Hoffa's Syndrome, Anterior Knee Pain Syndrome
(Fat Pad Impingement)

What is it?

Hoffa's fat pad syndrome can occur when symptoms suggest damage to the meniscus or ligament but investigation shows they are intact. There is pain under the patella and there may be effusion (excessive fluid inside the knee joint). Extending a bent knee with pressure on the patellar tendon will elicits a strong pain and a defensive reaction. With this condition, the fat pad in the anterior portion of the knee becomes inflamed from repeated impingement. Impingement results from excessive pressure on the fat pad. If this occurs in a runner, specialists will usually examine the runners overall biomechanics and running gait to determine why they received this condition in the first place and correct it so that it doe not continue or reoccur; continued symptoms could lead to scarring. A physical exam will reveal tenderness in this fat pad which could be of a varying size.

Treatment

Hoffa's Syndrome is typically treated by a lidocaine injection and non-steroidal anti-inflammatories (NSAIDs), though ultrasound is becoming very popular in treatment for this condition, especially in patients that want to decrease their medication levels. Be sure to rest the area (reduce impact and weight pressures on the knee), regular ice, stretching and physiotherapy are all helpful. An ultrasound application over the affected area 2 to 3 times daily will reduce swelling quickly and increase blood flow to the area - increasing the healing rate of the tendon.

The most common cause of an tendon inflammation (tenosynovitis or tendonitis) is overuse of the affected tendon. Rest of the affected tendon is all that is required in some cases. Other treatments such as anti-inflammatory drugs or a steroid injection are sometimes needed. Infection of a tendon is an uncommon cause but needs treatment with antibiotics if it occurs.

What is tenosynovitis and tendonitis?

* Tendonitis means inflammation of a tendon. (It is sometimes spelled as tendinitis.)
* Tenosynovitis means inflammation of the sheath that surrounds a tendon (the sheath is called the synovium). Tenosynovitis can be caused by calcium deposits, repeated strain or trauma, high levels of blood cholesterol, rheumatoid arthritis, gout, or gonorrhea.
These two conditions often occur together.

Never use Ultrasound over an area injected with a steroid (ie. cortisone) for at least 30 days.

Never use Ultrasound after surgery until your physician recommends and approves of it.