Adhesions? I just disregarded the pain, figuring it would heal in a few daysto a week. Is she seeing a physical therapist or certified athletic trainer? Results of logistic regression revealed that edema of Hoffa's fat pad was one of the most important diagnostic MRI criteria for the diagnosis of Hoffa's fat pad impingement. Mechanical and sharp debridement can be painful. My thoughts: You problem does sound intra-articular (inside the joint) like a swelling or meniscus issue. However I cannot bend the leg (heel to bum) much at all. Also, patella mal-tracking has been linked with Hoffa fat pad impingement, especially in younger patients (Subhawong et al., 2010). Thank you for all of the informative responses you have given other peoples questions, but I have a few unique ones of my own. The MRIs show mild chondromalacia patellae and the bone scan shows increased uptake in both patellae. 5. Helpful read, thanks! But it seems like some imaging would tell us for sure whether there is anything else going on. Materials and methods: 6 yrs after your injury is a long time so Im sure you have been compensating for the pain and limited range of motion of your knee. Limited arc knee extensions will do it as long as that arc is pain-free. I have constant over rotation from being so imbalanced and now I suffer from super bad sciatica. However should this also cause my knees to cluck/pop when moving. we need him on the mend asap (the weed eating really needs to get done!) I take turmeric, and flax seed oil to help with inflammation and ice is definitely my best friend. 2023 Jan 1;13(1):352-369. doi: 10.21037/qims-22-368. Keep me posted Janene. surgery.ucsf.edu/conditions--procedures/debridement.aspx, northwell.edu/plastic-surgery/procedures/debridement-for-chronic-wounds, winchesterhospital.org/health-library/article?id=2010813272, kaminskidental.com/images/Post_Op_Instructions_After_Full_Mouth_Debridement-20146.pdf, intermountainhealthcare.org/ext/Dcmnt?ncid=520684503, facs.org/~/media/files/education/patient%20ed/wound_surgical.ashx, Everything You Should Know About Avascular Necrosis (Osteonecrosis). Surgical sharp debridement is also used for large, deep, or very painful wounds. Ive had two surgeries now to remove plical folds that the surgeon told me were irritating the fat pad. I totally agree with you about the surgery iv heard once your cut its never right again. Get a PT who knows this injury very well This is a tough rehab to do on your own. Im not a fan of putting a needle into an injury but I think it might be well merited for your chronic injury with a long record of rehab and many factors which increase your symptoms. Getting a steroid injection followed by simple treatment to regain knee ROM and patella mobility is a top priority. Also, I do not seem to have much movement and cannot tense my leg muscles at this stage. I think it will do well with a physical therapist monitoring your healing. The problem is my job requires me being on my feet most the day:( Do my symptoms seem to match up with fat pad ? Really desperate and scared any advice? Look for a local college or sports team to help you. ; It can become hypertrophic and may become impinged between the patella and the femoral condyle, causing sharp pain when the . 4. I could drive her and could get her crutches. Severe pain, an antalgic block, and defensive behavior are considered diagnostic of fat pad impingement. Patella mobilizations and massage are needed asap to keep the knee plica from scarring down just as tight as it was before the surgery. Restore full knee extension and 90% of knee flexion. I could not straighten my leg for 6 months. Mike. My PT doesnt feel fat pad is very irritated. The procedure is useful if you havent had a dental cleaning for several years. Hi Jacob, Yes, you need to completely rest your knees in a position of about 30 degrees of flexion with pillows behind the knees. This will determine the physical evaluation required. Arthroscopic resection of fat pad lesions and infrapatellar contractures. None of these cause sharp pain but do sometimes cause swelling and/or dull, mild aching. Will I get movement and range of motion back or will I never use aga? Tips to help: Use a hard roller daily, get daily patella mobilizations and stretch your ITB. Help Please, I was diagnosed with Hoffas syndrome in my right knee which I was advised that the inflammation is on the lower right side if im looking down. I started to have a knee inflammation 7 months ago and managed to calm down the inflammation after a couple of months. An injection might be an option. I strongly suggest a solid 4-6 weeks of physical therapy before going he way of surgery. I suggest you find an orthopedic doctor who works with lots of runner and who knows this injury VERY well. Im thinking of just avoiding knee strikes on hard surfaces as I think thats what did my knee. What activities can I do to stay in shape that will still allow the fat pad to heal? Mike Ryan, PT,ATC. They didnt know the cause so I asked/ gave permission for them to take a look. Im due to go on holiday in 3 weeks time and really need to be able to walk (gently) for an hour or so at a time. Get with a rock-solid PT who can help with little things like patella mobilizations, proximal fibular mobs, soft-tisse release of your patellofemoral ligaments,..etc. I had alot of pain and tried to get back to Running, but couldnt. We will talk soon and Id be happy to help you turn the corner. Autolytic debridement uses your bodys enzymes and natural fluids to soften bad tissue. The IFP is found in the anterior knee compartment as a mass of adipose tissue that lies . And after six years should surgery be the first option? Taping can be effective in helping alleviate the pressure of the kneecap on the fat pad. Is there anything else you can recommend other than stretching, strengthening, and foam rolling? Now the pain and swelling are back. In complex fat pad impingement cases, we suggest you speak to your doctor about a cortisone injection to help with rehab. Sometimes it can hurt when the dressing is changed. Avascular necrosis (osteonecrosis) is a condition that affects your bones. Thanks again for the info, I had never even heard of a fat pad before today! I wish this article was out sooner! Best to you Hans. sharing sensitive information, make sure youre on a federal The fat pad is a normal structure but it can sometimes become a problem: It can become damaged and painful; It can be deliberately removed at arthroscopic surgery to make it easier for the surgeon to see what they are doing - but this can also lead to scarring and pain. the only thing that seems to stop the pain when Im trying to sleep at night is to put a pillow under my knee (but I have been told this is a bad thing to do) I keep taking pain killers but its not solving the problem. However now 2 months on I really struggle to bend the knee from a lying position as it feels it will lock. I cannot even perform basic household tasks or walk much anymore, let alone the running, snowboarding, and other athletic activities I used to do. For example, if shes not full weight bearing (FWB) she needs to be working on her quad strength and knee range of motion to prepare her entire leg to be ready for the rigors of walking. Thanks Mike, I talked to my doctor and he changed the brace to an unlock giving more motion and has me doing walks in the evening which has lessened my pain when I try to bend!! Try doing it in a 45-90 degrees of flexion to see it is allows for more motion when it thaws out. I have pain only when my knee touches the floor.. Thats a great Q to ask your doctor. Can I ask how you found a surgeon to help you with this condition, or who you actually saw? This site needs JavaScript to work properly. That helps restore normal motion of your knees to maximize the opportunity to put normal stress on the tissue around the knee. She dealt with 8 doctors and countless rounds of physical therapy before we found a wonderful doctor who understood that fat pad impingement is about inflammation and turmeric reduces inflammation. Remained is activities triggered pain. Never long distance as knees wouldnt let me. I have had chronic knee pain for the better part of six years that all started by my right knee giving out rounding third base in softball. He said the best way to fight against hoffas fat pad issues was to break the tissues and therefore worked on it by putting high pressure on my fat pad area. It has been termed Hoffa's Syndrome as but can also be known as fat pad impingement. Did your PT have you using a hard thigh roller? Based on the factors you explained, here are my suggestions: I had recent MRI which shows a continued inflamed and scarred fat pad. What should I be expecting roughly and what should I be doing? Found this article so helpful thank you!! Pain-free quad strength work. Is surgery the answer? Things you can do to help your Hoffa fat pad injury: This pain often responds to non-operative measures but may require surgery. Can someone explain what this means. In september i had arthroscopic surgery on my left shoulder. Keep me posted and fast healing. Knee Surg Sports Traumatol Arthrosc. 1. Ive been told I need to accept that the knee is not normal and I may not be able to do things like Run. My quad muscles are gone and I have been trying to build them but everything is so painful-should I just push through the pain or can you suggest anything else I should try? Ive read through most your responses listed above. Orthopaedic Clinic | Sports Medicine | +65-683 666 36, A Rare Form of Soccer Injury Rectus Femoris TendonRupture, Horizontal Cleavage Tear (HCT) of Meniscus with MeniscalCyst, Surgical Treatment of Chronic Proximal Rectus FemorisRupture, Treatment of Osteoid Osteoma of theFemur, Peroneal Longus Tendon Tear A Cause of Lateral AnklePain. Make sure you have very flexible quads on both legs, mobile kneecaps and you use a roller 2x/day. The pain feels deep and explosive. Specialist sent me to head physio as second opinion as he couldnt understand without going back in, head physio just said push through and attend gym every day for 6 months until strong again.. Muscle strengthening exercises to maintain the strength and fitness of the surrounding muscle groups. In some cases, new and severe wounds may need debridement. Increase your quad strength WITHOUT increasing your knee symptoms. Also, if a specific surgeons name cannot be mentioned here, please email me at amanda.papili@ymail.com. The thermal impact is deeper with ice massage and the max time of the treatment is 10 Minutes. Im quite annoyed Im in the dark and having to read up and frankly ask you. Everyone with this injury feels that b/c few medial specialists appreciate the limitations and pain associated with fat pad impingement. 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