Infra-patellar Fat Pad Syndrome (Hoffa’s Syndrome)

Infrapatellar Fat Pad Syndrome (IPFPS), also known as Hoffa's disease occurs when the fatty tissue under the knee-cap is pinched between the femur (thigh bone) and tibia (shin bone). The fat pad is located at the front of the knee joint below the patella and sits either side of the patella tendon (tendon from the knee-cap to the shin bone). The fat pad is richly innervated by nerves and blood vessels, hence it can be easily irritated.

Pain under the knee-cap such as burning or aching is the most common symptom. Activities that straighten the knee or repeated kneeling, repeated jumping and landing can aggravate the condition. Swelling under the knee-cap can be present along with tenderness on palpation.

IPFPS commonly caused by acute trauma, such as falling onto the knee or from knee surgery. Repetitive microtrauma that occurs with biomechanical deficits may also irritate the IPFP. A classic example are patients with 'squinting patellae' where the knee-cap faces in, which places undue loading on the IPFP.

IPFPS is usually correctable with physiotherapy. Management involves settling the inflammation with ice, rest and avoidance of aggravating activities. Anti-inflammatory medication may be useful, although a check with your pharmacist prior to commencing this medication is advisable.

Taping the knee to offload and shorten the fat pad is often very successful in reducing pain and immediately improving function. Strengthening of the lower limb musculature such as the quadriceps, gluteals and calf to further offload the IPFP may be indicated. Correction of any biomechanical factors such as foot mechanics, knee and pelvic mechanics is essential. Stretching or releasing tight muscles may also be indicated, especially those around the front and side of the hip.

Severe cases may warrant a cortizone injection and those cases that are not responding may go on to have surgery.

All Physica staff have received training in the diagnosis and management of IPFPS. We will conduct a thorough examination to identify all of your contributing factors and we will devise a step by step plan to return you to optimal health.

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