■ ■ ■ Description

Hoffa’s disease is characterized by a pinching of the fatty tissue below the kneecap (patella) between the end of the thigh bone (femur) and the leg bone (tibia). The fat pad protects the patellar tendon from scarring to or getting stuck on the leg bone below the knee. Sometimes this fat can get pinched or injured, resulting in inflammation that causes the fat pad to be repeatedly pinched.

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■ ■ ■ Common Signs and Symptoms

• Pain below the patella, worsened by physical activity, including sports or when completely straightening the knee

• Swelling of the knee (occasionally)

• Tenderness and swelling (occasionally) on either side of the patellar tendon

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■ ■ ■ Causes

Hoffa’s disease is caused by direct injury to the knee or repeated injury to the fat pad below the patella during activities that require maximal bending or straightening of the knee. The fat pad becomes caught and pinched between the end of the femur and the upper part of the tibia.

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■ ■ ■ Risk Increases With

• Sports that require repeated, forceful straightening or bending of the knee (such as kicking or jumping)

• Repeated injuries to the knee

• Sports in which the knee may receive direct injury (volley-ball, soccer, football) or those that require prolonged kneeling

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■ ■ ■ Preventive Measures

• Maintain appropriate conditioning:

  • Knee flexibility

  • Muscle strength and endurance

• Wear proper padding to reduce direct injury to the fat pad.

• Allow a complete recovery before returning to sports.

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■ ■ ■ Expected Outcome

Usually there is complete recovery with proper treatment.

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■ ■ ■ Possible Complications

• Frequent recurrence of symptoms, resulting in chronically inflamed tissue and eventually resulting in a chronic problem

• Disability severe enough to diminish an athlete’s competitive ability

• Delayed healing or resolution of symptoms, particularly if activity is resumed too soon

• Risks of surgery, including infection, bleeding, injury to nerves (numbness, weakness, paralysis), continued pain and pinching of the fat pad, and rupture of the patellar tendon

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medications and ice to relieve pain and reduce inflammation, stretching and strengthening exercises, and modification of the activity that produces the symptoms. These may be carried out at home, although occasionally referral to a physical therapist or athletic trainer may be indicated. Occasionally your physician may recommend an injection of cortisone to reduce the inflamed tissue that is repeatedly getting pinched. Your physician may also recommend a heel lift for your shoes to help prevent complete straightening of the knee (and thus reduce pinching of the fat pad). Surgery is not usually necessary; it is usually reserved for cases in which symptoms persist despite conservative treatment. Surgery is usually done arthroscopically to remove the inflamed tissues or chronic scar tissue.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Topical ointments may be of benefit.

• Stronger pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use only as directed and only as much as you need.

• Injections of corticosteroids may be given to reduce inflammation, although not usually for acute injuries.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment

• Any of the following occur after surgery:

  • Pain, numbness, or coldness in the foot and ankle

  • Blue, gray, or dusky color appears in the toenails

  • Increased pain, swelling, redness, drainage, or bleeding in the surgical area

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever)

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)