Fact-sheet: Hoffa's disease


Updated on 08/26/2020 at 2:04 PM

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Definition

Pathology of the infrapatellar fat pad.

Hoffa's fat pad is a wedge-shaped fatty mass located in the anterior aspect of the knee, intracapsular but extrasynovial.
It is bounded anteriorly by the patellar ligament, superiorly by the patella, and posteriorly by the synovium.

This fat is composed of adipose tissue and connective tissue, as well as pluripotent cells.

Inflammation of Hoffa's fat pad results from impingement of the fat between the femur and tibia during extension (acute trauma, microtrauma, overuse)

These changes may lead to fibrosis or ossification of the fat pad.

Predominantly affects young women, and occurs in jumping sports (basketball, volleyball)

Clinical features

  • Patellofemoral syndrome: anterior knee pain when going up and down stairs
  • Limited range of motion (flexion-extension)
  • Hoffa's test: pain on palpation of the medial and lateral borders of the patellar ligament during extension.

Radiography

  • Occasionally, opacification/fullness of Hoffa's fat pad visible on the lateral view of the knee
  • At the late stage: +/- intra-articular chondroma

Ultrasound

  • Joint effusion
  • The fat pad, normally hypoechoic, becomes hyperechoic.
  • Cystic changes of Hoffa's fat pad.

CT

  • Ossification of the infrapatellar fat pad
  • Infiltration of the fat surrounding the ossification

MRI

Edema-like signal abnormality of Hoffa's fat pad, hypointense on T1 and hyperintense on T2 FatSat

Frequent mass effect on the patellar tendon

Management

  • Physical therapy (quadriceps strengthening)
  • NSAIDs
  • Corticosteroid injection
  • Arthroscopic resection

Differential diagnosis

  • Patellofemoral friction syndrome
  • Cyclops syndrome
  • Infrapatellar plica impingement