11/01/2026
๐๐ฎ๐ ๐ฃ๐ฎ๐ฑ ๐ฆ๐๐ป๐ฑ๐ฟ๐ผ๐บ๐ฒ: ๐ ๐๐ผ๐บ๐ฝ๐ฟ๐ฒ๐ต๐ฒ๐ป๐๐ถ๐๐ฒ ๐ข๐๐ฒ๐ฟ๐๐ถ๐ฒ๐
๐ Introduction
โฌ Acute or chronic inflammation of the Infrapatellar Fat Pad is a common source of anterior knee pain; this condition is also called Hoffa's disease, fat pad syndrome, or hoffitis.
โฌ Fat pad syndrome was first reported by Albert Hoffa in 1904.
๐ฆด Anatomy and Function
โฌ The infrapatellar fat pad is found in the anterior knee compartment as a mass of adipose tissue that lies intracapsular but is extra synovial, extra-articular.
โฌ This fat depot is structured into distinct lobules composed of unilocular adipocytes encapsulated by a layer of connective tissue, containing a rich supply of blood vessels, nerve fibres, and various immune cell populations.
โฌ The infrapatellar fat pad plays a crucial role in knee joint health by reducing load, enlarging the synovial space, supporting blood supply to the patellar tendon, and distributing lubricant within the joint.
โฌ Due to the relatively high density of nerves within the structure, the infrapatellar fat pad also functions as a mechano-receptor and proprioceptor.
โ๏ธ Biomechanics
โฌ The infrapatellar fat pad is a dynamic structure that alters position, pressure, and volume throughout the knee range of motion.
โฌ When the knee moves into flexion, the superolateral portion of the fat pad becomes relaxed, freely expansive, and moves posteriorly.
โฌ Consequently, the most commonly observed symptoms are associated with extension, though pain can be seen in flexion if the infrapatellar fat pad is trapped between the patellar tendon and the anterior femur.
โฌ Knee mechanics can be altered when there is adhesion in the fat pad that changes the position of the patella and patellar tendon.
โฌ This compromises the effectiveness of the extensor mechanism, decreasing the effective moment arm and placing greater demands on the quadriceps to produce the same knee extension force.
๐งฌ Metabolic Influence
โฌ While early studies reported the fat pad as a lubricant structure, it has become clear that the infrapatellar fat pad yields more sophisticated functions due to its complex neurovascularity.
โฌ The infrapatellar fat pad is considered to be a producer of many inflammatory mediators found in association with osteoarthritis.
โฌ As an adipose tissue, the infrapatellar fat pad mainly secretes fatty acids, which are well known for their pro-inflammatory effects, and actively secretes IL-6 and its soluble receptor sIL-6R.
โ ๏ธ Pathophysiology and Risk Factors
โฌ Predisposing factors for the development of fat pad syndrome include high patellar height, larger tibial tubercle-tibial groove distance, and an increased trochlear angle.
โฌ The condition is predominantly seen in young women, while jumping sports and ligamentous laxity are also considered to be risk factors.
โฌ There is growing evidence of a connection between fat pad syndrome and knee osteoarthritis, as fat pad impingement appears to frequently co-occur with osteoarthritis and other knee injuries.
โฌ Some authors consider the fat pad to be a key structure in osteoarthritis and patellar tendinopathy.
๐ฉบ Diagnosis and Clinical Picture
โฌ The inflamed fat pad is often enlarged, firm in consistency, and easy to palpate.
โฌ To avoid pain provocation in adjacent structures, a modification of Hoffaโs test is suggested, which involves taking the knee into passive forced hyperextension by lifting the heel and keeping anterior pressure on the tibia.
โฌ This position stimulates pain exclusively in the fat pad if it is inflamed.
โฌ Pain in hyperextension is a strong indicator of the presence of an inflamed infrapatellar fat pad.
โฌ Regarding differentiation, pain and or discomfort from long walks, flat shoes, and prolonged standing mainly refers to fat pad syndrome, whereas pain resulting from up- or downhill walking is a characteristic of patellofemoral pain syndrome.
๐ง ๐ ๐ฎ๐ป๐ฎ๐ด๐ฒ๐บ๐ฒ๐ป๐
๐ข Conservative Treatment
โฌ Treatments reported to relieve symptoms include taping, physiotherapy, non-steroidal anti-inflammatory drugs, and injections of local anaesthetics and or corticosteroids.
โฌ Diagnostic and therapeutic injections into the fat pad have resulted in immediate pain relief and reconstruction of movement.
โ๏ธ Acute Management
โฌ Acute symptoms management includes ice massage to relieve acute symptoms.
๐ Chronic Management
โฌ For chronic cases, biomechanical assessment and correction are essential components.
โฌ Addressing biomechanical abnormalities such as excessive hyperextension is crucial to decrease infrapatellar fat pad loading, which can be achieved through the use of relatively elevated shoes.
โฌ Movement awareness, knee straightening exercises, and quadriceps and anterior hip stretching have also been found to improve infrapatellar fat pad restriction symptoms.
๐ Surgical Intervention
โฌ When conservative interventions are not effective, surgery may be the next step.
โฌ Studies have evaluated the results of arthroscopic resection, which showed improvement on knee rating systems.
โฌ Additionally, a partial excision of the infrapatellar fat pad significantly reduced pain and improved function in patients with knee osteoarthritis.
