What Is Fat Pad Syndrome?

Fat pad syndrome, also called Hoffa’s Syndrome or infrapatellar fat pad impingement, is a common knee pain condition. The fat pad sits beneath your kneecap and acts as a natural shock absorber. When irritated or compressed, it can become swollen and painful. This often creates sharp pain at the front of the knee, especially when you straighten the leg.

The fat pad is sensitive tissue. Even small increases in pressure or load can trigger symptoms. Sports, repeated knee strain, or prolonged standing with the knees fully locked can all aggravate the area.

Common Causes

Fat pad syndrome often follows a direct knock to the knee, such as a fall or contact during football or running sports. It can also develop gradually.

Contributing factors may include:

• Tight quadriceps or hip flexors
• Repeated knee hyperextension
• Patellofemoral pain syndrome or altered kneecap tracking
• Pelvic or foot posture changes
• Post-surgical irritation
• Knee osteoarthritis

Lower limb biomechanics have a significant influence. Excess load through the front of the knee, especially during walking, running, or squatting, can increase irritation.

Symptoms of Fat Pad Syndrome

Symptoms often include:

• Sharp pain under or beside the kneecap
• Pain that increases when straightening the knee fully
• Discomfort with walking, stairs, running or squatting
• Swelling around the kneecap
• Pain when standing with knees “locked back”
• Sensitivity when kneeling

Some people report relief when keeping a slight bend in the knee.

Diagnosis

A physiotherapist or sports doctor can diagnose fat pad syndrome with a clinical assessment. Key findings may include tenderness beside the patella and pain during quadriceps contraction. An MRI can confirm inflammation and rule out other knee pain causes.

Lower limb posture, hip strength and foot mechanics are also assessed to find contributing factors.

Treatment Options

Most people improve with non-surgical care. Your physiotherapist may use:

• Load modification to reduce compression on the fat pad
• Taping or padding to de-load the front of the knee
• Strengthening for the quadriceps, hips and calf
• Mobility work for stiff or tight regions
• Correction of pelvic, hip or foot alignment issues
• Gait retraining to reduce knee hyperextension

Structured knee exercises can help settle symptoms and restore control. A personalised knee treatment plan usually provides reliable improvement over time.

Do You Need Surgery?

Most people recover without surgery. Injections or surgical options are considered only when long-standing swelling or mechanical irritation does not respond to conservative care. A physiotherapist or sports doctor can guide this decision.

Preventing Recurrence

Prevention includes strengthening the knee, hip and ankle, improving lower limb alignment and avoiding excessive knee hyperextension. Supportive footwear, activity pacing and early response to front-of-knee pain can also reduce flare-ups.

Addressing contributing factors is important for long-term results.

Research & References

Current research highlights the biomechanical role of the fat pad and its involvement in anterior knee pain and osteoarthritis:

• Lastoria DAA, Benny CK, Hing CB. Predisposing factors for Hoffa’s fat pad syndrome: a systematic review. Knee Surg Relat Res. 2023;35(1):17. Available from: https://pubmed.ncbi.nlm.nih.gov/37296488/
• Wang MG, Seale P, Furman D. The infrapatellar fat pad in inflammaging, knee joint health, and osteoarthritis. NPJ Aging. 2024;10(1):34. Available from: https://pubmed.ncbi.nl.gov/39009582/
• Pereira Herrera B, Emanuel K, Emans PJ, et al. Infrapatellar fat pad as a source of biomarkers and therapeutic target for knee osteoarthritis. Arthritis Res Ther. 2025;27(1):81. Available from: https://pubmed.ncbi.nlm.nih.gov/40188073/
• DuBose JJ, Taqi A. Hoffa Pad Impingement Syndrome. In: StatPearls [Internet]. 2023–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK589637/

Related Articles

• Patella Tendinopathy
• Patellofemoral Pain Syndrome
• Chondromalacia Patella
• Osgood-Schlatter Disease
• Sinding-Larsen-Johansson Syndrome
• Knee Bursitis
• ACL Injuries
• Runner’s Knee
• Common Sports Knee Injuries
• Osteoarthritis of the Knee
• Post-Surgery Knee Care

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