Overview
Hoffa's disease, also known as infrapatellar fat pad syndrome, involves inflammation and pinching of the fat pad beneath the patella, typically resulting from direct or repetitive knee injury. Proper management typically leads to complete recovery, but recurrence and complications are possible.
Description and Causes
- Hoffa's disease is caused by the fat pad beneath the kneecap getting pinched between the femur and tibia, often due to injury.
- Direct knee trauma or repetitive overuse in activities requiring maximal knee straightening or bending are common causes.
- The fat pad's primary function is to protect the patellar tendon from scarring or sticking to the tibia.
Signs and Symptoms
- Pain below the kneecap, especially during activity or knee extension.
- Swelling and tenderness occasionally present near the patellar tendon.
- Symptoms worsen with physical activity.
Risk Factors
- Participation in sports involving forceful knee extension or bending (e.g., jumping, kicking).
- Repeated knee injuries or prolonged kneeling.
- Contact sports like volleyball, soccer, and football increase risk.
Preventive Measures
- Maintain knee flexibility, muscle strength, and endurance.
- Use appropriate knee padding during risky activities.
- Ensure full recovery before resuming sports.
Expected Outcome and Complications
- Most individuals fully recover with appropriate treatment.
- Possible complications include chronic inflammation, recurring symptoms, delayed healing, and disability.
- Surgical risks include infection, bleeding, nerve injury, persistent pain, and tendon rupture.
General Treatment Considerations
- Initial treatment includes rest, ice, anti-inflammatory medication, stretching, and activity modification.
- Physical therapy referral may be needed for persistent symptoms.
- Corticosteroid injections and heel lifts may be recommended in certain cases.
- Surgery is considered only if conservative management fails, usually via arthroscopy to remove inflamed tissue.
Medication
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are commonly used as directed by a physician.
- Topical ointments and stronger pain medications may be prescribed post-surgery if needed.
- Corticosteroid injections are reserved for chronic inflammation, not acute injuries.
Rehabilitation and Exercises
- Stretching and strengthening exercises for quadriceps and hamstrings are recommended, progressing as tolerated.
- Exercise routines include quadriceps stretches, knee flexion, hamstring stretches, short arc quad exercises, step-ups, and wall slides.
- Cold therapy is used for pain and inflammation; heat is applied before stretching.
- Exercise should cease if pain occurs; professional guidance is advised for progression.
Recommendations / Advice
- Notify healthcare provider if symptoms persist beyond two weeks or worsen.
- Report any new symptoms, signs of infection, or complications following surgery immediately.
- Resume exercise and sports only after full symptom resolution and professional clearance.