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Hey @gmj1892,This sounds similar to my situation. I had a plica removed (as well as a bit of other work done) on 22nd of July, so coming up 10 weeks. I had swelling up to around week 8 – which was limiting my range of motion. Only in the last week I have got full extension and flexion is still around 90 degrees, so still got a lot of work to do here.I also have a sharp medial pain in the same area that you described that I didn’t had previously – in addition to this I have a constant pulsating feeling in the front of the knee, occasional sharp pain behind the knee and a burning/hot sensation over the knee cap most evenings. This is has all started since surgery. I told the OS about all this at the 8 week telehealth follow up appointment – he is hoping it is all just ‘healing pain’ and wanted me to give it another 4 weeks, if its no better (12 weeks post surgery) he will look at further treatment. I haven’t had any real improvement in the last 2 weeks.Its very frustrating to not get the results, have been seen physio and doing exercises daily. Surgery was my last resort after 8 months of living on pain killers, still having to take pain killers (for the new pain) is quite annoying. Interested to see how you are getting on…
Have you been encouraged to massage the area where the portal scars are? The sort of deep massage that can break up scar tissue? I had this and a steroid injection if placed correctly can really help. The impingement left me with palpitations on the affected side of the knee and constant low-level pain. Does that sound similar to what you've got? Everyone's different in how their body responds to a surgical procedure and it turns out my body responds by creating a lot of scar tissue. Sounds like your surgeon is on top of this and an injection will help to break up the scar tissue and you'll be on your way to a full recovery. Best of luck with it.
I'm a bit further down the line to you, but when I was where you are I would have loved to have been seeing my current OS. The people I was seeing when I was where you're at had no real clue about fat pat impingement, so they ended up causing further damage to my knee which was completely avoidable. Might be that your OS has brought you as far as he's able to. You could let him administer a steroid injection, but its placement is critical. If he puts it in the knee joint then it will be pointless and won't help. It needs to go into the fat pad and where the portal scar tissue has built up. If it's put in the right place, then you'll feel a difference within a couple of weeks. To be honest, I last ran before my first arthroscopy in 2011 and haven't been able to run due to my left knee since then. I do other things now to remain fit and active. After a poorly placed steroid injection didn't help (how could it?) my team got a bit creative and put my knee through various things which served only to damage it further over the years. Pair that with numerous physios who said they understood fat pad impingement when they didn't, and all these people go on with their busy lives while ours remain blighted. Well, after many years I found Charles Willis Owen who practices in Bournemouth, and he really helped get me back on my feet and be pain free for the first time in years in 2018. I was in a bad way when I first met him, on crutches and limping and generally struggling. I made him read my 10-page knee history and when he came to get me for my appointment he informed me that it sounded like textbook fat pad impingement straight away. He's had this condition himself and is an elite athlete and all-round good bloke. Fast forward a couple of years and a few silly things happened. I walked into a coffee table and hit the knee right on the fat pad (my proprioception is quite poor on that side due to all the issues over the years). Another steroid injection got me back on my feet again. An accident where my knee hit my car's steering column presented further issues and again, he got me back on my feet and out of pain within a few short weeks. Then I started working with a trainer and kept mentioning how fragile my knee was. I sounded like a broken record, but the knee was coping with all the exercises I was asked to perform. On our fifth session I was asked to do some low jump squats and I knew it was risky but as the knee was doing so well, I gave it a go. Very bad decision. This was in June and my knee deteriorated over 3 days and I haven't been able to walk since then. Charles gave me two large injections to try and help me with it (he only wanted to give me one, I had to persuade him to give me the second one as he felt it wouldn't help and he was right). This left us no option but to proceed to surgery. I had to wait 3 months for this as the steroid injections lower the immune system and increase the risk of infection. I had a bilateral fat pad trim and suprapatellar plica removal last Wednesday and was doing really well until a couple of days ago when I had my first physio session. He got me to do some deadlifts and raised leg bridges and calf raises and also wiggled the kneecap around a bit to check (I assume) there were no adhesions and it was free to move. I have no idea which one of those things unleashed holy hell but by 11pm on Wednesday evening I was in 10/10 pain which lasted until 1pm the next day (no sleep). GP and pain specialist (who I see every 6 months for facet joint injections due to facet joint arthropathy caused by gait changes due to the knee pain over time) came up with a plan and I'm now taking high doses of morphine 4 times daily along with paracetamol, naproxen and pregabalin, just to get me through this flare. I will no longer listen to anyone, regardless of their qualifications, when it comes to my knee. I know what’s best for my knee. My surgeon hand-picked this physio, as his patients have had good results with him in the past, but that doesn’t make him an expert on my knee. I hope you can benefit from my experience and avoid my pitfalls. If you get the injections now, then just be careful with the knee going forward. Once you’ve had fat pad impingement, you are susceptible to it again so need to do everything in your power to ensure you don’t place the knee in a position where it is likely to become impinged again. Best of luck to you and hope you can soon run pain-free again.
Quote from: GeorgieR on September 27, 2021, 05:50:19 AMHey @gmj1892,This sounds similar to my situation. I had a plica removed (as well as a bit of other work done) on 22nd of July, so coming up 10 weeks. I had swelling up to around week 8 – which was limiting my range of motion. Only in the last week I have got full extension and flexion is still around 90 degrees, so still got a lot of work to do here.I also have a sharp medial pain in the same area that you described that I didn’t had previously – in addition to this I have a constant pulsating feeling in the front of the knee, occasional sharp pain behind the knee and a burning/hot sensation over the knee cap most evenings. This is has all started since surgery. I told the OS about all this at the 8 week telehealth follow up appointment – he is hoping it is all just ‘healing pain’ and wanted me to give it another 4 weeks, if its no better (12 weeks post surgery) he will look at further treatment. I haven’t had any real improvement in the last 2 weeks.Its very frustrating to not get the results, have been seen physio and doing exercises daily. Surgery was my last resort after 8 months of living on pain killers, still having to take pain killers (for the new pain) is quite annoying. Interested to see how you are getting on… Hi Georgie. Sorry to hear about your problems. I can certainly empathise with your frustration at surgery providing you with more issues - that's not what we went under the knife for!Good to hear you've made progress with flexion and extension. Hopefully once they're back to normal other things will start to improve for you. Unfortunately, and somewhat curiously, my medial knee pain has persisted even after regaining full flexion/extension and strengthening surrounding muscles back to pre-op levels. My physio seems a bit nonplussed by why I'm having so many ongoing problems despite being very quick with the rehab, and my knee being in good structural condition.Like you, my OS advised me to wait until around the three-month mark before further treatment. Perhaps the injection will be mentioned as a possibility for you too? My knee is sadly in the same state as before so I'm waiting about 3 more weeks before seeing my OS again. Keep me updated with your recovery, and best of luck.
How would you describe the main symptoms of fat pad impingement in your case? My OS did use the word 'impingement' but didn't specifically mention the fat pad. I've read about it online and it seems like the pain is typically felt at the front of the knee below the kneecap. My pain is actually on the medial side above the arthroscopic portal, under which the scar tissue is obvious to the touch. I'm therefore not sure if fat pad impingement is what I'm suffering from, although perhaps the symptoms are more varied than the internet makes out
Quote from: gmj1892 on October 12, 2021, 10:38:03 AMQuote from: GeorgieR on September 27, 2021, 05:50:19 AMHey @gmj1892,This sounds similar to my situation. I had a plica removed (as well as a bit of other work done) on 22nd of July, so coming up 10 weeks. I had swelling up to around week 8 – which was limiting my range of motion. Only in the last week I have got full extension and flexion is still around 90 degrees, so still got a lot of work to do here.I also have a sharp medial pain in the same area that you described that I didn’t had previously – in addition to this I have a constant pulsating feeling in the front of the knee, occasional sharp pain behind the knee and a burning/hot sensation over the knee cap most evenings. This is has all started since surgery. I told the OS about all this at the 8 week telehealth follow up appointment – he is hoping it is all just ‘healing pain’ and wanted me to give it another 4 weeks, if its no better (12 weeks post surgery) he will look at further treatment. I haven’t had any real improvement in the last 2 weeks.Its very frustrating to not get the results, have been seen physio and doing exercises daily. Surgery was my last resort after 8 months of living on pain killers, still having to take pain killers (for the new pain) is quite annoying. Interested to see how you are getting on… Hi Georgie. Sorry to hear about your problems. I can certainly empathise with your frustration at surgery providing you with more issues - that's not what we went under the knife for!Good to hear you've made progress with flexion and extension. Hopefully once they're back to normal other things will start to improve for you. Unfortunately, and somewhat curiously, my medial knee pain has persisted even after regaining full flexion/extension and strengthening surrounding muscles back to pre-op levels. My physio seems a bit nonplussed by why I'm having so many ongoing problems despite being very quick with the rehab, and my knee being in good structural condition.Like you, my OS advised me to wait until around the three-month mark before further treatment. Perhaps the injection will be mentioned as a possibility for you too? My knee is sadly in the same state as before so I'm waiting about 3 more weeks before seeing my OS again. Keep me updated with your recovery, and best of luck.Hey gmj1892, Yes is very frustrating to have continual pain after surgery, especially when it is a minor procedure like an arthroscopy. I saw the OS again a week ago (12 weeks post op). As soon as he assessed the knee he said there is definite inflammation and scar tissue. Range of motion still isn’t 100% which he said is likely because of the scar tissue blocking movement. He did a cortisone/ local anaesthetic injection. Up till today it felt no different. But today I think there may be slight relief, straightening and bending the knee is definitely easier, medial pain is still there but a little easier to tolerate. The OS wants me to get ROM back asap before the scar tissue matures. Fingers crossed we’re on the right path now.Sorry to hear your pain is just as bad as post surgery, constant pain is very frustrating and tiring. Sure hope they manage to get it under control for you soon.Interested to hear how you are doing.
Quote from: gmj1892 on October 17, 2021, 01:14:23 PMHow would you describe the main symptoms of fat pad impingement in your case? My OS did use the word 'impingement' but didn't specifically mention the fat pad. I've read about it online and it seems like the pain is typically felt at the front of the knee below the kneecap. My pain is actually on the medial side above the arthroscopic portal, under which the scar tissue is obvious to the touch. I'm therefore not sure if fat pad impingement is what I'm suffering from, although perhaps the symptoms are more varied than the internet makes outThe pain when I had it was sometimes just overall pain in the whole knee area and beyond (probably not very helpful). It was mostly gnawing pain that was quite exhausting. It was never sharp. I was unable to put my heel on the floor at all as this would bring about the pain, however, I could actually walk on the ball of my foot quite happily. I always found that odd. The pain from the last episode of impingement was purely lateral so I know that's where the impingement was. I've never felt any scar tissue anywhere. The problem is that surgeons put the portals where the fat pads are so you're likely to have scarring in them as a result of an arthroscopy. I can see now that my surgeon has put the portals lower down this time to help avoid this issue in the future. Saw my surgeon yesterday as I'm now 2-weeks post op. Off all pain meds. The flare lasted a full 5 days. Was quite restricted with my ROM including struggling with full flexion until seeing the surgeon and he gave me 2 exercises to do which have got me into full flexion over a few hours and improved my range of motion a bit too. All that sliding my knee towards me on the floor wasn't getting me anywhere so he's got me dangling my feet over a table and swinging them to encourage ROM and it's working but I'm still only at around 95 degrees. He seems happy with that though. I won't be returning to physio for a few weeks until I'm completely happy that things are progressing well.
Quote from: GeorgieR on October 20, 2021, 11:32:12 PMQuote from: gmj1892 on October 12, 2021, 10:38:03 AMQuote from: GeorgieR on September 27, 2021, 05:50:19 AMHey @gmj1892,This sounds similar to my situation. I had a plica removed (as well as a bit of other work done) on 22nd of July, so coming up 10 weeks. I had swelling up to around week 8 – which was limiting my range of motion. Only in the last week I have got full extension and flexion is still around 90 degrees, so still got a lot of work to do here.I also have a sharp medial pain in the same area that you described that I didn’t had previously – in addition to this I have a constant pulsating feeling in the front of the knee, occasional sharp pain behind the knee and a burning/hot sensation over the knee cap most evenings. This is has all started since surgery. I told the OS about all this at the 8 week telehealth follow up appointment – he is hoping it is all just ‘healing pain’ and wanted me to give it another 4 weeks, if its no better (12 weeks post surgery) he will look at further treatment. I haven’t had any real improvement in the last 2 weeks.Its very frustrating to not get the results, have been seen physio and doing exercises daily. Surgery was my last resort after 8 months of living on pain killers, still having to take pain killers (for the new pain) is quite annoying. Interested to see how you are getting on… Hi Georgie. Sorry to hear about your problems. I can certainly empathise with your frustration at surgery providing you with more issues - that's not what we went under the knife for!Good to hear you've made progress with flexion and extension. Hopefully once they're back to normal other things will start to improve for you. Unfortunately, and somewhat curiously, my medial knee pain has persisted even after regaining full flexion/extension and strengthening surrounding muscles back to pre-op levels. My physio seems a bit nonplussed by why I'm having so many ongoing problems despite being very quick with the rehab, and my knee being in good structural condition.Like you, my OS advised me to wait until around the three-month mark before further treatment. Perhaps the injection will be mentioned as a possibility for you too? My knee is sadly in the same state as before so I'm waiting about 3 more weeks before seeing my OS again. Keep me updated with your recovery, and best of luck.Hey gmj1892, Yes is very frustrating to have continual pain after surgery, especially when it is a minor procedure like an arthroscopy. I saw the OS again a week ago (12 weeks post op). As soon as he assessed the knee he said there is definite inflammation and scar tissue. Range of motion still isn’t 100% which he said is likely because of the scar tissue blocking movement. He did a cortisone/ local anaesthetic injection. Up till today it felt no different. But today I think there may be slight relief, straightening and bending the knee is definitely easier, medial pain is still there but a little easier to tolerate. The OS wants me to get ROM back asap before the scar tissue matures. Fingers crossed we’re on the right path now.Sorry to hear your pain is just as bad as post surgery, constant pain is very frustrating and tiring. Sure hope they manage to get it under control for you soon.Interested to hear how you are doing.Hi Georgie,Glad to hear your OS was at least able to make a straightforward diagnosis. How is the knee now a couple of weeks on from the injection? Has it provided lasting improvement, or have the positive effects faded? And did your OS tell you the injection could help to shrink the scar tissue, or was it more about just providing pain relief? Would be interested to hear your experience. Hopefully you've continued to make progress since your last post.I'm going back to my OS a week today, so will report back then. I'm pretty sure he will proceed to the injection, which I'm hoping will solve my problems once and for all but am naturally sceptical about!Take care,Greg