Hi,
looking for some advice. I developed AF in/around the Hoffa‘s fat pad following ACL reconstruction in March. Fortunately, I don’t have much pain. My primary issue is with ROM, particularly extension as I have 15 degree of extension deficit and 110 degree of flexion which is not great but at least allows me to ride a stationary bike. So far, I have been reluctant to do a second surgery despite two of my doctors independently arguing for another scope with removal of the fibrotic tissue. Instead, 5 weeks ago I started to follow the general recommendations for AF patients to reduce inflammation, keep the leg moving through cycling etc while avoiding painful PT sessions. At least, this has significantly reduced swelling around the knee, now looking way more similar to my healthy knee.
Now I am wondering what my next steps should be. Do I continue conservatively and hope for improvement? If not, when would be the right time to do a second surgery?
I have the feeling that most of the fellow AF patients already tried MUA and/or LOA before being diagnosed with AF or starting to read about treatment of AF. As a result, I want to maximize my chances going into a second surgery or most preferably to fully recover without a second surgery as I am afraid that surgery will make it worse.
Does anyone here have recommendations on how to approach this or any success stories/experiences of patients who were in a similar situation?
Highly appreciate your support!
Best,
Marco
Hi Marco,
All very good questions!
Regarding the stretching, go slowly and learn how it feels to feel some pressure without going into pain. Think about how it feels to stretch your finger backwards to the limit without doing harm, that is what you're aiming for. You'll learn pretty quickly what good stretch is. Research indicates that gentle stretch is anti-inflammatory. However, if you try to push through pain and go harder (overpressure) you run a real risk of tearing tissues and bleeding, and that is extremely detrimental.
If you have pain when you move your leg after it has been immobile for a time, that is likely from adhesions being torn apart, and that is a different thing to overpressure pain.
Regarding timing, it's true that walking with a leg that won't straighten will put pressure on cartilage in places and joints (like hips) where it isn't natural, and over time this can cause wear. To avoid this you could use crutches, or a wheelchair, and this has the added benefit of letting your Hoffas fat pad settle down, since it won't continue to get pinched in the joint when its under load. This will be a big help for getting inflammation under control.
If you get to the one year point post-op and you still have a limp from a leg that won't straighten you might want to consider surgery. However, surgery in itself can have a negative impact on cartilage, since there is an increase in inflammation, and if that continues for too long it has detrimental effects. So, it's a difficult decision, weighing up largely unknown degrees of risk.
Best regards,
Kayley
Hi Marco,
Thanks for sharing your story with us. I'm glad that the IAA has provided useful information and that you're now avoiding painful PT! I can't give medical advice, but if it was my knee, I would continue with conservative management with a focus on knee restoration and not on building muscle. Getting swelling down is important. You could try to slowly gain extension by placing the affected leg straight and supported at each end, but not at the knee. Allow gravity to stretch the knee downwards gently, and for as long as comfortable. Repeat this as much as your knee tolerates each day, and when you’re in bed you can let gravity help you in the same way, when lying on your back with your heal propping up your leg. You could try to hang some weight around the knee to add to the stretch if this is tolerated, but first try it without weights, and be very careful not to tear tissues!
If it was my knee, I would be happy to continue with conservative treatment so long as you can make some slow progress. Hopefully, you'll find that over the coming months you'll be able to gain more extension (it will take quite a bit of time) and it will be enough that you don't need to consider surgery. As you're aware, there is a wide range of reactions to surgery and it can make your knee worse.
Best regards,
Kayley