What is an Infrapatellar Fat Pad?
The infrapatellar fat pad is also known as the Hoffa Pad after being discovered by Albert Hoffa in 1904. It is one of three fat pads in the front of your knee. It is located below the knee cap and above the patellar tendon, enclosed by the thigh bone and shin bone, and resting between the knee joint capsule and connective tissues of your knee. It is composed of fat lobules separated by thin fibrous cords, making it a flexible soft tissue structure which can accommodate the mobility of your knee. In addition, the infrapatellar fat pad is rich in nerve structures, having branches of the femoral, peroneal and saphenous nerves, which make it one of the most sensitive areas of the knee.
Why is the Infrapatellar Fat Pad Important?
Hoffa’s Fat Pad is your knee bones cushioning shock absorber. It reduces the friction between your patella (knee cap), patella tendon, and the boney structure of your knee. It also prevents pinching of the connective tissues that encapsulate your knee joint. And even though it is one of the most sensitive areas in the knee, it is commonly overlooked as the source of anterior knee pain. This is because many of the symptoms associated with Hoffa’s Knee Pad Syndrome can also be present with a number of other knee injuries.
Symptoms of Infrapatellar Fat Pad Syndrome?
Symptoms of Infrapatellar Fat Pad Syndrome include:
- swelling of the knee
- front aspect knee pain
- pain below the knee cap
- pain with leg strengthening exercises
- pain during squatting motions
- pain during kicking movements
- pain with prolonged walking
- pain when wearing heels
Causes of Injury to the Infrapatellar Fat Pad?
Your knees’ Hoffa Pad can cause pain and limitation when there is micro trauma, major trauma, post-surgical scaring, obesity, osteoarthritis and/or non-optimal movement patterns. Trauma to the fat pad can occur from a notable injury to the front of the knee or from something as minor as tight quadriceps muscle, hyper-extension of the knee and/or a forward pelvic tilt. The infrapatellar fat pad can also be pinched by the knee cap and shin bone. Once trauma has occurred, the resulting swelling and inflammation alters the knees’ movement pattern making it more likely for the micro trauma or pinching to reoccur. This is especially true for osteoarthritis in the knee as there is often repeated flare ups of knee inflammation. Obesity is also a risk factor for Hoffa’s pad syndrome as inflammation is triggered by the ongoing strain to the knee joint.
What Tests Confirm Hoffa’s Syndrome?
If you are worried that you may be experiencing Hoffa’s syndrome, It is best to visit a trusted physical therapist or sports medicine consultant so that they can provide a thorough examination of your knee and associated movement patterns. They will perform the Hoffa’s test, an assessment technique which involves movement of the knee cap during contraction of the quadriceps muscle. Although an MRI can be used to diagnose the source of inflammation, it cannot indicate the root of the problem and why it is that the Hoffa’s pads is being irritated. Only a trusted health care practitioner can evaluate the root of the problem and provide individualized treatment to resolve the issue.
Physical Therapy Treatment Techniques for Fat Pad Syndrome
Your Rebalance therapist will create an individualized treatment plan based on your mechanism of injury, your movement patterns, your muscle imbalances and your overall treatment goals. The aim of treatment is pain reduction, normalized range of motion, improved strength through the leg as well as improved proprioception and control to avoid future re-injury. Treatment methods for Fat Pad Syndrome include, but are not limited to:
- Ice to reduce inflammation
- Manual therapies to improve lower extremity alignment and mobility
- Ultrasound or laser therapy to promote tissue healing
- Taping of the knee for support and to offload the inflamed tissues
- Corrective exercises for strength, flexibility and proprioception