Infrapatellar Fat Pad Syndrome | Diagnosis & Treatment

Introduction & Pathomechanism

Pathomechanism

Biomechanically, the fat pad is a mobile structure that can help to stabilize the patella and the patellar tendon and prevents pinching of the synovial membrane.In 1904, Hoffa was the first to describe an isolated impingement of the fat pat as an inflammatory hypertrophy, and hyperplasia of the adipose tissue characterized by fibrosis and calcifications. These changes can either result from trauma as well as chronic repetitions like those experienced in regular sporting activities.

Clinical Picture & Examination

Patients with Hoffa’s syndrome present with burning or aching anterior knee pain with variable duration of symptoms from weeks to even years. Oftentimes, swelling on both sides of the patella is observed even in the absence of arthritis. On physical examination pain and tenderness around the patellar tendon, usually near the inferior pole of the patella is one of the hallmark signs of the pathology. Range of motion is limited to some extent, with most studies reporting pain at end-range extension. Pain is then also often aggravated by full extension and dynamic extension such as during stair climbing or a prolonged period of flexion. A test that can be used to diagnose the syndrome is Hoffa’s test. Similar to other body regions and pathologies, there is only a weak association between abnormalities seen on imaging techniques and clinically diagnosed Fat pad syndrome. Therefore, the diagnosis should not be solely based on medical imaging but is rather a clinical diagnosis.

Physical Examination

THE ROLE OF THE VMO & QUADS IN PFP

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Treatment

Although successful management is reported with physiotherapy treatment, there is only anecdotal evidence from case studies that support different approaches. Recommendations range from closed-chain quadriceps exercises and gluteus medius training to bracing and stretching. Initially, it is recommended to desensitize the sensitive fat pad, which can be achieved by avoidance of hyperextension by making sure the knees are not in a locked back position during standing, icing and taping. In case conservative therapy fails, patients may benefit from surgical fat pat resection.

References

Genin, J., Faour, M., Ramkumar, P. N., Yakubek, G., Khlopas, A., Chughtai, M., … & King, D. (2017). Infrapatellar fat pad impingement: a systematic review. The Journal of Knee Surgery, 30(07), 639-646.