Hoffa Disease

What is Hoffa Disease

Hoffa disease is a condition that causes pain in front of the knee, below the kneecap. The pain is caused by pinching (impingement) of a swollen or scarred mass of fatty tissue (fat pad) below your kneecap. There are two kinds of Hoffa disease:

  • Acute Hoffa disease. This kind develops due to a recent injury.
  • Chronic Hoffa disease. This kind develops over time.

Hoffa disease is also called infrapatellar fat pad impingement.

What are the causes?

Acute Hoffa disease is caused by an injury to the fat pad below your kneecap. It can happen if:

  • You are hit under your kneecap.
  • You fall on your knee.
  • You forcefully straighten your knee more than normal (hyperextend your knee).

Chronic Hoffa disease can be caused by repeated minor injuries, such as:

  • Repeatedly kneeling or falling on a hard surface.
  • Repeatedly hyperextending your knee.

What increases the risk?

This condition is more likely to develop in people who play:

  • Contact sports, such as hockey and football.
  • Sports that involve forceful extending of the knee, such as football and soccer.

What are the signs or symptoms?

The main symptom of this condition is pain in the front of your knee. The pain may:

  • Be burning or aching.
  • Get worse when you straighten your knee, squat, or stand for long periods of time.
  • Be felt when you touch or move the kneecap (patella).

There may also be swelling below the patella.

How is this diagnosed?

This condition may be diagnosed with:

  • Your medical history.
  • A physical exam. The exam may include straightening your knee with pressure near the fat pad and moving your knee in different directions.
  • MRI. This may be done to look for swelling or changes to the fat pad.

How is this treated?

This condition may be treated by:

  • Resting your knee until swelling and pain improve.
  • Icing your knee.
  • Taking over-the-counter pain medicine to reduce pain and swelling.
  • Wrapping or taping your knee.
  • Injecting the fat pad with numbing and anti-inflammatory medicine (steroid).
  • Doing knee exercises.
  • Avoiding putting direct pressure on your knees, such as by kneeling.
  • Staying aware of the way you walk and stand so your knee does not hyperextend.

If these treatments are not helpful, you may need to have surgery. Surgery usually includes taking out the part of the fat pad that is causing pain.

Follow these instructions at home:

If your knee is wrapped or taped:

  • Wear the wrap or tape as told by your health care provider.
  • Loosen the wrap or tape if your toes tingle, become numb, or turn cold and blue.
  • Remove the wrap or tape only as told by your health care provider.

Managing pain, stiffness, and swelling

  • If directed, apply ice to your knee.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your toes often to avoid stiffness and to lessen swelling.
  • Raise (elevate) your knee above the level of your heart while you are sitting or lying down.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Avoiding putting direct pressure on your knees, such as by kneeling, for as long as told by your health care provider.
  • Do exercises as told by your health care provider.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure to use equipment that fits you.
  • When playing contact sports, wear pads that protect your knees.
  • Be safe and responsible while being active to avoid falls.
  • Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.

Contact a health care provider if:

  • Your knee pain or swelling is not improving after 2 weeks of home treatment.
  • Your knee pain or swelling is getting worse.

Hoffa Disease Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain, swelling, numbness, and tingling.

Exercise A: Quadriceps, prone

  1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
  2. Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
  3. 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.
  4. Hold this position for __________ seconds.

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

Exercise B: Superior patellar mobilization

  1. Sit with your legs out in front of you.
  2. Place your fingertips on the bottom border of your left / right kneecap. Keep your thigh muscles relaxed.
  3. Gently pull toward you so your kneecap slides up toward your hip.
  4. Hold this position for __________ seconds.

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

Exercise C: Standing lunge (hip flexors)

  1. Stand with your left / right foot 2–3 ft (0.6–1 m) in front of your other foot.
  2. Keeping good posture with your head over your shoulders, tuck your tailbone underneath you and shift your hips forward. You should feel a gentle stretch in the front of your back thigh and hip.
  3. Hold this position for __________ seconds.

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

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise D: Wall slides (quadriceps)

  1. Lean your back against a smooth wall or door while you walk your feet out 18–24 inches (46–61 cm) from it.
  2. Place your feet hip-width apart.
  3. Slowly slide down the wall or door until your knees bend __________ degrees. Keep your knees over your heels, not your toes. Keep your knees in line with your hips.
  4. Hold for __________ seconds.
  5. Push through your heels to stand up to rest for __________ seconds after each repetition.

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

Exercise E: Straight leg raises (hip abductors)

  1. Lie on your side with your left / right leg in the top position. Lie so your head, shoulder, knee, and hip line up. You may bend your bottom knee to help you keep your balance.
  2. Roll your hips slightly forward so your hips are stacked directly over each other and your left / right knee is facing forward.
  3. Leading with your heel, lift your top leg 4–6 inches (10–15 cm). You should feel the muscles in your outer hip lifting.
    1. Do not let your foot drift forward.
    1. Do not let your knee roll toward the ceiling.
  4. Hold this position for __________ seconds.
  5. Slowly lower your leg to the starting position.
  6. Allow your muscles to relax completely.

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

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