Fat Pad specialists

[Samiul27]

Hi,

Having taken me a year to almost cure my tendinopathy with physio, another issue has popped up. I had a scope on my patella in Oct 2019 with Professor Nick London in Leeds but ever since I've had occasional burning sensations on the medial side of my left knee. He made two incisions, I'm guessing he may have irritated something on one of the sides.

I'm currently having issues with my media Fat Pad on my left knee, I'm booked in to see Claire Robertson at Wimbledon clinics and possibly a steroid injection. But if all that is unsuccessful are there any recommendations for fat pad orthopedic surgeons, from what I read surgery on the fat pad is not very successful and leaves people with further complications.

I've come across Dr Charles Owen in Bournemouth who claims to treat over 200 a year
https://www.sportsorthopaedicspecialist.co.uk/sports-injuries/fat-pad-impingement-hoffas-syndrome

Thanks

[vickster]

I doubt there’s such a thing, maybe a patellofemoral specialist if you have general PF issues

My OS trimmed quite a lot off my *good* right knee back in 2015 as well as tidying up some wear and tear and frayed meniscus, not had any issues with it since.
Certainly not a specialism of his but he does hundreds of knee scopes and replacements a year, only operates on knees.

Clare Robertson is very good and focused on the PF joint, and has a strong point of view on matters related to the fat pad. She often recommends ice massage to the area (she did to me when I saw her a few years back, mine can be a bit swollen just as a consequence of all the wear in my bad knee).

Never heard of Charles Owen but there are a lot of knee surgeons in the U.K.!
Is it this Mr (surgeons in UK are Mr not Dr) Charles Willis-Owen?

https://www.kneeguru.co.uk/KNEEnotes/knee-surgeon/dr-mr-charles-willis-owen

[Limping_Loafer]

I've been to both Claire in Wimbledon and Charles Willis-Owen in Bournemouth and you're in good hands with both of them. From a surgical perspective, I'd say that Charles Willis-Owen is the only person I've come across who understands fat pad impingement as he has had it himself. He delivers cortisone injections differently to standard orthopaedic surgeons and if it's genuinely a fat pad issue, it'll improve under his care. It took me over 10 years to find him and I won't let anyone else touch my knee now. Happy to answer any other questions if I can help at all. 

[Limping_Loafer]

Hi Samiul27, for some reason I'm unable to send you a message via this forum. Anyway, Mr Willis Owen will be able to tell if you have fat pad impingement from an MRI. My fat pad was lit up like a Christmas tree. This was due to the formation of scar tissue following an exploratory arthroscopy 11 years ago which I should never have agreed to. I've had numerous injections in the past but surgeons always refuse to deliver the injection directly into the fat pad due to UK guidelines on how they are supposed to be delivered. Mr Willis Owen understands that in order for the injection to be effective, it needs to be delivered directly into the fat pad. The action of the cortisone will then shrink the fat within the fat pad which will stop it impinging and allow you to get back to your life. I live in Surrey so seeing Mr Willis Owen involves a 4-5 hour round trip journey but it's totally worth it. If your issue isn't fat pad related, I would have full confidence in him finding out what the issue is. He is an elite athlete himself, very personable and you'll feel like you have someone in your corner once you consult with him. I'm so glad I found his details when desperately searching at 3am one morning a couple of years ago. Sorry I can't reply to your message directly. Hope this helps.

[vickster]

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[Samiul27]

Hi Samiul27, for some reason I'm unable to send you a message via this forum. Anyway, Mr Willis Owen will be able to tell if you have fat pad impingement from an MRI. My fat pad was lit up like a Christmas tree. This was due to the formation of scar tissue following an exploratory arthroscopy 11 years ago which I should never have agreed to. I've had numerous injections in the past but surgeons always refuse to deliver the injection directly into the fat pad due to UK guidelines on how they are supposed to be delivered. Mr Willis Owen understands that in order for the injection to be effective, it needs to be delivered directly into the fat pad. The action of the cortisone will then shrink the fat within the fat pad which will stop it impinging and allow you to get back to your life. I live in Surrey so seeing Mr Willis Owen involves a 4-5 hour round trip journey but it's totally worth it. If your issue isn't fat pad related, I would have full confidence in him finding out what the issue is. He is an elite athlete himself, very personable and you'll feel like you have someone in your corner once you consult with him. I'm so glad I found his details when desperately searching at 3am one morning a couple of years ago. Sorry I can't reply to your message directly. Hope this helps.

Think I will send him my MRI beforehand, I live in Yorkshire so its a 10 hour round trip. I think my Patella is too low hence causing stress on medial retinaculum and fat pad.

[Samiul27]

Just come back from an appointment with my OS, he doesn't seem to thinks it's a fat pad issue (nothing showing on MRI) but a prepatellar Bursitis is showing up, opting for an injection to see if that helps, it's really bugging me.

[Limping_Loafer]

How are you getting on now? Hope you're doing better.

[Samiul27]

How are you getting on now? Hope you're doing better.

Not great at the moment issues with swelling,   icing twice a day which helps.

[Limping_Loafer]

Sorry to hear you're struggling with swelling. I'm due to have an arthroscopy to have my fat pad trimmed next week. What's helped me with internal inflammation (no real sign of swelling externally) is wearing an actipatch device https://amzn.to/3uD48K5 I binned the black thing they give you with it and taped it to my knee exactly where I wanted it and left it on for days, just removing it to shower. I also got this https://www.stressnomore.co.uk/catalog/product/view/id/6184/s/handheld-pain-relief-laser-therapy-device-12700/ I'm not sure which one has helped me more, but I think it might be the actipatch. I think I'll know more when I use them post-op. If you want to buy the laser, register on their website, leave it a few days and they start to send you discount codes. My physio has suggested blood flow restriction training post-op to build strength to support the knee. Not sure if you've tried this but it might help you with your recovery. Hope your knee feels better soon. 

[Samiul27]

Sorry to hear you're struggling with swelling. I'm due to have an arthroscopy to have my fat pad trimmed next week. What's helped me with internal inflammation (no real sign of swelling externally) is wearing an actipatch device https://amzn.to/3uD48K5 I binned the black thing they give you with it and taped it to my knee exactly where I wanted it and left it on for days, just removing it to shower. I also got this https://www.stressnomore.co.uk/catalog/product/view/id/6184/s/handheld-pain-relief-laser-therapy-device-12700/ I'm not sure which one has helped me more, but I think it might be the actipatch. I think I'll know more when I use them post-op. If you want to buy the laser, register on their website, leave it a few days and they start to send you discount codes. My physio has suggested blood flow restriction training post-op to build strength to support the knee. Not sure if you've tried this but it might help you with your recovery. Hope your knee feels better soon.

Thanks for the suggestions.
Due to conflicting opinions not even sure its fat pad, no pain or swelling if I'm not active. I've got medial plica irritation, don't know it it has something to do with it. Will try injections to try and calm inflammation, surgery last resort. My current consultant Dr Vladmir Bobic ( very good surgeon) doesn't remove plicas. Might get an opinion from Dr Ian Mcdermott or Tim Spalding.
Keep us updated with your recovery.

[Limping_Loafer]

Just a quick update following my arthroscopy 2 days ago. The suprapatellar plica was somehow involved in the fat pad impingement. I think he said it was tethering it so he has completely removed the suprapatellar plica along with trimming the fat pad on both sides of the knee. Prior to the surgery, we had never discussed the plica. I had the medial plica removed 11 years ago. They grow back. Interesting that your surgeon takes that stance towards their removal. I feel in very good hands with Charles Willis-Owen. He's been in contact by phone and e-mail since the surgery and is also in contact with my physio (whom he suggested as he's had good results with him with fat pad removal patients). He's very keen to give me a good clinical outcome. So different to the surgery I had 11 years ago.

[Samiul27]

Just a quick update following my arthroscopy 2 days ago. The suprapatellar plica was somehow involved in the fat pad impingement. I think he said it was tethering it so he has completely removed the suprapatellar plica along with trimming the fat pad on both sides of the knee. Prior to the surgery, we had never discussed the plica. I had the medial plica removed 11 years ago. They grow back. Interesting that your surgeon takes that stance towards their removal. I feel in very good hands with Charles Willis-Owen. He's been in contact by phone and e-mail since the surgery and is also in contact with my physio (whom he suggested as he's had good results with him with fat pad removal patients). He's very keen to give me a good clinical outcome. So different to the surgery I had 11 years ago.

Glad to hear your surgery went well, what scares me is scar tissue that sometimes forms after these procedures that could cause problems, hope you get well soon. You full weight bearing?
Keep us updated with your progress.

[Limping_Loafer]

4 days post-op now and been fully weight-bearing since day of surgery. No issues there. Had quite bad swelling all down the leg into the foot but that seems to have calmed down now. Quad is also firing nicely but only able to get knee to bend to 90 degrees at the moment and not sure if that's good or not. Scar tissue was definitely an issue after my last surgery but I can see the arthroscopic incisions have been made much lower this time, which I think must be an effort to reduce the effect of any scar tissue build-up. I'm doing the exercises I was given each day and will meet with my physio on Wednesday.