Infrapatellar fat pad syndrome

Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Next review due December 2023

Infrapatellar fat pad syndrome is a condition that causes knee pain. Your infrapatellar fat pad is one of three pads of fatty soft tissue that lie under your kneecap (patella), at the front of your knee. It’s also known as the Hoffa’s fat pad.

About infrapatellar fat pad syndrome

Your infrapatellar fat pad sits behind and just below your kneecap (patella), where it acts as a protective cushion, separating your kneecap from your shin and thigh bones.

Infrapatellar fat pad syndrome is when your fat pad becomes pinched (impinged) between your kneecap and thigh bone, or your thigh and shin bones. It’s also known as infrapatellar fat pad impingement. Your infrapatellar fat pad has a rich supply of nerves, so impingement can be very painful.

Causes of infrapatellar fat pad syndrome

Infrapatellar fat pad syndrome can happen for a number of reasons. It can be caused by a sudden injury, such as a direct blow to your knee. More often though, it develops gradually over time if you repeatedly over-extend your knee. This is when your knee is forced beyond its fully straightened normal position. You may have always been able to over-straighten your knee, which is called knee hyperextension or genu recurvatum.

Symptoms of infrapatellar fat pad syndrome

Infrapatellar fat pad syndrome can be extremely painful. You’ll usually feel the pain at the front of your knee, around the bottom of your kneecap. This pain may be worse when your leg is completely straight, or if you stand for a long time or when you go up or down stairs. The area around the bottom of your kneecap may also feel very tender to the touch. You may have some swelling there too.

Self-help for infrapatellar fat pad syndrome

It’s best to stop doing any activities that make the pain worse. This might mean not standing for too long, being aware not to over-extend your knee, and taking a break from doing any sports that usually make your pain worse.

Treatment of infrapatellar fat pad syndrome

The initial treatment for infrapatellar fat pad syndrome aims to reduce pain and inflammation, which you can try to do with rest (see self-help above) and medicines. Further treatments include taping your knee and physiotherapy to gradually get you back to your usual activities.

You may find it helpful to see a sports medicine professional, such as a physiotherapist or a sports doctor. Your GP may be able to refer you, or you can book an appointment with a physiotherapist yourself.

Physiotherapy

Your physiotherapist will carefully assess your knee and plan an individual programme of rehabilitation exercises to help strengthen your knee and leg muscles gradually. This may involve specific strengthening exercises and training in how to not over-extend your knee. Make sure you do these exercises as they’re an important part of your recovery.

Your physiotherapist may also recommend taping your knee. This is done in a particular way to relieve the impingement on your fat pad. You may need to keep your knee taped until your pain has gone.

Medicines

Over-the-counter painkillers like non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help ease pain and reduce inflammation and swelling. Always read the patient information that comes with your medicine, and if you have questions ask your pharmacist for advice.

Your doctor may also offer you a corticosteroid injection into your knee joint to provide temporary pain relief.

Surgery

Most people with infrapatellar fat pad syndrome don’t have surgery. But if other treatments haven’t worked it might be an option. There are a number of surgical procedures that can be used to treat infrapatellar fat pad syndrome. If your doctor recommends that you have surgery, they’ll discuss the pros and cons with you.