Clinical Education

Fat Pad

Infrapatellar fat pad syndrome, also called Hoffa’s disease, involves pain below the kneecap (patella) due to the thigh bone (femur) and shinbone (tibia) pinching fatty tissue below the patella.

The fat pad is meant to protect the patella from injury


MRI T2WI sagittal images of knee showing hyperintense lesion from Hoffas fat pad

Subjective Examination:

Severe injury (acute trauma) or ongoing (chronic) stress on the fat pad below the kneecap. This often occurs during activities that require full bending or full extension of the knee. The fat pad is pinched between the thigh bone and shinbone, and becomes inflamed, causing pain.
Patient involved in sports that require repeated, forceful straightening or bending of the knee (kicking or jumping).
Pain reported below the patella.
Patient reports that pain that gets worse with physical activity, including sports or when completely straightening the knee.
Objective Examination:

Swelling of the knee (sometimes).
Tenderness and swelling (sometimes) on either side of the tendon connecting the kneecap and shinbone (patellar tendon).
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).
Observation of Genu Recuvatum (hyperextended knees)

Image from OpenI – Licensed by CC
Image from OpenI – Licensed by CC

Treatment :

If you feel that your patient is suffering with patella fat pad syndrome then refer to physiotherapy and we can work with the patient to get them back to sport through:

The use of ice to reduce pain and inflammation.
The use of strengthening and stretching exercises to help reduce pain with activity. These exercises may be performed at home or with a therapist.
A heel lift may be worn in the shoe, to prevent full extension of the knee.
Taping/ strapping can also help

Image from OpenI – Licensed by CC
Image from OpenI – Licensed by CC