Hydrodissection

Thanks a lot for the explanation and the doctor's info, that's really helpful! It sounds as though hydrodissection could be useful for treating at least some forms of arthrofibrosis.

Kayley

The pain I had was primarily with going down stairs because the tissues don’t glide. Can see it on ultrasound screen. My biggest issue was less about pain and more about severe instability and taking forever to get stronger. I couldn’t walk correctly or do stairs.

Cortisone reduces inflammation and can generally help with pain. What has worked for me, though, is the needle going in and separating the thick scar tissue adhesions, fluid injected between the layers (doc said he felt some scar tissue ‘pop’ once), and that cortisone can soften scar tissue so it could stretch/reshape more with use because it was not loosening up for me despite being super diligent with exercises.

I’m still working on it; the scar tissue will still tighten up with use. KT tape or wearing strap around thigh above kneecap helps. I tried taping and straps and other knee gadgets after both surgeries but didn’t help then—they do now after hydrodissections and getting stronger. I’m walking and doing stairs much better—-looks pretty normal (just feels weird internally but still improving).

The doc that has performed my hydrodissections (and shockwave):

Dr. Brett Martindale

Ogden Clinic

Ogden, Utah

https://www.ogdenclinic.com/provider-directory/brett-martindale-md/

This is really helpful and interesting to know Marisa, thank you so much for sharing your experience!! I'm curious to know if you had knee pain before you had the ultrasound guided hydrodissection, and if so, did the procedure help reduce it?

If you're comfortable, please feel free to share the name of the doctor who performed the hydrodissection, and city.

Kayley

I’ve had 3 hydrodissections done this year, 2024, on my scar tissue that tethers my patellar tendon to Hoffa’s fat pad. Resulted from ACL surgery in April 2022; quad tendon autograft. Had a second ‘clean out’ surgery in September 2022. Scar tissue returned again within a week of second surgery where the two incisions were made for the scope; wasn’t as bad as the first surgery but still EXTREMELY limited mobility. I was misdiagnosed for a long time (docs & PTs claiming just quad weakness) and tried everything because I can’t handle another surgery. Luckily I found a sports med doc that told me about and performs ultrasound guided hydrodissection. I also found this published paper: https://pubmed.ncbi.nlm.nih.gov/33532163/

Hydrodissection has helped me IMMENSELY! My first hydrodissection was with cortisone. Second was dextrose. Third was cortisone. I think the cortisone helped more by softening the scar tissue. I might do a fourth but the scar tissue is still changing/becoming more stretched but v e r y s l o w l y and still lifting heavy, slow, eccentric movements. There’s still a lot of scar tissue in there but it’s less restricting than before.

Sorry, I only just saw the YouTube video link. I think hydrodissection could be a safer way (compared to surgery or MUA) to force apart adhesions between the fat pad to tendon, but this won't address a fat pad that remains enlarged from inflammation, and which sticks out and gets pinched between the bones of the knee. And, as both you and I mentioned, there will be some damage and inflammation as a result.

Kayley

Hi Mike,

Thanks for your question. Hydrodissection is an interesting treatment, and I’ve been reading about it. Hydrodissection involves inserting a needle, usually guided by ultrasound, and injecting carefully targeted high pressure fluid to separate adhered tissues.

I haven't seen hydrodissection being used for treating arthrofibrosis (although hydrodilation is used), and would be interested to know of any accounts. But as you say, ultrasound guided hydrodissection is used to break the adhesions that tether nerves to surrounding tissues (nerve decompression), and it’s also used in eye treatment. In these contexts it’s considered to be safer than surgery, and doesn’t damage nerves.

A 2020 paper by Song et.al. used hydrodissection to free an adhered fibular nerve with fat pad impingement. However, in one area the scar tissue around the nerve was too dense and it required surgery to free it.

A 2022 paper by Dosal et.al. reports they successfully used hydrodissection to separate scar tissue and adhesions in Achilles tendinopathy. They state that Achilles tendinopathy is a fibrotic disease that involves the associated Kager’s fat pad (fat pads and fibrosis again!). The authors state that in addition to freeing the tendon from the fat pad, hydrodissection may help to break down scar tissue. However, there are “crucial variables such as fluid type, dose, and frequency are not well defined” and if corticosteroids are used there is an increased risk of tendon rupture. This means there are large differences in how hydrodissection is used in practice. Small amounts of injected fluid (usually anaesthetic and saline) seem to be less damaging than larger volumes.

My feeling is that hydrodissection could be a safer alternative than manipulation under anaesthesia or surgical lysis in cases where the scar tissue hasn’t matured (less than 12 months post diagnosis) and isn’t too extensive. If there is a small area of adhesions that can be freed, then in theory hydrodissection could be a useful option, since there will be much less tissue trauma than MUA and surgery. However, even in experienced hands there will be some amount of trauma and associated discomfit, so as with everything, there are no guarantees. If hydrodissection was (mis)used to destroy an area of the fat pad then that would likely create a strong fibrotic reaction.

I hope that helps,

Kayley

is it possible Hydrodissection injection could be like an injury that would trigger more inflammation?