Fat Pad Syndrome


Article by J. Miller, D. Levan

Fat Pad Syndrome

(aka Fat Pad Impingement, Hoffa's Syndrome) 


image source: http://www.uwhealth.org/sports-medicine/clinic/fat-pad-impingement/10106 

What is Your Fat Pad?

The knee fat pad, or infrapatellar fat pad, is a soft tissue structure which lies just below and under the kneecap (patella). The fat pad is also enclosed by the thigh bone and the shin bone. Because the fat pad is richly innervated it is considered one of the most sensitive structures in the knee. 

If irritated, your fat pad can be a great source of knee pain and discomfort. Since the fat sits just below the knee cap, if there are problems with the kneecap alignment it can cause pinching or “impingement” on the fat pad. Fat pad syndrome is also known as Hoffa's Syndrome.

What Causes Fat Pad Syndrome?

  • Forceful blow to the front of the knee (i.e. fall, motor vehicle accident, football tackle)
  • Tight quadriceps
  • Genu Recurvatum (excessive extension of the knee)
  • Forward tipping pelvis
  • History of osteoarthritis in the knee
  • Scarring and subsequent fibrosis (hardening) of the fat pad

What are the Symptoms of Fat Pad Syndrome?

Fat Pad Impingement, also called Hoffa’s Syndrome can include some or all of the following symptoms:

  • Pain in the front of the knee
  • Swelling below and around the knee
  • Pain with fully straightening the knee
  • Pain with prolonged walking, squatting and kicking activities
  • Pain with wearing high heels

These symptoms can also be characteristic of several other knee conditions including patellar tendonitis and patellofemoral joint pain syndrome, so it is best to contact your physiotherapist for a thorough assessment and proper diagnosis.

How is Fat Pad Syndrome Diagnosed?

On examination, your physiotherapist or sports doctor will look for signs of the symptoms mentioned above. In addition, they will perform a clinical test called Hoffa’s test which involves moving the kneecap after you contract your quadriceps muscles. 

An MRI may also be used to diagnose fat pad inflammation but it is not very accurate for diagnosing fat pad impingement. A thorough assessment from your physiotherapist or sports doctor is usually able to provide you with a more definitive diagnosis.

What is the Treatment for Fat Pad Syndrome?

Physiotherapy treatment will hasten your recovery. Your physiotherapist will aim to:

  1. Reduce your pain and inflammation. This may entail usage of electrotherapy, cryotherapy, therapeutic taping, acupuncture and gait education.
  2. Normalise your joint and muscle range of motion.
  3. Strengthen your knee and leg muscles.
  4. Optimise your patellofemoral (kneecap) alignment.
  5. Improve your proprioception, agility, dynamic balance, landing technique and function eg walking, running, squatting, hopping and landing.

We suggest that you discuss your knee injury after a thorough examination and accurate diagnosis from your knee injuries clinician such as your sports physiotherapist, sports doctor or knee surgeon.

If knee pain and symptoms continue to persist fat pad surgery may be an option. Surgical treatment of fat pad impingement may involve arthroscopic debridement or partial removal of the fat pad.

How to Prevent Fat Pad Syndrome?

The best way to prevent occurrence or recurrence of fat pad impingement is to optimise the strength and flexibility of the muscles around the knee, hip and ankle. Your physiotherapist is an expert at guiding you towards the best exercises to correct for any deficits in these areas. 

If you have previously battled fat pad impingement it is best to avoid potentially aggravating activities such as kneeling, squatting and kicking for prolonged periods. For females, it is best to avoid or limit walking in high heels.

For more advice, please consult with your physiotherapist.

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Knee Pain

Common Causes

knee pain

Knee Ligament Injuries

Knee Meniscus

Knee Tendonitis

Muscle Injuries

Children's Knee Conditions

Other Knee-Related Conditions

Knee Surgery

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Fat Pad Syndrome Treatment Options

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Closed Kinetic Chain Exercises
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Orthotics
  • Real Time Ultrasound Physiotherapy
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Prehabilitation
  • Running Analysis
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
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    FAQs about Fat Pad Syndrome

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Massage Styles and their Benefits
  • What Causes Post-Exercise Muscular Pain?
  • Barefoot Running: Your MUST READ Guide to the Pro's and Con's.
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • Heat Packs. Why Does Heat Feel So Good?
  • How Can You Prevent a Future Leg Injury?
  • How Much Treatment Will You Need?
  • Post-Run Soreness: Should You Be Concerned?
  • Runners: How to Reduce Your Knee Stress
  • Sports Injury? What to do? When?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What Can You Do To Help Arthritis?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What's the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
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    Helpful Products for Fat Pad Syndrome

    Knee Injuries

    Excellent for stretching your tight thigh structures: ITB, quadriceps and hamstrings.

    kneecap pain
    More information or to purchase online: Foam roller

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    Last updated 26-Sep-2019 11:45 AM

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