Knee Joint

Infrapatellar Fat Pad Syndrome | Diagnosis & Treatment

Check our shop
Infrapatellar fat pad syndrome

Infrapatellar Fat Pad Syndrome | Diagnosis & Treatment

 

Introduction & Pathomechanism

Infrapatellar fat pad anatomy

The infrapatellar fat pad is an intracapsular and extrasynovial adipose tissue occupying the anterior knee joint. It is bordered anteriorly by the patellar tendon and the joint capsule, superiorly by the inferior pole of the patella, inferiorly by the proximal tibia and the deep infrapatellar bursa, and posteriorly by the joint synovium. As it is highly vascularized and innervated, impingement of the infrapatellar fat pad is a potential source of nociception causing anterior knee pain that is often overlooked.

 

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.

Like what you're learning?

Follow a course

  • Learn from wherever, whenever, and at your own pace
  • Interactive online courses from an award-winning team
  • CEU/CPD accreditation in the Netherlands, Belgium, US & UK

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

Free video lecture on patellofemoral pain
Like what you're learning?

Follow a course

  • Learn from wherever, whenever, and at your own pace
  • Interactive online courses from an award-winning team
  • CEU/CPD accreditation in the Netherlands, Belgium, US & UK

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.

Like what you're learning?

Follow a course

  • Learn from wherever, whenever, and at your own pace
  • Interactive online courses from an award-winning team
  • CEU/CPD accreditation in the Netherlands, Belgium, US & UK
Online Course

Increase Your Treatment Success in Patients with Knee Pain

ENROLL IN THIS COURSE
Online course banner background (1)
Patellofemoral Online Course
Reviews

What customers have to say about this online course

Hannah Toppets Avatar
Hannah Toppets
06/12/22
PFP & FAT PAD SYNDROME Great course with nice video’s and clear info on the objects. Also nice to have a little quiz after each chapter. Nice to know how to tape and sport-specific rehab.
Wait before you go!GET ACCESS TO A FREE HEADACHE REHAB PROGRAM

Subscribe now and download a free home exercise program for headaches designed by our headache expert René Castien