Hoffa's Syndrome

Question 1

What tissue is affected by Hoffa’s Syndrome?

Answer 1

The Infrapatellar fat pad

Question 2

What is the function of the Infrapatellar fat pad?

Answer 2

Distributes pressure across the PFJ and facilitates flexible deformation of the knee. May also have a role in proprioception due to the high density of nerves within.

Question 3

What is Hoffa’s Syndrome?

Answer 3

Acute or Chronic inflammation of the Infrapatellar Fat Pad (IFP).

Question 4

Where is the IFP located?

Answer 4

Found in the anterior knee compartment, it is intracapsular but is extra-synovial / extra-articular.

Question 5

Tell me about about the Pathophysiology of Hoff’s Syndrome, including the Risk Factors:

Answer 5

Little is known about the development.
MOI is likely overuse or repeated micro-traumas.
Risk factors: Young, Female, Jumping Athletes, Ligamentous Laxity.

Question 6

What is Hoffa’s Test?

Answer 6

A test to clinically diagnose IFP impingement, the knee is flexed over the PT’s leg and then the PT pinches the medial and lateral patellar tendon. The knee is then passively extended.
+ve = pain during final 10 degrees of KE.
This manoeuvre forces the inflamed fat pad into the PFJ.

Question 7

What objective findings suggest IPD inflammation is present?

Answer 7

+ve Hoffa’s Test
Pain during Hyperextension
Adhesion / Restriction on patella glides

Question 8

Is Hoffa’s Syndrome present usually as a primary disorder or is it typically secondary to other pathologies?

Answer 8

~1% of AKP = isolated fat pad
~7% as a secondary disorder to Meniscal Injuries or ACL rupture.

Question 9

What is the clinical presentation of Hoffa’s?

Answer 9

Effusion & Dec. ROM
AKP aggrev. by Long Walks, Flat Shoes, Prolonged Standing, Hill walking.

Question 10

What is the best imaging technique to diagnose IFP inflammation?

Answer 10

MRI referral recommended to exclude other pathologies and if history of trauma.

Question 11

What is the management for Hoffa’s Syndrome?

Answer 11

Conservative:
Stretch & Strengthen
?+ Taping, NSAIDS, Corticosteroids

Orthopaedic surgeon referral if not successful.

Question 12

What foot wear should be avoided for someone with Hoffa’s Syndrome?

Answer 12

Flat footwear should be avoided to minimise IFP loading and avoid hyperextension.

Question 13

What is the relationship between BMI and Hoffa’s Syndrome?

Answer 13

Higher BMI = Worse Symptoms of Hoffa’s.