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It is not the most common of knee injuries but it may be one of the most difficult ailments to eliminate. Many knee injuries involve a blow to the front of the knee and the fat pad is an effective structure to buffer the forces on the vulnerable articular surfaces of the distal femur. The two most common mechanisms of injury for fat pad impingement is a direct blow to the patella and front of the knee and hyperextension of the knee joint itself. Both mechanisms create a pinching of the fat pad resulting in swelling of the pad and surrounding tissue. With this type of a knee injury, the fat pad becomes very painful and slow to heal. Pain below and to the sides of the patella tendon with squatting. Pain below and to the sides of the patella tendon with leg extension along with noticeable bulges to the sides of the patella tendon when the knee reaches full extension. Increased warmth and a sense of fullness in front of the knee below the patella. The inability to actively extend the knee to full extension due to pain when pressure is applied to both sides of the patella tendon. Ice, ice and more ice. The necessary modalities and therapy devices to reduce swelling, decrease pain and restore normal knee mechanics. The use of a roller and massage therapy for the hip flexors, quadriceps, ITB, hamstrings and calves to increase tissue mobility and reduce patella compressive forces. Painfree flexibility activities for the hip flexors, quadriceps, ITB, hamstrings and calves to improve lower extremity range of motion. Implement a quad-strengthening program that is painfree while being performed in a range of motion between 90 degrees of flexion and 20 degrees from full extension. Patellofemoral taping can be an effective treatment for sub-acute and chronic knee injuries that involve the patella and the patella tendon. Knee sleeves that provide stability and motion control to the patella may be helpful if additional pressure is not applied to the infrapatella area. Are you certain of the diagnosis Dx of fat pad impingement and does this Dx match my mechanism of injury MOI? Are there any additional complications to this injury that I need to be made aware of? Do I show any signs of a mechanical abnormality such as a leg length discrepancy or chondromalacia that needs to be addressed in addition to my fat pad injury? What type of progression do I need to follow when I return to my sport? Treat it the right way now and be done with it. Pray for Help — Kneeling on the knee, as in the praying position, will increase the symptoms of an inflamed fat pad. Looking Elsewhere — If your fat pad is painful yet the mechanism of injury just does match up, the problem may be from somewhere else. Chronic foot pain , tight hips, a symptomatic plica and Jumpers Knee are just a few examples of injuries that can indirectly inflame a fat pad. Avoid the Knife — I have seen very few fat pads that required surgery. I strongly suggest that you avoid getting surgery on this issue until you have exhausted all of your conservative options and been diligent with your rehabilitation.
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