[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-417438-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-417438-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","chronic-infrapatellar-fat-pad-fibrosis-hoffas-disease-a-report-of-two-cases","Chronic Infrapatellar Fat Pad Fibrosis: Hoffa’s Disease - A Report of Two Cases","","Fibrosis of the infrapatellar fat pad (Hoffa’s disease) is an often overlooked cause of anterior knee pain in young, active individuals. A diagnostic approach is described in which the fat pad is injected with local anesthetic and then stressed using treadmill running to identify painful pathology. Two cases with imaging and arthroscopic findings of fibrotic infrapatellar fat pad are reported, with both patients responding well to selective arthroscopic debridement.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/chronic-infrapatellar-fat-pad-fibrosis-hoffas-disease-a-report-of-two-cases/417438/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/chronic-infrapatellar-fat-pad-fibrosis-hoffas-disease-a-report-of-two-cases/417438.png","ImageObject",300,407,{"name":42,"@type":43},"MrHarris58","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-07","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is Hoffa’s disease in relation to anterior knee pain?","Question",{"text":63,"@type":64},"Hoffa’s disease refers to chronic fibrosis in the infrapatellar fat pad, a treatable but rarely identified source of anterior knee pain.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How is the diagnosis supported in these cases?",{"text":68,"@type":64},"Diagnosis is supported by history, physical examination, imaging, and a diagnostic injection of the infrapatellar fat pad followed by stress testing with treadmill running.",{"name":70,"@type":61,"acceptedAnswer":71},"What intervention was used and how did patients respond?",{"text":72,"@type":64},"Selective arthroscopic debridement of the fibrotic infrapatellar fat pad was performed, and both reported cases responded well to surgical intervention.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},417438,1790765916,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Case Reports  \nChronic Infrapatellar Fat Pad Fibrosis: Hoffa’s Disease, a Commonly Unrecognized Source of Anterior Knee Pain – A Report of Two Cases  \nBrendan Swift, M. D.1,2, Frank Noyes, M. D.1,2,3a  \n1 Cincinnati Sports Medicine Research and Education Foundation, 2 Mercy Health-Cincinnati Sports Medicine and Orthopaedic Center, 3 Noyes Knee Institute  \nKeywords: Infrapatellar fat pad, Hoffa’s Disease, arthroscopic debridement  \n[https://doi.org/10.26603/001c.153923](https://doi.org/10.26603/001c.153923)  \n\n| International Journal of Sports Physical Therapy\u003Cbr>Vol. 21, Issue 1, 2026 |  |\n| --- | --- |\n| Fibrosis of the infrapatellar fat pad (Hoffa’s disease) is a frequently missed cause of anterior knee pain in young, active individuals. A diagnostic test that involves injection of the infrapatellar fat pad with local anesthetic and subsequent stress with treadmill running, is a simple in office strategy to effectively diagnose pathology of the fat pad. Selective arthroscopic debridement of the fat pad using superolateral viewing portal aids in adequate visualization not otherwise feasible using standard anterior viewing portals alone.\u003Cbr>The purpose of this case report is to describe two cases of anterior knee pain arising from fibrosis of the infrapatellar fat pad as identified on imaging and arthroscopy. Both patients were found to suffer from pain arising from a fibrotic infrapatellar fat pad and responded well to surgical intervention.\u003Cbr>Level of Evidence\u003Cbr>5 |  |\n| INTRODUCTION\u003Cbr>Anterior knee pain remains a frequent presenting concern in orthopaedic surgery and primary care clinics. Chronic fibrosis in the infrapatellar fat pad (Hoffa’s disease) is a rarely identified, yet treatable cause of anterior knee pain. The intraarticular, extra-synovial structure is highly vascularized, densely innervated and rich in the nociceptive substance-P.1‑5 The role of the infrapatellar fat pad is incompletely understood, but thought to be multifactorial.6 The fat pad in its normal state contributes to shock absorption in the knee7 and can be observed to cause altered distribution of forces in the setting of fibrosis, which may play a role in the development of osteoarthritis.8 The infrapatellar fat pad is densely innervated with sensory nerve fibers implicating its role in anterior knee pain.9 In recent years, a growing understanding has emerged on the functionality of adipose tissue as an endocrine organ. Specifically, | the infrapatellar fat pad has been recognized to secrete adipokines, 10 tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and vascular endothelial growth factor (VEGF) 11 and exists as a source of mesenchymal stromal cells.12 Conflicting evidence exists on the impact of resection of the infrapatellar fat pad on anterior knee pain. In a study of 1401 patients undergoing total knee arthroplasty, Moverly et al. demonstrated significantly increased patient reported outcome measures (Oxford Knee Score) in patients where the infrapatellar fat pad was preserved, as opposed to patients in whom the fat pad was resected.13 Conversely, Sekiya reported a marked improvement in anterior knee pain in patients with otherwise refractory knee pain after total knee arthroplasty who underwent arthroscopic infrapatellar fat pad resection.14\u003Cbr>Fibrosis of the infrapatellar fat pad can be caused by traumatic injuries, or can arise due to post-surgical changes.15 The diagnosis of Hoffa’s disease can be made |\n\na Corresponding Author: Frank R. Noyes, MD  \n4700 E. Galbraith Road, 3rd Floor Cincinnati, Ohio 45236  \nPH: 513-853-8886  \nFAX: 513-853-8892  \nEmail: [cpressman@mercy.com](cpressman@mercy.com)  \nwith a combination of history, physical exam, imaging, and diagnostic injection.2 The purpose of this case report is to describe two cases of anterior knee pain arising from fibrosis of the infrapatellar fat pad as identified on imaging and arthroscopy. The patients provided informed consent for publication of their cases.  \nCASE 1  ","cbCaimcMRYPl82xH","https://ap.wps.com/l/cbCaimcMRYPl82xH","pdf",769486,"English","# Introduction\n# Case 1\n## Clinical presentation\n## Physical exam and imaging\n## Diagnostic injection","[{\"question\":\"What is Hoffa’s disease in relation to anterior knee pain?\",\"answer\":\"Hoffa’s disease refers to chronic fibrosis in the infrapatellar fat pad, a treatable but rarely identified source of anterior knee pain.\"},{\"question\":\"How is the diagnosis supported in these cases?\",\"answer\":\"Diagnosis is supported by history, physical examination, imaging, and a diagnostic injection of the infrapatellar fat pad followed by stress testing with treadmill running.\"},{\"question\":\"What intervention was used and how did patients respond?\",\"answer\":\"Selective arthroscopic debridement of the fibrotic infrapatellar fat pad was performed, and both reported cases responded well to surgical intervention.\"}]","Chronic Infrapatellar Fat Pad Fibrosis: Hoffa’s Disease - A Report of Two Cases | PDF",1790609163,15]