Hoffa’s syndrome, sometimes called infrapatellar fat pad impingement, is a potential cause of pain at the front of the knee involving the fat pad beneath the kneecap and behind the patellar tendon. Symptoms can include pain around or below the kneecap, particularly when straightening the knee, standing with the knee fully straight or during activities that repeatedly load the knee.
What Is Hoffa’s Fat Pad?
Hoffa’s fat pad is also known as the infrapatellar fat pad.
It is a soft tissue structure located at the front of the knee, underneath the kneecap and behind the patellar tendon.
The fat pad is richly supplied with nerves and can therefore be a source of pain when irritated.
It also moves and changes shape as the knee bends and straightens.
What Is Hoffa’s Syndrome?
Hoffa’s syndrome refers to pain associated with irritation or impingement of the infrapatellar fat pad.
Because the fat pad sits at the front of the knee, symptoms are usually felt around or below the kneecap.
The fat pad is not the only structure that can cause pain in this area.
Patellofemoral pain, patellar tendon problems and other knee conditions can produce similar symptoms, which means the location of pain alone does not confirm Hoffa’s syndrome.
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How Can Hoffa’s Fat Pad Become Irritated?
There is not always one clear cause.
Symptoms may develop following a direct injury to the front of the knee or after repeated irritation of the fat pad.
In some people, repeatedly moving into knee hyperextension, where the knee moves beyond a straight position, may aggravate symptoms.
Problems involving the fat pad can also occur following knee surgery or other knee injuries.
Rather than assuming there is one specific cause, it is useful to understand:
- How your symptoms started.
- Which movements aggravate them.
- Whether there has been a previous knee injury or surgery.
- How the knee moves.
- What activities you are trying to return to.
This can help determine whether the fat pad is likely to be contributing to your symptoms and what to do next.
What Are The Symptoms Of Hoffa’s Syndrome?
Symptoms can vary, but may include:
- Pain at the front of the knee.
- Pain around or just below the kneecap.
- Tenderness either side of the patellar tendon.
- Pain when fully straightening the knee.
- Pain when standing with the knee pushed into a fully straight or hyperextended position.
- Discomfort during activities that repeatedly load or straighten the knee.
- Swelling or a feeling of fullness around the front of the knee.
These symptoms are not unique to Hoffa’s syndrome.
Several different knee problems can cause anterior knee pain, so symptoms need to be considered alongside the history and physical assessment.
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How Is Hoffa’s Syndrome Diagnosed?
There is no single symptom that proves your pain is coming from the infrapatellar fat pad.
An assessment may look at:
- Where you feel your pain.
- How the symptoms started.
- Movements that reproduce your symptoms.
- Knee movement.
- Tenderness around the fat pad.
- Strength and control around the knee and lower limb.
- Previous knee injuries or surgery.
- Other possible causes of pain at the front of the knee.
The aim is not simply to find something painful at the front of the knee.
It is to determine whether the fat pad provides a reasonable explanation for your symptoms and whether another knee problem needs to be considered.
Do I Need An MRI For Hoffa’s Syndrome?
Not necessarily.
Imaging can sometimes provide useful information about the infrapatellar fat pad and other structures within the knee.
MRI can show changes involving the fat pad, but scan findings should be interpreted alongside your symptoms and physical assessment rather than being considered in isolation.
Imaging may be considered when the diagnosis remains uncertain, another problem is suspected or the result is likely to change how the condition is managed.
You therefore do not automatically need an MRI simply because you have pain at the front of your knee.
What Are The Treatment Options For Hoffa’s Syndrome?
Treatment depends on what we find during your assessment and what appears to be aggravating your symptoms.
Conservative management is normally considered before more invasive treatment where appropriate.
This may involve:
- Temporarily modifying movements or activities that repeatedly aggravate the knee.
- Gradually restoring comfortable knee movement.
- Strengthening the muscles around the knee and hip where appropriate.
- Improving control of movements relevant to your symptoms.
- Gradually rebuilding the activities you want to return to.
For someone whose symptoms are aggravated by repeatedly pushing the knee into hyperextension, for example, temporarily modifying that movement may form part of the initial plan.
As symptoms improve, rehabilitation can then become progressively more demanding.
There is not one standard exercise programme that everybody with Hoffa’s syndrome needs to follow.
Can Physiotherapy Help With Hoffa’s Syndrome?
Physiotherapy can help assess whether the fat pad is likely to be contributing to your knee pain and identify which movements or activities are currently aggravating your symptoms.
Depending on what we find during your assessment, your rehabilitation may involve improving movement, building strength and gradually increasing what your knee can tolerate.
The aim is not simply to reduce irritation temporarily.
It is to help you progressively return to the everyday activities, exercise or sport that matter to you.
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What If My Knee Pain Is Not Improving?
If your progress is not matching expectations, we reassess.
This may involve:
- Reviewing how your symptoms have changed.
- Retesting relevant movement and strength.
- Reconsidering whether the original explanation still fits.
- Adjusting your rehabilitation or activity.
- Progressing your programme when appropriate.
- Considering imaging if it is likely to change management.
- Considering medical or specialist referral if the presentation warrants it.
We do not want to simply repeat the same treatment indefinitely.
If the clinical picture changes, the plan should change too.
When Should I Get My Knee Assessed?
Consider getting your knee assessed if:
- Your symptoms are not improving.
- Pain is affecting walking, exercise or everyday activity.
- You are struggling to fully straighten the knee.
- The knee repeatedly swells.
- You are struggling to return to sport or training.
- Symptoms developed following a significant knee injury.
- You are unsure whether the pain is coming from the fat pad or another structure.
An assessment can help establish what is most likely contributing to your symptoms and what the next step should be.
Still Struggling With Pain At The Front Of Your Knee?
If pain around your kneecap is not improving or is stopping you from doing the activities you want to do, we can assess your knee and help you understand what may be contributing to the problem.
At Fit2Function, your first appointment lasts 60 minutes and gives us time to understand your symptoms, assess your movement and strength, explain what we find and build a plan around what you want to return to.
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