Hoffa's syndrome | Fat pad impingement

A very nice article on the fat pad impingement syndrome (Hoffa's syndrome) by Dr Chang Haw Chong :

What is Fat Pad Impingement?

Sometimes after a forceful direct impact to the kneecap, the fat pad can become impinged (pinched) between the distal thigh bone ( femoral condyle) and the kneecap (patella).

As the fat pad is one of the most sensitive structures in the knee, this condition is known to be extremely painful. The knee pain is  situated anteriorly on either side of the lower kneecap and is worsened by straightening (extension) of the knee joint. Hence the fat pad comes under constant irritation and may become significantly inflamed.

It is also termed Hoffa’s Syndrome.

What Are the Symptoms of Fat Pad Impingement?

• Pain and/or swelling around the bottom and under the kneecap
• Patients may have a history of knee hyper-extension (called genu recurvatum)
• Positive Hoffa’s test (with the patient in lying with their knee bent, the examiner presses both thumbs along either side of the patellar tendon, just below the patella. The patient is then asked to straighten their leg. Pain and/or apprehension of the patient is considered a positive sign for fat pad impingement)

Treatment of Fat Pad Impingement

Treatment of this condition is normally by conservative methods such as:

• Rest and avoiding aggravating activities – stop running.
• Ice or cryotherapy to reduce pain and inflammation.
• Physiotherapy modalities such as ultrasound and TENS.
• Muscle strengthening exercises to maintain the strength and fitness of the surrounding muscle groups
• Taping the patella may help. One method involves taping the upper surface of the patella to allow more space for the structures beneath the lower surfaces i.e. the fat pad.  This leads to less stress and impingement on the fat pad.

If conservative treatment does not work then surgery may be advised. This may involve the complete or partial removal of the fat pad itself.

Read more.

You can also read a nice article here.