Infrapatellar Fat Pad Inflammation

Infrapatellar fat pad inflammation or impingement arises when the fat pad beneath your kneecap becomes pinched between the knee joint bones. This can lead to pain, swelling, and restricted movement, especially when the knee is fully extended.

The infratellar fat pad (Hoffa’s fat pad) is positioned just below the kneecap and at the back of the patellar tendon. It sits at the meeting point of the femur (thigh bone) and tibia (shin bone); this thus makes it an important feature of knee function.

The infrapatellar fat pad is full of nerve endings, making it particularly sensitive when pinched. These nerves help relay information about knee position and movement; hence, this contributes to balance and coordination.

Beyond its sensory function, the fat pad serves as a shock absorber. It spreads forces across the knee and helps to stabilise the patellofemoral joint (kneecap). As a result, this reduces stress on surrounding structures.

Signs and Symptoms

Pain that often occurs behind or just under the kneecap.
Symptoms that worsen with activities that put extra pressure on the knee such as climbing or descending stairs, running or jumping
For severe cases, localised swelling may develop, and knee movement can become limited.

Possible Causes

The exact reasons for infrapatellar fat pad inflammation aren’t fully understood; researchers suggest several potential causes:

A fall or direct hit to the fat pad that can cause swelling.
Overextending the knee repeatedly can lead to chronic inflammation and thickening of the fat pad.
High-intensity exercise (such as prolonged running) can cause fat pad inflammation.
The shape or position of the kneecap as well as surrounding bones may contribute to impingement.

Diagnosis

Your healthcare provider or physiotherapist can diagnose infrapatellar fat pad inflammation by asking about your symptoms and conducting a physical examination. A number of physical tests may be done to help rule out other possible causes of knee pain, and to evaluate your movement and function. They will also assess how the condition affects your daily activities. This will help create a personalised treatment plan based on your specific needs and goals.

Imaging tests like MRI or ultrasound are unnecessary for diagnosis but may be used in complex or unusual cases.

Treatment Options

Infrapatellar fat pad inflammation treatment focuses on reducing irritation and swelling while gradually restoring knee function. Since every injury is unique, not all treatments work for everyone. It’s essential, thus, to assess how you feel before and after each intervention.

These treatment options include:

Avoid painful positions. Do not fully straighten the knee; keep it slightly bent while standing. These, however, are temporary adjustments—once healed, aim to regain full knee mobility.
Footwear and gait adjustments. Flat shoes force more knee extension; while those with a slight heel (like running shoes) or heel-lifting insoles may reduce pinching. Shortening your stride can also help.
Taping. Taping techniques tilt the kneecap slightly, relieving pressure on the fat pad.
Ice therapy. Apply ice packs to the knee to ease discomfort, swelling and inflammation.
Anti-inflammatory medication. Ibuprofen (either tablets or gel) may help ease swelling—consult a doctor before use.
Manual therapy. A physiotherapist may mobilise the kneecap through manual therapy if the kneecap is stiff.
Stretching. Quadriceps stretching can help; but it should only be attempted after acute pain subsides. Foam rolling the quads may be a gentler alternative in such cases.
Strengthening exercises. Avoid early quadriceps exercises, as they can worsen pain. Instead, focus on glutes, hamstrings, quadriceps or foot and ankle muscles during initial recovery.
Movement pattern retraining. In case you overextend your knee while walking, a physiotherapist may assist you in correcting this pattern through retraining movements to prevent re-injury.
Orthotics. If overpronation (excessive foot rolling) contributes to knee stress, arch-supporting orthotics may help.
Corticosteroid injections. These can be injected into the joint to reduce inflammation, swelling, and pain. However, it may cause fat pad atrophy risk, which may lead to more pain.
Surgery. This is usually the last resort if all other treatments are not effective. Keyhole surgery is usually recommended to remove only scar tissue and thickened regions while preserving the healthy fat pad.

Bottom Line

Although infrapatellar fat pad impingement can cause persistent knee pain and discomfort, treatment can help you recover and get back to your normal activities. Professional care can make a difference if you need expert guidance on pain management, physiotherapy or other treatment options.