Original Article
Impingement of Infrapatellar Fat Pad (Hoffa’s Disease): Results of High-Portal Arthroscopic Resection

https://doi.org/10.1016/j.arthro.2007.05.013Get rights and content

Purpose: We performed a retrospective cohort study with prospective data collection to assess clinical and functional outcomes of painful impingement of the infrapatellar fat pad (Hoffa’s disease) treated with high-portal arthroscopic resection. Methods: Hoffa’s disease as an isolated lesion was confirmed by arthroscopy in 34 patients with recalcitrant anterior knee pain. The visualization portals were made high in the soft spot above the level of the lower pole of the patella. Patients were treated by resection of the affected part of the fat pad and assessed via the Lysholm knee and Tegner activity level scales preoperatively and at 3 months and at 1 year postoperatively, as well as at the conclusion of this study. Results: The mean age of the patients was 38 years (range, 19 to 62 years). The mean duration of symptoms before surgery was 10 months (range, 1 to 22 months). Twelve patients had one or more previous failed arthroscopies at other centers. The mean follow-up period was 68 months (range, 49 to 95 months). The mean improvement in Lysholm score was 44.76, 55.58, and 53.97 at 3 months, at 1 year, and at the latest follow-up, respectively. On the basis of the Tegner activity level, all but 4 patients returned to their preinjury status. A statistically significant negative correlation was found between duration of symptoms and gain in Lysholm score after surgery (Pearson r = −0.58). Three types of lesion were identified. After resection, patients with acute lesions (type 1) had a quicker return to their previous level of activity according to the Tegner scale as compared with patients with chronic lesions (types 2 and 3) (P = .05 and .03, respectively). Conclusions: Patients with Hoffa’s disease without any other concomitant pathology can expect resolution or long-term improvement in their symptoms and function after arthroscopic resection. Level of Evidence: Level IV, therapeutic case series.

Section snippets

Methods

We performed a retrospective analysis of a consecutive series of patients with the diagnosis of isolated Hoffa’s disease treated with high-portal arthroscopic resection of the infrapatellar fat pad between January 1993 and December 2001, with prospective data collection. Patients with additional intra-articular pathologies were excluded.

All of the patients in this series had been treated with oral analgesics or nonsteroidal anti-inflammatory drugs (or both) and had undergone physiotherapy for

Results

In this study 34 patients (22 men and 12 women) were diagnosed and treated for isolated Hoffa’s disease. The mean age at presentation was 38 years (range, 19 to 62 years), and the mean duration of symptoms before surgery was 10 months (range, 1 to 26 months). The right knee was involved in 19 patients and the left in 15. Of the patients, 32 performed regular sporting activities, but only 23 (67%) described a definite injury to the knee precipitating their symptoms (their mechanism of injury is

Discussion

Metheny and Mayor4 described the anatomy of the infrapatellar fat pad based on their cadaveric study and were the first investigators to report its arthroscopic resection, in 4 patients. Jacobson et al.9 and Saddik et al.10 described the MRI appearance of the infrapatellar fat pad in various disorders, stressing the importance of this diagnostic tool. We did not use MRI in patients clinically suspected to have isolated Hoffa’s lesions, because awake patients in the scanner do not fully extend

Conclusions

Patients with symptomatic impingement of the fat pad without any other concomitant pathology can expect resolution or long-term improvement in their symptoms and function after arthroscopic resection.

Acknowledgment

The authors thank Anna Taylor for help in collection and compilation of data, Dr. Korostoff for histologic analysis, and Dr. Herman-Kuiper for statistical advice. They also thank the illustration departments of Royal Glamorgan Hospital, Flantrisant, and Morriston Hospital, Swansea.

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Study conducted at Hemel Hempstead General Hospital, St. Albans City Hospital, and BUPA Hospital, Harpenden, England. The authors report no conflict of interest.

Note: To access the supplementary Table 2 accompanying this report, visit the November 2007 issue of Arthroscopy at www.arthroscopyjournal.org.

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