Massage therapy · Kitchener–WaterlooHoffa's Syndrome

Hoffa's fat pad (also called the infrapatellar fat pad) is a cushion of fat that sits just below the kneecap, behind the patellar tendon (the thick tendon that runs from the bottom of the kneecap to the shin bone) (Draghi et al., 2016). It can become pinched (impinged), irritated and inflamed. This can happen after a direct blow to the knee, but it most often follows repeated small strains on the knee (repetitive microtrauma), such as repeatedly over-straightening the knee (hyperextension). Knee surgery or keyhole surgery can also cause scarring of the fat pad (Draghi et al., 2016). The fat pad is one of the most sensitive structures in the knee, so the condition can be quite painful (Hannon et al., 2016). Pain is usually felt at the front of the knee, below the kneecap and on either side of the patellar tendon, and it can be worse when straightening the knee. The fat pad ends up being constantly irritated and can become inflamed. It has been termed Hoffa's Syndrome, but it can also be known as fat pad impingement.

Patients with Hoffa's syndrome report having difficulty sitting in tight seats for long periods of time, such as airplane seats or theatre seats. They then report having to straighten their knee every few minutes to stop the pain. On straightening the knee, the knee-cap can give a click which can be painful. This is usually due to inflammation under the knee cap. Activities such as squatting, climbing stairs, jumping and running can also aggravate the pain (Hannon et al., 2016).

Hoffa’s Syndrome Anatomy

How to Treat Hoffa’s Syndrome

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• If you play sports where blows to the knee are possible, such as rugby, football, hockey and soccer, avoid activities that increase your pain while the fat pad settles (Draghi et al., 2016).
• Repeated knocks to the front of the knee and repeated over-straightening of the knee can both irritate the fat pad (Draghi et al., 2016).
• If you have a history of hyperextending the knee, there is the chance that this condition could occur (Draghi et al., 2016).
• Previous knee surgery or keyhole surgery can lead to scarring in the fat pad (Draghi et al., 2016; Hannon et al., 2016).
• See your family doctor or nurse practitioner if your knee pain doesn't improve within a few weeks (NHS, 2023).

Hoffa's fat pad is very sensitive, so once it's irritated, everyday things like standing with your knee locked straight or sitting in a cramped seat can keep it flaring. My aim is to calm it down, take pressure off the fat pad, and build strength around your knee and hip so it copes with your activities again.

I start by assessing how your knee moves and whether it over-straightens, how your kneecap moves, the strength and flexibility of your thigh and hip muscles, and how you stand, squat and use stairs. If something doesn't fit, I'll ask you to see your family doctor or nurse practitioner.

When It's Sore

• Cutting back the activities that flare it, rather than stopping everything
• Standing with your knees soft rather than locked back, and changing position often when you sit
• Taping the kneecap to take pressure off the fat pad, and I'll show you how to tape it yourself
• Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
• Hands-on work for the thigh, hip and calf, keeping pressure off the tender fat pad

As It Settles

• Stretches for the quadriceps and the front of the hip
• Thigh strength, starting with gentle holds in a comfortable knee bend rather than forcing it fully straight
• Hip strengthening, building to mini-squats, step-ups and slow step-downs
• Gentle mobilisation of the kneecap, and a home programme between visits

Getting Back to Activity

1. Hannon, J. et al. (2016) 'Evaluation, treatment, and rehabilitation implications of the infrapatellar fat pad', Sports Health, 8(2), pp. 167–171. doi: 10.1177/1941738115611413.
2. Draghi, F. et al. (2016) 'Hoffa's fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice', Insights into Imaging, 7(3), pp. 373–383. doi: 10.1007/s13244-016-0483-8.
3. NHS (2023) Knee pain. Available at: https://www.nhs.uk/symptoms/knee-pain/ (Accessed: 8 October 2026).