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You are here: Home / Sports Injuries and Rehabilitation / Hoffa Syndrome or Patellar Tendon Lateral Condyle Friction Syndrome

Hoffa Syndrome or Patellar Tendon Lateral Condyle Friction Syndrome

Dr Arun Pal Singh ·

Last Updated on November 9, 2023

Hoffa syndrome is a condition due to irritation of infrapatellar fat pad and a cause of anterior knee pain. It is also called Hoffa’s disease or fat pad impingement syndrome or simply fat pad syndrome.

Hoff’s fat pad or the infrapatellar fat pad is a cylindrical piece of fat that is situated under and behind the patella bone within the knee. It is very rich in nerve supply.

It is also called patellar tendon lateral condyle friction syndrome.

Contents hide
1 Pathophysiology of Hoffa Syndrome
2 Clinical Presentation
2.1 Hoffa’s test
3 Differential Diagnoses
4 Treatment of Hoffa Syndrome
4.1 Acute Injury
4.2 Taping
4.3 Physical therapy
4.4 Patient Education

Pathophysiology of Hoffa Syndrome

Hoffa syndrome can result from acute trauma or chronic injury. The fat pad can get irritated due to direct trauma to the anterior aspect of the knee or during the course of time.

Chronic irritation is said to occur when on the extension, the inferior pole of the patella tilts back upon the underlying fat pad.

Mostly, this occurs because of hyperextension of the knee. Sports that require frequent kicking or jumping, such as football or volleyball may increase the risk.

Anterior pelvic tilt seen commonly in women wearing high heel shoes pushes the knee into hyperextension which leads to shortening of quadriceps [rectus femoris].

Tightened quadriceps pulls the patella superiorly, tilting the inferior pole posteriorly and causing impingement.

Sports or profession requiring prolonged kneeling are also at risk.

Recurrent episodes of irritation will result in swelling and inflammation of the fat pad and swelling further enhances the impingement, thus setting the vicious cycle.

 

MRI HoffaSyndrome
H-Hoffa’s fat pad, Image Credit: Apple Cart Dec 2011 Vol4

Clinical Presentation

Patients with Hoffa syndrome would present with acute or chronic sharp pain below the patella which is worsened by activities like walking, prolonged standing, wearing high heel shoes or any other activity that puts their knee into full extension.

On examination, there may be swelling in the infrapatellar region, and it is tender to touch.

The patients get significant relief when the inferior pole of the patella is tipped up and away from the fat pad by pushing the superior border of the patella posteriorly. This posterior pressure, by see-saw effect, lifts the inferior pole of the patella, offloading the fat pad from direct pressure from the patella. This leads to a reduction of the symptoms.

Hoffa’s test

Hoffa’s test is a useful diagnostic test which involves palpating the infrapatellar region for pain. The patient lies supine with knees bent and the examiner presses both thumbs along either side of the patellar tendon in the infrapatellar region. 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

Differential Diagnoses

  • Patellofemoral pain syndrome
  • Patellar tendonitis.

Treatment of Hoffa Syndrome

Treatment of this condition is normally by conservative methods such as:

  • Rest and avoiding aggravating activities.
  • Ice therapy to reduce acute pain and inflammation.
  • NSAIDs
  • Ultrasound and TENS.
  • Taping the patella
  • Muscle stretch and strengthening exercises

Acute Injury

In the acute period, the aim is to reduce inflammation and pain. Ice can be applied to the infrapatellar region for approximately 15-20 minutes, 2-3 times a day.

Whenever needed NSAIDs can be used to reduce inflammation and pain. Reduction of swelling itself contributes to the reduction of impingement.

Ultrasound and TENS can also help to reduce inflammation and swelling

Taping

Taping aims at involves lifting up the inferior pole to offload the fat pad and prevent impingement. The medial and lateral border of the patella is pulled diagonally upwards to sling the patella superiorly and the superior border is be taped across horizontally to tilt the inferior pole away from the fat pad. Range of motion of knee may be restricted.

taping-Hoffa-syndrome

Taping may also be done to prevent excessive hyperextension which aids in the reduction of the symptoms.

Physical therapy

Stretching and Strengthening exercises of the quadriceps and hamstring muscles are done to gain a range of motion and strength of the muscle.

Patient Education

The biomechanical factors also need to be addressed Patients are advised to avoid heels and excessive hyperextension of the knee.

 

Sports Injuries and Rehabilitation This article has been medically reviewed by Dr. Arun Pal Singh, MBBS, MS (Orthopedics)

About Dr Arun Pal Singh

Dr. Arun Pal Singh is a practicing orthopedic surgeon with over 20 years of clinical experience in orthopedic surgery, specializing in trauma care, fracture management, and spine disorders.

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Dr. Arun Pal Singh is an orthopedic surgeon with over 20 years of experience in trauma and spine care. He founded Bone & Spine to simplify medical knowledge for patients and professionals alike. Read More…

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