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INFRAPATELLAR FAT PAD SYNDROME “Hoffa’s Syndrome”

September 26, 2016

 

The Infrapatellar Fat Pad is a soft tissue structure that lies just posterior to the patella in what is called the anterior interval.  Although, there is no definitive function of the fat pad, it is said to be the buffer for direct forces placed on the anterior knee as well as protect the underlying structures.  When direct force occurs to the patella pinching of the fat pad between the femoral condyle and/or tibial plateau can result.  Due to the increased vascularity and nerve innervation of the fat pad, increased pinching will eventually lead to sharp anterior knee pain.

 

Symptoms:                                                                                                                    

Complaints of anterior knee pain                              

Clicking/catching reported at the knee                    

Positive Hoffa’s test and Patellar tilt test                   

Pain with knee extension                                            

Stair negotiation ascending > descending              

Prolonged period of Flexion                                                                        

Extension Block tasks

Decreased patellar mobility

 

Assessment:

Knee/Hip/Ankel AROM/PROM

Patellar mobility

Quadricep Strength

Gluteal Strength

Function Testing - squatting, gait, single limb balance, daily work/sport specific

 

Conservative Treatment:

Physical therapy to address; hip/knee/ankle range of motion, Quad*/Gluteus retraining, gait training, functional  lower extremity mechanics in closed chain, pain reduction with soft tissue management and modalities as needed.

Taping may be used to offload the inferior pole of the patella and allow for decreased pinching or pressure on the fat pad

*It is important to adjust quadricep exercises to effectively strengthen through painfree motion, as typical fat pad syndrome presents with pain in full knee extension when in open chain. Thus, lending to a more closed chain biased exercise regime. 

 

Surgical Intervention (if conservative treatment :

Fat Pad excision- All or partial of the fat pad is removed as to offload the pain

Debridement of Fibrosis on/near Fat pad

Anterior Interval Release

Synovectomy

Infrapatellar plica release

Denervation of the inferior pole of the patella

 

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