Introduction:- Hoffa's pad syndrome also known as Infrapatellar fat syndrome is an intrinsic disease of Hoffa's fat pad and a problem of knee joint which causes the pain at the front of knee joint so this pain is known as anterior knee pain. Hoffa's fat pad contains pluripotent cells that can differentiate into osteoblasts and chondrocytes. Hoffa's pad becomes inflamed or Damaged by The crushing of the pad between the femur and tibia during extension, causes inflammation of Hoffa's fat pad. Nerve supply of fat pad is excellent( It receives branches of the femoral , common peroneal and saphenous nerves) so if it occurs any injury ,causes a sharp anterior knee pain. The infrapatellar fat pad is a pad of adipose tissue underneath or deep to the patella tendon and the top of the fat pad attaches to the lower part of patella (knee cap). hoffa's pad is a shock absorber ,when there is a direct force on the patella can result in pinching of the fat pad between femur and tibial plateau. The tibial plateau is the proximal tibial surface on which the femur rests. HFP is surrounded anteriorly by the patellar tendon and the joint capsule, superiorly by the inferior pole of the patella, inferiorly by the proximal tibia and the deep infrapatellar bursa, and posteriorly by the joint synovium . The main function of the HFP is to reduce friction between the patella, the patellar tendon, and the deep skeletal structures. In addition, it prevents pinching of the synovial membrane and it facilitates the vascularization of adjacent structures. Causes:- cause is usually due to single or repetitive traumatic episodes. when you extend your knee the fat pad act as a cushion and reduces friction between outer patella facets and quadriceps tendons . when you flex your knee ,upper part of fat pad becomes tensioned, it moves backwards in the knee. it develops gradually over time if you repeatedly move your knee. This is when your knee is forced to move forward from its completely straight normal position. You may have always been able to over straighten your knee, which is called knee hyperextension or genu recurvatum  . hyperextension sports such as basketball, volleyball or high jumping may also cause inflammation of Hoffa's pad. Hoffa's disease is more frequent in young women and the symptoms are anterior knee pain when upstairs and downstairs. Sign and Symptoms:- Complaints of anterior knee pain occurs when playing hyperextension sports such as basketball ,volleyball or high jumping .effusion and inflammation may be occurs and decreases the ROM of joint , stair negotiation . Symptoms may worsen if the knee is overly straightened or bent for too long a period. Complications may include an inability to fully straighten the knee. Diagnosis:- Hoffa's syndrome completely diagnosed by MRI .we have requirement of an experienced orthopaedics to diagnose it. primary Assessment have to check the Active and Passive Range Of Motion(AROM/PROM) of Hip joint and Knee joint.

1. HOFFA'S SYNDROME : WHAT IS FAT PAD
IMPINGEMENT

2. HOFFA'S SYNDROME : WHAT IS FAT PAD IMPINGEMENT
▪ Hoffa's pad syndrome also known as Infrapatellar fat syndrome is an intrinsic disease
of Hoffa's fat pad and a problem of knee joint which causes the pain at the front of
knee joint so this pain is known as anterior knee pain.
▪ Hoffa's fat pad contains pluripotent cells that can differentiate into osteoblasts and
chondrocytes.
▪ Hoffa's pad becomes inflamed or Damaged by The crushing of the pad between the
femur and tibia during extension, causes inflammation of Hoffa's fat pad.
▪ Nerve supply of fat pad is excellent( It receives branches of the femoral , common
peroneal and saphenous nerves) so if it occurs any injury ,causes a sharp anterior
knee pain.
▪

4. ▪ The infrapatellar fat pad is a pad of adipose tissue underneath or deep to
the patella tendon and the top of the fat pad attaches to the lower part of
patella (knee cap).
▪ hoffa's pad is a shock absorber ,when there is a direct force on the patella
can result in pinching of the fat pad between femur and tibial plateau. The
tibial plateau is the proximal tibial surface on which the femur rests.
▪ HFP is surrounded anteriorly by the patellar tendon and the joint capsule,
superiorly by the inferior pole of the patella, inferiorly by the proximal
tibia and the deep infrapatellar bursa, and posteriorly by the joint
synovium .
▪

5. ▪ The mainfunction of theHFP is to reduce friction betweenthe
patella,the patellartendon,and thedeep skeletalstructures. In
addition,it preventspinchingof thesynovial membraneand it
facilitates thevascularization of adjacentstructures.

6. WHAT IS THE CAUSES OF HOFFA'S SYNDROME
▪ cause is usually due to single
or repetitive traumatic
episodes.
▪ when you extend your knee
the fat pad act as a cushion
and reduces friction between
outer patella facets and
quadriceps tendons .
▪ when you flex your knee
,upper part of fat pad
becomes tensioned, it moves
backwards in the knee.

7. ▪ it develops gradually over time
if you repeatedly move your
knee.
▪ This is when your knee is
forced to move forward from
its completely straight normal
position.
▪ You may have always been able
to over straighten your knee,
which is called knee
hyperextension or genu
recurvatum .
▪ hyperextension sports such
as basketball, volleyball or high
jumping may also cause
inflammation of Hoffa's pad.

8. ▪ Hoffa's
disease is
more
frequent in
young
women and
the
symptoms are
anterior knee
pain when
upstairs and
downstairs.

9. WHAT ARE THE SYMPTOMS OF HOFFA'S SYNDROME.
▪ Complaints of anterior knee pain occurs when playing hyperextension
sports such as basketball ,volleyball or high jumping .effusion and
inflammation may be occurs and decreases the ROM of joint , stair
negotiation .
▪ Symptoms may worsen if the knee is overly straightened or bent for
too long a period. Complications may include an inability to fully
straighten the knee.

10. HOW WE CAN DIAGNOSED HOFFA'S SYNDROME
▪ Hoffa's syndrome completely diagnosedby MRI .we haverequirementof
an experienced orthopaedicsto diagnoseit.
▪ primaryAssessment have to check the Active and Passive Range Of
Motion(AROM/PROM)of Hip joint and Knee joint.Can check strength
of Quadriceps muscles, Glutealmuscle .
▪

11. HOW CAN TREAT HOFFA'S SYNDROME
Initially, the aim of treatment for infrapatellar fat pad syndrome is to reduce
pain and inflammation,
which can with reduced by rest and medicines.
Further treatments include taping the knee and strengthening exercises
which provided by a physiotherapist or an orthopedic expert.
▪

12. PHYSIOTHERAPY
▪ your physiotherapist
will asses you and will
make a plan .Tapping
may be used to
offload the inferior
pole of patella ,
strengthen of
Quadriceps muscle
throw painfree
exercises and pain
reduction by using
Soft Tissue
Management.

13. ▪ Soft Tissue Management:- proper adjustment of physio hand can be use for Reducing Pain , Improving
Muscle Relaxation, Re-educate proper joint movement and Improving the Ability of joints to move
normally.
▪ Neuromuscular Re-education:- Improving muscle co-ordination ,or Facilitating muscle firing in muscle
that are or inhibited.
▪ Stabilization :- Exercises targeted to your specific goals, fitness, activities.

14. ▪ Ultrasound:- Ultrasound can
be effective to calm down
irritable tissue that may not
respond well to hands on
techniques.
▪ it may also be used to
reduce local swelling, relax
tissue, improve blood flow
for tissue healing and break
down scar tissue.

15. THANK YOU
Om Pal Singh (BPT)
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