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Fat Pad Impingement or Hoffa’s Pad Impingement: Symptoms, Treatment- Ice, TENS Unit

The infrapatellar fat pad also called as the Hoffa’s pad is a bulk of fatty tissue that lies below the kneecap and behind the patellar tendon. It acts as a cushion in order to absorb the direct pressure or impact to the knee.[1]

Fat Pad Impingement or Hoffa's Pad Impingement

About Fat Pad Impingement or Hoffa’s Pad Impingement

The infrapatellar fat pad is a soft tissue which lies beneath the kneecap. It separates the patella from the femoral condyle. It acts as a cushion to absorb direct pressure or impact to the knee hence protecting the underlying structures in the knee. In case of a severe or forceful trauma impacting the kneecap directly results in impingement of the fat pad between the femoral condyle and patella causing excruciating pain to the affected person since it is an extremely sensitive structure of the knee. Extension or straightening of the knee results in further irritation and hence this condition is usually chronic in nature and may result in significant inflammation.[2]

Symptoms of Fat Pad Impingement or Hoffa’s Pad Impingement

  • Pain in the front part of the knee.
  • Tenderness beneath the kneecap.
  • Swelling beneath the kneecap.
  • The fat pad can get impinged if a person has had hyperextension of the knee previously, a condition called as genu recurvatum.
  • Sometimes, the swelling may result in bulging of the bottom of the kneecap outwards.
  • Hoffa’s test is positive.

Treatment for Fat Pad Impingement or Hoffa’s Pad Impingement

  • Adequate rest and avoidance of activities that can further irritate the fat pad.
  • Use of ice helps in reduction of inflammation and pain.
  • Use of TENS unit and ultrasound is useful in pain and inflammation.
  • Exercises to strengthen the muscles are done so that the strength of the adjoining muscle groups are maintained.
  • Anti-inflammatory medicines also help in reducing inflammation.
  • Steroid injections may also be given in some cases.
  • Stretching the quadriceps and hip flexor muscles lessens some of downward pressure that the patella applies to the fat pad and helps in the healing process.
  • Another extremely useful treatment for this injury is taping of the patella, especially taping the upper portion giving extra space to the structures beneath the lower surfaces thus putting less stress on the fat pad and promote healing.
  • In cases of failure of conservative treatment, surgery is required. The surgical procedure may completely or partially remove the fat pad for pain relief.[3]


Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 6, 2020

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