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Knee Fat Pad Impingement (Hoffa's Syndrome)

Knee fat pad impingement causes pain beneath the kneecap when the infrapatellar fat pad becomes inflamed or pinched. Physiotherapy, strengthening, taping, and movement correction relieve symptoms.

Understanding Knee Fat Pad Impingement

Hoffa's Syndrome occurs when the infrapatellar fat pads — two cushioning structures beneath the kneecap — become irritated, inflamed, or pinched between the bones of the knee joint. The fat pads are highly innervated and very pain-sensitive, making this a particularly uncomfortable condition. It is commonly mistaken for patellar tendinopathy.

Causes

  • Hyperextension injuries, particularly in young women and jumping athletes
  • Repetitive microtrauma from overloading
  • Direct impact to the front of the knee
  • Abnormal patellar mechanics increasing fat pad compression
  • Flat feet or altered lower limb biomechanics

Symptoms

  • Pain on both sides of the patellar tendon (beneath the kneecap)
  • Pain when fully extending or straightening the knee
  • Discomfort with jumping, squatting, or prolonged standing
  • Swelling or feeling of fullness beneath the kneecap
  • Grinding or creaking sensation with knee movement

Treatment

  • Patellar taping to lift the kneecap and reduce fat pad compression
  • Quadriceps and hip strengthening
  • Stretching of the quadriceps and hip flexors
  • Activity modification – avoiding hyperextension
  • Manual therapy and soft tissue treatment
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Rehabilitation & Exercise

Caution: Perform all exercises only as directed by your Healthweave clinician. Stop any exercise that increases your pain and inform your practitioner. Exercise programs are tailored to individual needs and must not be self-prescribed.

Knee Rehabilitation for fat pad impingement focuses on reducing compression of the fat pad, strengthening the muscles that support the knee, and correcting movement patterns that cause repeated impingement. Avoid full knee extension loading in the early phase.

  • Quadriceps strengthening – avoiding hyperextension
  • Hip and gluteal strengthening
  • Knee flexor strengthening – hamstrings
  • Arch support and footwear assessment to correct lower limb alignment
  • Activity modification – reducing jumping, squatting, and stair loading during recovery

Specialist & Regenerative Medicine Options

For chronic fat pad impingement where inflammation has persisted or fibrous scarring has developed, our Prestidge sports physicians can offer specialist treatments.
  • Corticosteroid Injections – Ultrasound-guided injection directly into the inflamed fat pad provides rapid reduction in swelling.
  • Platelet Rich Plasma (PRP) Therapy – For chronic fat pad fibrosis, PRP may stimulate tissue remodelling and restore normal fat pad architecture.
  • Hyaluronic Acid – Where fat pad impingement coexists with early patellofemoral joint degeneration, viscosupplementation may reduce mechanical stress.
  • Image-Guided Needling – For fat pads with chronic fibrous change, ultrasound-guided needling can disrupt scar tissue.

Our sports and exercise physicians at Prestidge work alongside your treating clinician to determine the most appropriate option for your condition, goals, and stage of recovery. All injectable and prescription treatments are subject to individual clinical assessment. Visit healthweave.com.au or prestidge.com to learn more.

Important: All specialist consultations, prescription treatments, and injectable procedures are subject to individual clinical assessment by a registered medical practitioner. Suitability, benefits, and risks will be discussed at your consultation. No outcomes are guaranteed. Prescription medicines are only available following appropriate medical review in accordance with TGA and AHPRA requirements. Exercise programs should be performed only as directed by your Healthweave clinician. Exercise images © CPDO / Educom Pty. Ltd. — used under licence.