Fat pad or Hoffa's syndrome or Plica syndrome

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Fanis
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Joined: Sat Jan 09, 2010 3:16 pm

by Fanis

Four months ago I have knee issues.my problem started while I was doing Leg press to the gym.it was the first time that I did this excersise.
First doctor told me that I need relax.one month later the problem was there.second doctor told me that I have Fat pad syndrome.he gave me antiflegmon and told that in 2-3 weeks I could start ride again.
Also I did ten physiotherapies(laser,tens,ultrasound) to help my recovery.
Unfortunately none of that help my problem.

If anyone has the same problem please tell me how you worked through it
I have to ride four months and I am going to be nuts
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drchull
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by drchull

Need a lot more info. Plica is more medial to patella and fat pad (Hoffa's syndrome) is below the patella. The typical physical finding for Fat pad (Hoffa's sign) is if you lay down with knee bent and someone places their thumbs on either side of your patellar tendon pushing down it hurts to straighten your knee. Plica is more common to cyclists and certainly can happen from leg presses.
Where in the knee does it hurt (be precise) what is the pain like (shooting, dull, sharp...). When does it hurt. What motions make it better or worse. Does it hurt when you walk, pedal, sit, walk up stairs. Have you injured the knee before.
Were you doing a seated leg press, how deep, how heavy. Did you have your knees straight or in valgus or varus.
Did it hurt right away, did it swell or bruise, if so where. Any grinding, catching or locking.
I could go on but really without an actual examination I would just be guessing, Hell sometimes with a proper history and physical it is hard to tell.
As a Dr. I will tell you that I would likely believe what your PT thought over your family doc. Ask to see a Sports Med doc or Orthopod as family docs generally are good at identifying some problems but are not nearly as good as someone with that focus.

So here is the canned answer. Ice, rest and NSAIDS (topical is better). Check saddle and cleat position. In the gym start lower weights and higher reps. Focus on medial quads, hamstrings and balance exercises with lots of stretching, active before and passive after.

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Fanis
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Joined: Sat Jan 09, 2010 3:16 pm

by Fanis

Hi Drchull
and thank you for your answer
as you explained me i have fat pad (Hoffa's syndrome) because i hurt below the patellar tendon not in the medial to patella.
as i said i went to two doctors,the first one is Sports Med doc and the second one is Orthopedic.
only the second one told me that i had Fat pad syndrome and suggested me rest-ice and Arcoxia anti inflammatory tablets.
i forgot to inform that i have both my knees ACL reconstructed(1995 left-2001 right) but without any problems all these years.
the pain started one day after leg presses early August and consists until today.it's not strong pain but it likes dull and is always there except in the night when i sleep.
i can walk,ride etc but always with this hurt.
when i did leg press my knees was straight,the knee angle was until 90° and the weight was 15kg.i think that it's not too heavy weight for press.it was the first time in my life that i did leg press.in the gym always i did leg extensions-leg curl-adductions/abductions,calf raises with low weights-high reps.warm up 10min to the stationary bike,stretching,weights and finally again stretching.
both saddle/pedal cleats setup is ok because i have done pro bike-fitting.

PS look at this photo the red circle to see where i hurt,below the patellar tendon.
http://img201.imageshack.us/img201/3273/fatpad.jpg
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drchull
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by drchull

Fanis, I guess best first make the obligatory medico-legal statement that seeing as I haven't examined you I can't directly comment on your situation. I can make some general comments on Hoffa's syndrome though. As a matter of disclosure I am a family doc with an interest in cycling and sports but not a sports med doc or orthopod.
In a situation like yours when you have had significant damage to your knee in previous injuries, the diagnosis of Hoffa's syndrome is not always so easy to make as can easily be confused with meniscal injury and patellar ligament (or bursa) issues. Really for a definitive diagnosis would likely need MRI. That being said the initial course of treatment prescribed would be appropriate as it will settle many issues.
As far as initial treatment of Hoffa's synd., you were given the correct treatment. Avoid painful activities, ice, ice, ice, PT. I would add taping. If you do an online search you can find some taping modalities. I do find that physio tape does a great job for a lot of issues, and hey Spidertech gives back to the sport by sponsoring a team.
Next up assuming a definitive diagnosis of Hoffa's syndrome is steroid injection. This is a fairy precise area of injection and really needs to be done by an expert.
Next is surgery, this is usually a fairly minor surgery and works very well by my understanding.
This is all prefaced by the fact that you need a definitive diagnosis which I cannot give you. You could well have a meniscal issue causing your pain.

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Fanis
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by Fanis

Thank you doc
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User Name
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by User Name

Chondromalacia??

Standing straight leg raises/kicks with a very light weight

KWalker
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by KWalker

I had inflamed plica last year from a crash and then a ramp up of training right after. I took 2 Alleve 2/day for about a month until it subsided.
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Machinenoise
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by Machinenoise

Interesting read, I hope all goes well for you! I have to be quite careful with ramping up my training towards goals in season, as I've got a long standing weakness in my left patellar tendon due to a car vs. cyclist injury which left me with some small tears to the tendon itself.

It took me about 6 months from bits of tarmac embedded in the tendon to riding and full pace again. I know thats a fairly long recovery, but a recovery CAN be made with the right medical advice.

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roadieboy
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by roadieboy

I have a similar ailment with almost those exact symptoms, and maybe what helps with mine could benefit you as well.

I have had a strange flicking sensation above my left knee on the lateral side, I have been misdiagnosed with ITB syndrome, but after finding a wonderful PT, it was determined that I actually had a larger than normal lateral knee plica (Lateral Synovial Plica Syndrome). It turned out that using SPD pedals had exasperated it magnificently, so I was given a prescription of Meloxicam to keep the swelling down. After a week of that I was back to normal, and after I quit using SPDs, very little knee pain.

I have found that foam rolling and icing regularly seems to keep it at bay, though it has been recommended that I consult with an orthopedic surgeon to fix it for good.

Good luck with the knee!

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