Fat Pad Syndrome

Fat Pad Syndrome

Article by John Miller

Fat Pad Syndrome

Fat Pad Impingement, Hoffa’s Syndrome

What is Your Hoffa’s Fat Pad?

Hoffa’s fat pad is your knee fat pad, or infrapatellar fat pad is a soft tissue structure that lies just below and under the patella tendon. The fat pad has abundant nerve innervation, making it one of the most pain-sensitive knee structures.

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

What Causes Fat Pad Syndrome?

  • A 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. e.g. patellar tendinopathy or patellofemoral joint pain syndrome. Hence, it is best to contact your knee 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. Also, 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 diagnose fat pad inflammation, but it is not very accurate for diagnosing fat pad impingement. A thorough assessment by your physiotherapist or sports doctor is usually able to provide you with a more definitive movement associated diagnosis.

Please seek the advice of your physiotherapist.

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. Modalities may include 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, e.g. 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 clinicians 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 the occurrence or recurrence of fat pad impingement is to optimise the muscles’ strength and flexibility around the knee, hip, and ankle. Your physiotherapist is an expert at guiding you towards the best exercises to correct 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 limit walking in high heels.

Please seek the advice of your physiotherapist.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

Knee FAQs

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your knee physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.