Evaluation and treatment of disorders of the infrapatellar fat pad
- PMID: 22149697
- DOI: 10.2165/11595680-000000000-00000
Evaluation and treatment of disorders of the infrapatellar fat pad
Abstract
The infrapatellar fat pad (IFP), also known as Hoffa's fat pad, is an intracapsular, extrasynovial structure that fills the anterior knee compartment, and is richly vascularized and innervated. Its degree of innervation, the proportion of substance-P-containing fibres and close relationship to its posterior synovial lining implicates IFP pathologies as a source of infrapatellar knee pain. Though the precise function of the IFP is unknown, studies have shown that it may play a role in the biomechanics of the knee or act as a store for reparative cells after injury. Inflammation and fibrosis within the IFP, caused by trauma and/or surgery can lead to a variety of arthrofibrotic lesions including Hoffa's disease, anterior interval scarring and infrapatellar contracture syndrome. Lesions or mass-like abnormalities rarely occur within the IFP, but their classification can be narrowed down by radiographical appearance. Clinically, patients with IFP pathology present with burning or aching infrapatellar anterior knee pain that can often be reproduced on physical exam with manoeuvres designed to produce impingement. Sagittal MRI is the most common imaging technique used to assess IFP pathology including fibrosis, inflammation, oedema, and mass-like lesions. IFP pathology is often successfully managed with physical therapy. Passive taping is used to unload or shorten an inflamed IFP, and closed chain quadriceps exercises can improve lower limb control and patellar congruence. Training of the gluteus medius and stretching the anterior hip may help to decrease internal rotation of the hip and valgus force at the knee. Gait training and avoiding hyperextension can also be used for long-term management. Injections within the IFP of local anaesthetic plus corticosteroids and IFP ablation with ultrasound guided alcohol injections have been successfully explored as treatments for IFP pain. IFP pathology refractory to physical therapy can be approached through a variety of operative treatments. Arthroscopic partial resection for IFP impingement and Hoffa's disease has showed favourable results; however, total excision of the IFP performed concomitantly with total knee arthroplasty (TKA) resulted in worse results when compared with TKA alone. Arthroscopic debridement of IFP fibrosis has been successfully used to treat extension block following anterior cruciate ligament reconstruction, and arthroscopic anterior interval release has been an effective treatment for pain associated with anterior interval scarring. Arthroscopic resection of infrapatellar plicae and denervation of the inferior pole of the patella have also been shown to be effective treatments for refractory infrapatellar pain.
Similar articles
-
An investigation of the anatomy of the infrapatellar fat pad and its possible involvement in anterior pain syndrome: a cadaveric study.J Anat. 2020 Jul;237(1):20-28. doi: 10.1111/joa.13177. Epub 2020 Mar 11. J Anat. 2020. PMID: 32159227 Free PMC article.
-
The surgical treatment of anterior knee pain due to infrapatellar fat pad pathology: A systematic review.Orthop Traumatol Surg Res. 2015 Jun;101(4):469-75. doi: 10.1016/j.otsr.2015.01.019. Epub 2015 Apr 29. Orthop Traumatol Surg Res. 2015. PMID: 25935799 Review.
-
The infrapatellar fat pad is a dynamic and mobile structure, which deforms during knee motion, and has proximal extensions which wrap around the patella.Knee Surg Sports Traumatol Arthrosc. 2018 Nov;26(11):3515-3524. doi: 10.1007/s00167-018-4943-1. Epub 2018 Apr 20. Knee Surg Sports Traumatol Arthrosc. 2018. PMID: 29679117
-
Inflammation of the infrapatellar fat pad.Joint Bone Spine. 2016 Jul;83(4):389-93. doi: 10.1016/j.jbspin.2016.02.016. Epub 2016 Apr 7. Joint Bone Spine. 2016. PMID: 27068617 Review.
-
A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa's disease.Arch Orthop Trauma Surg. 2008 May;128(5):515-9. doi: 10.1007/s00402-007-0397-5. Epub 2007 Jul 24. Arch Orthop Trauma Surg. 2008. PMID: 17647001
Cited by
-
Sonographic Characterization of the Pericruciate Fat Pad with the Use of Compression Elastography-A Cross-Sectional Study among Healthy and Post-Injured Patients.J Clin Med. 2024 Apr 27;13(9):2578. doi: 10.3390/jcm13092578. J Clin Med. 2024. PMID: 38731107 Free PMC article.
-
One-step stromal vascular fraction therapy in osteoarthritis with tropoelastin-enhanced autologous stromal vascular fraction gel.Front Bioeng Biotechnol. 2024 Feb 12;12:1359212. doi: 10.3389/fbioe.2024.1359212. eCollection 2024. Front Bioeng Biotechnol. 2024. PMID: 38410163 Free PMC article.
-
Superolateral Hoffa fat pad edema in adolescent competitive alpine skiers: temporal evolution over 4 years and risk factors.Insights Imaging. 2024 Feb 16;15(1):52. doi: 10.1186/s13244-024-01633-8. Insights Imaging. 2024. PMID: 38365902 Free PMC article.
-
The influence of inflammation on the characteristics of adipose-derived mesenchymal stem cells (ADMSCs) and tissue repair capability in a hepatic injury mouse model.Stem Cell Res Ther. 2023 Nov 19;14(1):334. doi: 10.1186/s13287-023-03532-z. Stem Cell Res Ther. 2023. PMID: 37981679 Free PMC article.
-
A rare cause of Hoffa's fat pad impingement: the crossed-doubled patellar tendon.BJR Case Rep. 2023 May 25;9(6):20220049. doi: 10.1259/bjrcr.20220049. eCollection 2023 Nov. BJR Case Rep. 2023. PMID: 37928710 Free PMC article.
References
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources