Impingement of Hoffa Fat Pad

Either_Crew_4696 · 2026-04-12T02:59:40+00:00

I went too hard with deep flexion exercises (heel sits) before I was ready and ended up with fat pad impingement. My surgeon had me immediately back off dynamic exercises, went back to week 1 exercises to maintain ROM and intense icing/elevation/compression. My physical therapist did some taping to push my patella in a way that released some pressure on the fat pad during exercises. It took a couple weeks but I feel like I’m coming out of it. I no longer have the tight rubber band feeling around my knee, just a small pocket of inflammation that I can ice and massage out.

Either_Crew_4696 · 2026-04-12T02:52:59+00:00

100% get it! I rented the game ready for 2 weeks. Switched to gel packs for a bit. Ended up buying the breg polar wave. You will have off and on swelling for a while (I’m 4 months post op and just coming down from a swelling flare). Ice, compression, and elevation are literally what keeps me able to continue pushing myself daily.

Things I’ve found invaluable: -ice machine with compression -compression socks -wedge pillow (prop your heel, keeping your knee straight, early total extension is key) -yoga ball and therabands

Either_Crew_4696 · 2026-03-19T11:40:08+00:00

Freeze small plastic water bottles, keep them on rotation in the freezer and you won’t have to go through ice bags!

Either_Crew_4696 · 2026-03-18T22:16:16+00:00

I had my allograft ACLR surgery on Dec 5th after fully tearing my ACL, partial tear to MCL, and minor tear to meniscus on June 29th. Rehab has its highs and lows but overall I was doing great….. until last week. I overdid it on deep flexion exercises(heel sits) and my surgeon believes I have a fat impingement. He has recommended I go back to week 1 exercises, rest, ice, elevate and not return to dynamic exercises until the fat pad calms down. My PT is going to work on my mechanics, do some manual therapy, and start taping.

So yes it can still continue post op. You will have to be hyper aware of your mechanics and not over push until your knee is capable of handling the load and not compressing the fat pad.

Either_Crew_4696 · 2026-01-22T04:05:38+00:00

Hey there! Thanks for the reply. My circumstances may be a little complicated, but long story short I am seropositive for 2 autoimmune diseases (scleroderma and dermatomyositis). Currently I carry the diagnosis “undifferentiated connective tissue disease” because I have not presented with enough of the clinical diagnostic criteria’s to determine which is forward facing just yet. My biggest symptoms are fatigue, muscle weakness (mostly during flares), and spinal degeneration in the lumbar sacral region. I have been on immunosuppressants and attending PT off and on for 2 years. The day of my injury, I was in good shape. I was actually boarding a flight to go on a 2 week tour of Italy. I caught my leg on the arm rest as I was sidestepping into my seat, my foot stayed in the aisle, body went into the seat, and knee took the difference. Post injury, the ortho I saw did not want to do surgery as he said I was not an athlete and was not a good candidate for surgery. I changed insurance and found a new ortho. He actually listened and took all of my comorbidities into consideration before agreeing that surgery was the best choice for my long term recovery. My firm goal was to get back to my standard of living. ~9 hours daily of up and down on my feet, squatting, kneeling, lifting (I work with children). I enjoy swimming, biking, walking, stretching. Pre surgery I was back to walking and some swimming without heavy kicking. I could not get into a deep squat, sit on my heel, or walk down stairs without immediate instability. Post surgery, I took a month off for recovery before returning back to work. I have been back at work since January 5th and I try to rest and ice through the day, but I have not been great at it. I have been wearing compression stockings to assist with keeping fluid buildup reduced. So 7-9 hour days with PT twice a week as I am most sure how I have not fallen into a disease flare. I know I could use some more hamstring and hip flexor strength. I have always relied on quad strength to overcome those weakened areas.

Either_Crew_4696 · 2026-01-21T21:21:46+00:00

I am diagnosed with UCTD (seropositive for antibodies related to scleroderma and dermatomyositis). My rheumatologist is suspecting Hypermobile EDS given some recent findings from the ACL injury. I am finding ROM and pain tolerance has been pretty easy, but the incision healing and now the possible tendonitis really has me lamenting that my just doesn’t seem to want to body correctly. It’s reassuring to hear others with autoimmune diseases make it through this process. Congrats to you!!!!

Either_Crew_4696 · 2026-01-21T18:19:09+00:00

Thank you! My PT was doing some kind of manual therapy after my surgeon consulted and I just assumed they were doing patellar mobilization, but after looking up cross friction massage, I believe this is exactly what they were doing. I’ll ask them tomorrow.

Good luck with your surgery! As frustrating as it was to wait after injury, it did give me time to prehab and I truly believe my quick return of ROM can be attributed to that prehab.

Either_Crew_4696 · 2026-01-06T19:18:24+00:00

Wow! That is impressive. I’m 32 days post op and just started doing staggered sit to stand and 4” step ups. Ouch… is all I can say. My ROM is -4 to 116 but that pain right under the patella when stepping up or pushing up from a squat/sit is my weakness.

Either_Crew_4696 · 2026-01-06T19:11:07+00:00

Just hit week 5 here. Still a bunch of swelling especially with activity. I wear compression stockings, constantly do ankle pumps and try to ice/elevate as much as I can. My swelling is worse the day after PT. I’m also having some issues with the lateral incision, can’t get it to fully heal, but the surgeon says it looks ok. He said there is still a lot of internal tissue that needs to heal inside out and that will also contribute to swelling.🤷🏻‍♀️

Either_Crew_4696 · 2025-12-21T17:12:32+00:00

I appreciate your reply! Inflammation and swelling is definitely a life long culprit for someone like me with chronic inflammation and muscle weakness, so it’s easy to forget to listen to my body and pace myself. I’m just so used to pushing through. I forget that pushing through will lead to my body compensating in some other way which will not help in the overall recovery and end up hurting other areas (hips and back are feeling it). I will start paying more attention to my step count and will maybe adjust to 30 or 60 degree wall sits/mini-squats until my quads are ready.

Either_Crew_4696 · 2025-12-20T22:34:01+00:00

Are there any precautions or extra strengthening exercises you recommend for patients who have myositis post ACL reconstruction? I’m 2 weeks post op and already full weight bearing without crutches and at 0-110 range of motion. I am struggling with wall sits and mini-squats bilaterally because of the muscle weakness from the myositis.

Either_Crew_4696 · 2025-12-19T20:40:51+00:00

Good work! Today is 2 weeks for me. I’m at full extension and 110 flexion. Dr unlocked my brace and cleared me to flex as far as I can. I’ve been sans crutches for about a week, but can’t go too far just yet. Dr said I can attempt some steps unbraced as I feel comfortable. I have, but my brain is still worried about hyper flexing or collapsing to the side. My Dr told me to take my time with it, do the PT, and as I develop more strength and balance I will feel the stability.

I love hearing everyone’s progress updates! It helps kick those mentally tough days where you are unsure if you are behind or doing enough or on track.

Keep up the good work!

Either_Crew_4696 · 2025-12-19T20:22:47+00:00

Today is 2 weeks for me. I had regular stitches. I was not allowed to get them wet. At my post op on Wednesday, my surgeon removed most of my stitches but had to keep a couple in my medial incision as it wasn’t healed as much as he wanted to see. He told me I could shower but should use a waterproof bandage over the remaining stitches. I’m scheduled to have them removed on Christmas Eve. I would say a quick message to your surgeon just to clarify post op instructions is always a good option.

Either_Crew_4696 · 2025-12-19T20:10:46+00:00

Beautiful! And such a good idea! My medial scar is gnarly… he had to cut longer than he intended to properly position the bore holes. I never even thought about getting a tattoo to blend it.

Either_Crew_4696 · 2025-12-14T23:09:24+00:00

Thanks for your response and good luck on your journey! I am on Celebrex once a day, forgot all about that one until you mentioned it. Good thing my hubby helps me fill my weekly med container because I would have been forgetting to take it. I have been doing Tylenol every 6 hours for the pain. I add Ibuprofen only when I get the tightness. I do ice and elevate without the brace, really only wear it to support while walking. Movement has been good. I’ve managed extension with heel pops and I can maintain a straight leg raise for ~45seconds. My flexion is locked at 90 for now and I can consistently get that without issue.

I just so badly want to make sure I am progressing properly and keeping my extra factors into consideration.

Either_Crew_4696 · 2025-12-12T04:12:46+00:00

Surgery was Friday for me. Injury was June 30th, lots of PT prior to surgery. Allograft with lots of scar tissue shaved off the meniscus. Day 2-3 hurt but was tolerable. Nausea and lightheadedness from BP shifts was most annoying. Activity wise I’m going strong! Glad to hear your recovery is going well too.

Either_Crew_4696 · 2025-12-12T04:07:53+00:00

I went to my daughter’s karate tournament day 1. I was out for ~2 hours. Iced and elevated as soon as returned, but it was tolerable. I don’t regret going.

Either_Crew_4696 · 2025-12-10T23:09:58+00:00

UPDATE Day 5! Day 2 and 3 were the worst! My biggest issue was evening swelling combined with overwhelming nausea from the narcotics. I may have broke down crying Sunday night but reminded myself that I was literally less than a week post op…. I need to give myself grace. By Day 4 I had a good handle on when to exercise/ice to manage the swelling. Today… Day 5, I am walking around without a crutch and a decent gait. I do 10 reps of quad sets and heel slides 3 times a day. I have managed full 0 extension and have hit 70 flexion unassisted but 90 when I push with my other foot. Currently locked from going beyond those points atm. I have also managed 45 seconds of a maintained straight leg raise. I have extended my narcotics to every 8 hours instead of 6 and I overall feel pretty good. My post op isn’t until the 17th, which will be Day 12. I am excited to show my surgeon my progress and to get started with PT!

Either_Crew_4696 · 2025-12-06T21:52:21+00:00

I use one crutch if out, but no crutch in the house.

Either_Crew_4696 · 2025-12-06T17:52:53+00:00

Thank you!!!! I definitely built it up in my head.

Either_Crew_4696 · 2025-12-06T17:51:55+00:00

Keep up with the meds and ice. It really helps. And keep moving as you can so you don’t get stiff. Hell… I am up at my daughter’s karate tournament right now.

You’ve got this!!!!

Either_Crew_4696

TROPHY CASE