Fat Pad Removal?

maurice41 · Post by **maurice41** » Thu Jan 10, 2008 4:55 am

Hello everyone, my name is Sean.

I have been a lurker on here for about a year now (since my knee pain started). At first I put it off and was still going about with my normal training schedule. Months went by and the injury built up until I couldn't run anymore. I then went to the doctor.

After countless PT sessions and 3 different doctors it has finally come to arthroscopic surgery. The doctors said I have a fat pad impingement in both of my knees and patellar maltracking. These injuries have completely side tracked my life because I was going into the Army in July and it is now December and still their is no change in my condition.

I was using the search button but couldn't find the answer to some questions of mine. They are....
1. After the surgery can I still resume my regular training (ex. running, conditioning, etc.)?
2. Will their be a greater chance of an injury to other parts of my knee and what could it feel like after the surgery (speaking in long term)
3. Since I have read that the fat pad absorbs shock that your knee takes. Is high impact activities a no? Does it depend on the amount of the pad that is removed?
4. Is it one of those things in your body that if you remove it it wouldn't make a difference?

Thank you everyone, this board has been a real help since I started lurking and I am anxious to soak in more info. I'm not to familiar with knee anatomy so I will probably go back to lurking again.

Respectfully,
Sean

tanyap · Post by **tanyap** » Thu Jan 10, 2008 12:50 pm

Hi Sean,
welcome and im glad you decided to post instead of lurk

I lurked for a while too - I think a lot of us do!!

Im sure you dont want to hear this - but really your OS will be the person to answer these questions for you - you see it depends on what exactly they do during the scope (arthroscopic) surgery. Personally I dont know much about fat pads. But I do know some about patellar maltracking.

What are they planning on doing during the surgery - or do you know yet? Are they going to treat both the fat pad impingement and the maltracking or just one or the other?

The key to recovery in any knee surgery is good strong muscles beforehand and a good approach to rehab afterwards. You say you have had countless PT sessions - over what period of time? I had a year and a half of PT most recently while my problem got worse because the wrong exercises were prescribed and not targeting the right muscle. Im now 7 months into a new physio program and starting to see results.

Regards
Tanya

maurice41 · Post by **maurice41** » Thu Jan 10, 2008 1:32 pm

Thank you for the welcome tanyap.

My OS said that he will most likely remove my fat pad. He still hasn't said if he is going to remove the whole thing or just partial. I don't think the maltracking is a serious enough problem for a scope but I guess that is for the doctor to determine. It's minor.

I was curious to what peoples experiences were post-op. That's why I brought up the questions. I make sure to talk to the doc.

I was in a similar situation to what you experienced. My first doctor thought it was a torn meniscus and inflamed hamstrings. The second thought it was because of flat feet and gave me orthotics. That made it worse. Third is my current OS and he doesn't seem like a quack.

. I was sent to rehab by all three doctors. The first two ended up making my condition worse me targeting the wrong muscles. It totaled to about 6-8 months of rehab.

Respectfully
Sean

tanyap · Post by **tanyap** » Thu Jan 10, 2008 1:41 pm

Hi Sean,
perhaps if you make a thread titled Fat Pad Removal people who have had it done will see it and be able to advise you more?

Its such a pain when the docs try diagnosis after diagnosis and things are getting worse as you try rehab and the wrong muscles are targeted - meanwhile things get worse etc....
You did the right thing by going to different OSs til you found someone you are comfortable with.

The best advice I can give you as regards questions for you OS is to ask him exactly what the goals are after surgery and what you will be able to do compared to before you had any knee problems. There is no point in you going in thinking that you are going to be 100% and have full function while the OS thinks differently - you both need to be singing off the same hymn sheet as it were. I know I was unaware of the limitations that I would have after my surgery - but I was only 14 or 15 years old at the time so I didnt fully understand what was going on. Even now at 33 I can find it hard to understand what the medical people mean sometimes, they can talk over peoples heads without meaning to.

In the meantime perhaps you can try to educate yourself a bit more about knees from this website or some google searches - if you understand some of the medical terms it can make it easier to know what the OS is talking about.

Do you have a surgery date scheduled yet?
Tanya

maurice41 · Post by **maurice41** » Thu Jan 10, 2008 2:18 pm

Tanya, I have no surgery date set yet. I am getting an MRI saturday morning. Then it's back to the doctor to hear the word and then a date for the scope. I'll try and keep updates while it develops.

Luckily, my OS explains everything to me like I'm in the third grade or something.

tanyap · Post by **tanyap** » Thu Jan 10, 2008 3:52 pm

well the more you hang around this website the more you will learn and find out what questions to ask etc...

i like when OS's explain that way - last time mine started drawing pictures to illustrate his points

Good luck with your MRI on saturday - last time I had one I fell asleep in the machine.

Audice · Post by **Audice** » Thu Jan 10, 2008 8:35 pm

tanyap wrote: ...last time mine started drawing pictures to illustrate his points

Tanya ~ Your doctor's illustrations brought to mind what my OS did. He pulled out a model of the knee to show me where I had missing and/or torn parts. But he looked at me in surprise when I started to laugh. I explained I'd been a teacher & had that same model which I'd used for eons to show kids how the knee worked.

Sean - good luck to you with that MRI. Hopefully it'll get to the bottom of the problems...Ellie

tanyap · Post by **tanyap** » Thu Jan 10, 2008 9:28 pm

even better was when mine explained different grades of arthritis to me and pointed at my boyfriends spiky hair saying 'youre not that bad yet - thats what i call the bart simpson grade'

Post by **The_KNEEguru** » Fri Jan 18, 2008 9:14 am

Hi
Sean, it is very easy to understand how frustrated you must be. Patella-related problems are not easy to diagnose or to manage, but I think that you should use this board to educate yourself before you submit yourself to surgery.

It would be very helpful if you outlined for us exactly how the problem started, what you were experiencing and where, and what brought it on. Also what regime of exercise you have been doing and how extreme the exercise. Then what investigations have been done, and when. (You can use the 'signature' part of your profile to briefly list this for our reference).

There is a suite of tutorials on the site that you may have read - http://www.kneeguru.co.uk/KNEEtutor/dok ... _pf_pain01 - which will give you a good background to why it is not easy to evaluate the patella. Many of the symptoms are inter-related, so for example anterior knee pain can cause quads inhibition which can then aggravate the lateral tracking.

I am going to see if I can find some useful articles for you about fat pad surgery.
KNEEguru

Post by **The_KNEEguru** » Fri Jan 18, 2008 9:53 am

A fat pad ('infrapatellar fat pad of Hoffa') that is so enlarged that it is being nipped and causing symptoms is called 'Hoffa's disease' or 'Hoffa's syndrome' (http://www.sportsinjuryclinic.net/cyber ... gement.htm).

This 2004 article from a respected centre in Oxford, UK -
http://www.ncbi.nlm.nih.gov/pubmed/1522 ... d_RVDocSum

concludes -

1. The fat pad of the knee is commonly injured but rarely discussed in the radiological (X-ray/MRI) literature.

2. Abnormalities within the fat pad are most commonly a result of direct injury but there can also be inflammatory disorders and tumours of the synovium (the fat pad may contain synovial cells - cells that line the inside of the knee joint)

3.Arthroscopy is the commonest cause of trauma (direct injury) to the fat pad!

4. Other causes of trauma include posterior and superior impingements - where the fat pad is too big it can get caught in the joint at the top of the fat pad (superior) or at the back of it (posterior).

5. The fat pad can also be damaged in patellar dislocation.

6. Trauma to the fat pad can also damage the Infrapatellar plica that is a normal anatomical structure posterior to it.

7. You can get cysts in the fat pad (fluid filled pockets). No-one really knows the cause of this, but they can sometimes be confused with a cyst of the meniscus or cruciate ligament.

8. Tumours (growths) in the fat pad may occur (rarely) from synovial cells within the fat pad tissue, and these tumours can sometimes be nasty.

9. The posterior border of the pad may also become inflamed and may cause increased joint fluid (effusion)

Post by **The_KNEEguru** » Fri Jan 18, 2008 10:25 am

This article from the University of California -

http://www.ncbi.nlm.nih.gov/pubmed/9153 ... stractPlus

says that -

1. The fat pad can be seen on any routine MRI scan

2. Problems related to the fat pad are not uncommon

3. Problems affecting the fat pad can arise from within the fat pad itself (eg Hoffa disease, intracapsular chondroma (a tumour of cartilage cells), localised nodular synovitis (inflamed synovium), postarthroscopy and postsurgery fibrosis (scarring), and shear injury) , or the fat pad can become secondarily affected by many other problems within the knee joint. (my emphasis)

Post by **The_KNEEguru** » Fri Jan 18, 2008 11:11 am

In this 1998 paper from Italy we can learn -

http://www.ncbi.nlm.nih.gov/pubmed/9676 ... d_RVDocSum

1. The characteristic symptom of Hoffa's disease is chronic ('going on for a long time') anterior knee pain mostly under the patella. It is more of a discomfort than a sharp pain. The knee may feel weak and sometimes swell.

2. If the knee has been damaged in an injury with Hoffa's pad rupture-detachment then the pain may be acute ('coming on suddenly), the functional impairment may mimic a ligament injury, and the knee may be very swollen with blood in the joint fluid.

3. In testing for Hoffa's disease, one tries to elicit a 'Hoffa's sign ' which is highly specific. The examiner applies pressure to the margins of the patellar tendon when the knee is bent, and maintains the pressure while the knee is straightened. In a positive result this causes a sudden severe pain and the patient refuses to keep on straightening the leg.

4. MRI is good for showing the fat pad, unlike arthroscopy where it cannot be clearly seen because it is usually behind the light source and instruments.

Post by **The_KNEEguru** » Fri Jan 18, 2008 11:19 am

This article from respected authors in the UK says -

http://www.ncbi.nlm.nih.gov/pubmed/8718 ... stractPlus

1. An injection of local anesthetic and steroid into the fat pad itself helps to decide if the fat pad is implicated in the pain that the the patient is experiencing. If it is then it will cause a transient relief of symptoms.

2. Fat pad pathology is usually secondary to other knee joint problems, and its primary involvement is rare. (My emphasis)

Post by **The_KNEEguru** » Fri Jan 18, 2008 11:22 am

Is there any chance you can type in your MRI report here?

maurice41 · Post by **maurice41** » Fri Jan 18, 2008 2:38 pm

Kneeguru,I can't tell you how much those articles have helped. Thank you very much.

The OS does think that I have some pinched synovial tissue in my knee and slight fluid. He says it is caused by other problems in my knee such as mal tracking and possibly flatfeet. The fat pad was not swollen though. All the cartilage, meniscus and everything was healthy. He thinks it is not serious enough condition to do surgery on, though it is hard to walk if I do something physical or am at work all day.

The Hoffa's test seemed like it didn't work. I felt no pain on either side of the patella. The pain is at the bottom tip of the patella. It's absolute agony when I straighten my leg to it's fullest.. It feels weak and unsupported like you said. The cortisone shots did not provide any type of relief unlike what the report said

Fat Pad Removal?

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