Hoffa's Disease (Infrapatellar Fat Pad Syndrome)

with Rehab

ExitCare ImageInfrapatellar fat pad syndrome, also called Hoffa's disease, involves pain below the kneecap (patella) due to the thigh bone (femur) and shinbone (tibia) pinching fatty tissue below the patella. The fat pad is meant to protect the patella from injury.

SYMPTOMS

  • Pain below the patella.

  • Pain that gets worse with physical activity, including sports or when completely straightening the knee.

  • Swelling of the knee (sometimes).

  • Tenderness and swelling (sometimes) on either side of the tendon connecting the kneecap and shinbone (patellar tendon).

CAUSES

Hoffa's disease may be caused by severe injury (acute trauma) or ongoing (chronic) stress on the fat pad below the kneecap. This often occurs during activities that require full bending or full extension of the knee. The fat pad is pinched between the thigh bone and shinbone, and becomes inflamed, causing pain.

RISK INCREASES WITH:

  • Sports that require repeated, forceful straightening or bending of the knee (kicking or jumping).

  • Repeated injuries to the knee.

  • Sports in which the knee may receive direct injury (volleyball, soccer, football) or those that require prolonged kneeling.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded knee protection.

  • Allow complete recovery before returning to sports.

PROGNOSIS

If treated properly, symptoms of Hoffa's disease usually go away.

RELATED COMPLICATIONS

  • Frequently recurring symptoms, that result in a chronic problem.

  • Disability that impairs an athlete's ability to compete.

  • Delayed healing or resolution of symptoms, especially if activity is resumed too soon.

  • Risks of surgery: infection, bleeding, injury to nerves (numbness, weakness, paralysis), continued pain and pinching of the fat pad, and tearing of the patellar tendon.

TREATMENT

Treatment first involves the use of ice and medicine to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. Your caregiver may advise corticosteroid injections for serious cases, to reduce inflammation. A heel lift may be worn in the shoe, to prevent full extension of the knee. Surgery is rarely performed for this condition.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Ointments applied to the skin may help.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • Any of the following occur after surgery:

  • Pain, numbness, or coldness in the foot and ankle.

  • Blue, gray, or dark color appears in the toenails.

  • Increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever).

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Hoffa's Disease (Infrapatellar Fat Pad Syndrome)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your healthy knee, placing your foot flat on the floor.)

  • Slowly slide your right / left heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool.

  • Keep a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist, until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Hoffa's Disease (Infrapatellar Fat Pad Syndrome)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

ExitCare Image STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your knee so that the knee slightly bends.

  • Raise only your lower leg by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 pound/0.5 kilogram increments.

ExitCare Image STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to be sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended, and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more, and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Step-Ups

  • Use a thick book, step or step stool that is __________ inches tall.

  • Hold a wall or counter for balance only, not support.

  • Slowly step-up with your right / left foot, keeping your knee in line with your hip and foot. Do not allow your knee to bend so far that you cannot see your toes.

  • Slowly unlock your knee and lower yourself to the starting position. Your muscles, not gravity, should lower you.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Wall Slides

Follow guidelines for form closely. Increased knee pain often results from poorly placed feet or knees.

  • Lean against a smooth wall or door, and walk your feet out 18-24 inches. Place your feet hip width apart.

  • Slowly slide down the wall or door until your knees bend __________ degrees.* Keep your knees over your heels, not your toes, and in line with your hips, not falling to either side.

  • Hold for __________ seconds. Stand up to rest for __________ seconds between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

* Your physician, physical therapist or athletic trainer will alter this angle, based on your symptoms and progress.