but when I got home and everything settled and I later tried walking on it, I was in a lot of pain. The pain is just this achy inflamed feeling, not in one particular spot, but more just in general on the lateral side under the patella. It also seems to shoot up and down my leg on the lateral side and I even get the achy pain behind my leg. This has been the hardest week psychologically since I had my knee surgery and had a bit of a breakdown on Thursday night because of it. Previously, I was able to stay optimistic as I could just say 'Oh I am only 3 month post operation, I am still in the window of common recovery time'. Now that it is approaching 7 months post operation, I am really having doubts to whether my knee will ever completely settle and that the operation actually made me knee considerably worse that pre op. I am tryinggggggg my best to stay positive, but it is hard. I am able to play my wheelchair basketball, go bouldering, go to the gym so that is a positive. The only thing is, I get these snippets of what life can be life with a good knee. And I start doing things I love, like going for walks, starting to jog, just being outside and using my body, especially as I spend a lot of time inside on a computer for my work, and then it all comes crashing down!

For the last 3 days, I have taken it really really easy. I haven't been going for walks, or been doing any gym workouts for my legs. I've just been mainly sitting around not doing a lot except playing chess online (add JuannyPubs23 on chess.com if you want a game!), but I have been going to the gym and doing some upper body workouts, to keep myself sane. I have also just been taking two celecobix every day to try and help. I have pulled right back on the icing, as I am a bit concerned about how much I am icing it and I think my knee needs a bit of a break - my knee has been pretty cold in general lately, but this might be because it is getting really cold where I am and I wear shorts all of the time (yes I am one of those). My knee has improved since and it was feeling OK today. I did some gardening and took my dog down to the park and went for a very very small walk today without much trouble. I am pleased that it has started to settle after the flare up but am still upset that it flared up in the first place. I clearly have to be more careful, and not start walking around the block three times a day the moment it starts to feel OK.

I have had a chance to do a lot of thinking over the past couple of days and have just been trying to figure out what is going on with my knee. I know its not great to dwell on it and look up different surgeries but I just can't help it. This is what I have come up with what could possibly be wrong with my knee:

  • Simply that my fat pad is still irritable, and that I keep irritating it and eventually it will calm down if I just take it easy
  • That the chondral defect under my patella is the source of my pain and needs to be sorted out
  • I have had ITB syndrome multiple times in my right knee (and not my left). I am also susceptible to it as I have quite bowed legs. I read that ITB syndrome is actually the ITB rubbing against the fat pad. Maybe I did pinch the fat pad, had it trimmed back, but my tight ITB is rubbing against it, and when I walk too much, it aggravates it
  • I have mild arthrofibrosis in my knee which is causing the inflammatory pain in my knee
  • maybe a mix of all of these

Other than that, I can't really think of what could be causing all this pain in my knee!

As I mentioned in a previous post, I am going to see a different surgeon to get some advice. Also as mentioned previously, I wont be getting another surgery for at least another 6 months but I am interested to get a second opinion. I am even thinking about seeing a third surgeon just to get a couple of opinions about what is going on (something I probably should have done before my first surgery).

Anyway that is all fo this week,

Ryan


TL;DR:
« Last Edit: June 13, 2021, 11:24:19 AM by RyanC »
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 #58 on: June 13, 2021, 05:27:05 PM »
Ryan,

I salute your intention to get a second opinion. And a third, if possible. I'd also recommend consulting with a physician who does injective therapy before you do any further surgery.

I've been seeing two knee docs (Cleveland Clc) and while I put neither on a pedestal, to their credit, when I presented with a fat pad impingement, degenerate meniscus tear, and generalized plus focal cartilage wear, neither even mentioned surgery. In fact the initial recommendation was to do absolutely nothing beyond rest and quad strengthening. I actually had to push to get PRP shots.

I remain skeptical you needed the first surgery. Within the paradigm of Dr. Dye your envelope of function is reduced. If you stay within the EoF (and you have tested the boundaries) you may be ok but the objective is to improve and at 29 you have a chance of doing that. Do look at the injective side of things (other than steroids).
2019 - Chondromalacia patella gr 1-2, both knees; early bilateral tibio-femoral arthritis; another 5mm focal lesion; degenerate meniscus tear (right knee)
2020 - PRP x3 in right knee
2021 - PRP x2 in right knee

Offline RyanC

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Re: Arthroscopy with Fat Pad Impingement Trimming Surgery & Recovery
« Reply #59 on: June 14, 2021, 09:30:39 AM »
Hi silver_maple,

Thanks, yes it will be interesting to see what they have to say. Regarding the injections, that is what I am thinking I will try before another surgery. I am pretty keen to stay away from the cortisone injections but understand there are other options. I'll chat to the surgeons about this in depth about these.

Sounds like you have some good knee doctors. My doc just went straight in there, without trying other types of treatment. I had no idea injections were a thing before my surgery and would have liked my health professional to take me through those options.

I agree, I am also skeptical that I needed surgery. To be honest, when I decided to have surgery, I hadn't done any physio for about 5 months. I did it for about 3 months after the initial injury but was not seeing any improvements so I stopped. I think the physio was quite inexperienced (he was about 25 - younger than me) and went quite aggressive with the physio and was trying to get me back into running as soon as I could. There was no recommendation of icing, taping, rest etc. I also spent a lot of time sitting last year. I was finishing off my computer science degree and was working three days a week as a web developer. I basically spend 60 hours a week at a computer and didn't do much exercise. Basically what I am saying is that I think I got really weak and unfit which did not help my knee at all. I am still struggling to get that strength back.

Thanks again for replying, I'll keep you posted.

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















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