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Fat Pad Impingement/Hoffa’s Syndrome
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I have searched the forum but was unable to answer my query, so here goes....

My left knee is a mess. I ruptured my PCL 33 years ago (rugby), damaged my medial cartilage twice (skiing), and a year ago managed to tear a small rip in the cartilage around the anterior horn (old age). Oh, and I also have pitting under the kneecap (Chondomalacia?). But I can live with these.

It’s my fat pad which is causing me real grief. For over a year now I have had pain below my knee cap. It hurts when I stand for a long time, when I sit for a long time, when I run downhill and after I cycle uphill. It’s not the patella - it’s the fat pad below the tendon at the front of my knee.

It’s been a year now and it hasn’t really improved. I had 5 months of intensive PT, but most of the exercises given me by the PT seem to aggravate it. I ended up completing a 19 week 80;20 training programme without too much difficulty, but now the season is over it’s time to sort this out.

My surgeon wants to take a look and snip out any bad bits. I have no problem with doing this for cartilage, but if I recall correctly the fat pad has loads of nerves and the interwebs seem full of horror stories with respect to similar operations.

Has anyone on ST had an operation for this?
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Re: Fat Pad Impingement/Hoffa’s Syndrome [BigHammer] [ In reply to ]
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I have had knee surgery for fat pad impingement as well as a number of other things. The fat pad took a very long time to heal after it was debrided. Around 4 months. From what I understand it is quite common in that this takes a while to heal.
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Re: Fat Pad Impingement/Hoffa’s Syndrome [BigHammer] [ In reply to ]
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This is a common problem for those riding forward.
Seat height is mega critical.

If this is the cause for you then maybe ditch the TT for a while and get back on a knee friendly straight road bike setup and let it heal itself.
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Re: Fat Pad Impingement/Hoffa’s Syndrome [titemple652] [ In reply to ]
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Thanks for responding. That’s given me food for thought. 4 months is much longer than my orthopod mentioned.

Hmmm
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Re: Fat Pad Impingement/Hoffa’s Syndrome [BigHammer] [ In reply to ]
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after a meniscus repair and plica removal ( both sides) Jan, 2019 a week later I was having huge issues. After going round and round with my surgeon he said I had fat pad impingement. It was horrible! I was on a crutch most of the summer and couldn't even kick in the pool. I had another surgeon do a fat pad debridement and clip the meniscus again on Sept 16th. it seemed I was making progress because I could ride again. I started going backwards after those 3 weeks. It has been a total nightmare for me! On sunday I had a great day and yesterday something sharp, like a nerve hit me again. The knee is so unpredictable. I stopped trying to ride the stationary a few weeks back which I would only get on for 15 minutes once a week. It wasn't painful during, but I had many problems the day or 2 after. Sometimes I feel like I'm getting better and then some days I feel like I'm going backwards. I wander if I will ever walk normal again. I have recently improved my strength which has taken a fast improvement. I am going to wait until next month before seeing someone else. I was told I should be able to ride, run and do everything again. Today may be my breaking point :( Good luck!
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Re: Fat Pad Impingement/Hoffa’s Syndrome [titemple652] [ In reply to ]
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I also had fat of impingement surgery and it also took a very long time to heal, about 8 months. Also from riding too far forward.
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Re: Fat Pad Impingement/Hoffa’s Syndrome [titemple652] [ In reply to ]
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titemple652 wrote:
I also had fat of impingement surgery and it also took a very long time to heal, about 8 months. Also from riding too far forward.

Did you have surgery. Any suggestions on what helped it heal?
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Re: Fat Pad Impingement/Hoffa’s Syndrome [chillybear] [ In reply to ]
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I did indeed have surgery, I had a plica and meniscus done at the same time. For months afterwards I worked with a head NHL Athletic therapist who said he would never advise getting fad pad surgery unless absolutely necessary.

The fat pad did heal up after around 8 months, but the plica remains problematic.
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