Hyper trophic inflamed Hoffa's fat pad (knee problems!)

I have been having a problem with my knee since October, on my commute home I had a crippling pain in my right knee, it was so bad I couldn’t pedal. The pain was so bad I coHyper trophic inflamed hoffas fat pad. ldn’t even pedal with my left leg and just let my right follow the pedal round, Long story short I ended up having to be picked up by the girlfriend.

I rested up for 2 weeks and went out again on the mtb. I made it a mile before the pain came back. I rested and iced for another 6 weeks tried again and the pain was still there. I went to see my gp who referred me to physio. He prescribed support insoles, leg exercises, more ice and stretching. This made things worse over the Christmas break. Finally in early February I managed to get on the bike and ride up a hill with no immediate pain, however there was still some discomfort by the time I got home.

Last week I got sent for an MRI finally after the physio said he couldn’t do anything else for me. The results came through today and the results are I have something called Hyper trophic inflamed hoffas fat pad and I am being referred to the hospital for an arphroscopy.

Has anyone else been through similar, and got any experience of the procedure?

Could be a long reply this one !

Late 2011 I came back from a winter cycle with a swollen knee. First time ever & no previous injury. The physio at FASIC in Edinburgh diagnosed tendinopathy in the patellar tendon & gave me eccentric exercises to strengthen the tendon. The exercises were done on an incline block to isolate the calf muscle. Cut to several months going backwards & an MRI later, I was having difficulty walking. The (private) consultant was convinced he could help things with an arthroscopy into the knee joint itself. The advice was also that the exercises I was doing were likely to causing more problems that they had solved. They place an immense amount of stress on the tendon & should be done under supervision.

Basically the arthroscopy achieved nothing. The inside of my knee was in excellent nick & all the had been removed was a miniscule “tuffet” of fibres from the periphery of one meniscus. It was approx one mm across & was nowhere near any of the articular surface.

So, six weeks off work (saturation diving) & getting on for six months off the bike, I got a private appointment with the ex British cycling team doctor. This was done through a friend & was the best money I’ve ever spent. At this point in time things were getting better & walking was no longer a problem

His diagnosis was that the likely explanation going on his (lengthy) examination & the MRI was that the fat pad was inflamed. His advice was to get back on the bike & see how things went. He said there is a procedure to reduce the fat pad via arthroscopy. However he advised that this was an absolute last resort as you could easily replace one set of problems with another IE scar tissue.

Three years on & I’m still aware that it’s not 100% For most activities I experience only minor discomfort. Pushing big gears can really set things back. This I simply now avoid doing. It’s an easy workaround.

The overriding message was to avoid surgery if at all possible because this can lead to further & potentially more serious complications. Possibly followed by the temptation of trying to sort this with more surgery.

I’d look into your problem exhaustively & if you must have surgery make sure the surgeon has done the exact procedure before. Don’t be afraid to ask for a 2nd opinion. It’s your knee.

D.

Surgery?? Surprising when fat pad inflammation can be dealt with by a cortisone injection..

As said above, I’d avoid surgery until its the last absolute resort..

Davesport thanks for the lengthy reply it is much appreciated and similar to you my problem came on with no previous issues, I’m making my appointment to go see the consultant tomorrow and if I don’t like what he says I won’t hesitate to go somewhere else. I’m really hoping to avoid surgery if I can and am going to enquire into the cortisone injections to find out if they are viable and I’m also going to ring and speak to the physio I’ve dealt with as he has also just been through knee problems. I’m 5 and a half months off the bike already so waiting a bit longer is no extra hardship right now, and I’d rather things were right!

Dave did you ask the ex British cycling doctor what he would have recommended if he had seen you first? And initially did yours feel fine when you were off the bike? Mine was weird when it initially occurred as I couldn’t pedal but walking was no real problem!

Not so sure on your fat pad procedure. But I had two knee arthroscopies last year. One was just a washout and look round. I was back to work and back on the bike within 3 weeks. Second time was for a menisectomy and to treat a ostechondral lesion on my articular cartilage. Spent 4 weeks nwb, two weeks own with a brace then two weeks with just the brace.

Every recovery is different but I wouldn’t be worried about an arthroscopy. First one took 40 mins, secon one about an hour and a half.