Author: Mr Oliver Eaton BSc (Hons), PG.Cert – Orthopaedic Specialist
Reviewed by: Mr William Sharples BSc (Hons) – Pain Management Expert
Last Updated: September 2025
In this article, you will find out everything you need to know about fat pad impingement and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
What is Fat Pad Impingement?
Knee fat pad impingement, also known as Hoffa syndrome, is a common cause of pain in the front of the knee. It occurs when the infrapatellar fat pad (Hoffa’s fat pad)—a wedge-shaped, highly innervated fatty structure behind the patellar tendon and kneecap—becomes pinched between the patella and femur. This can happen after a fall, direct blow, or repetitive knee extension, causing severe pain due to the fat pad’s rich nerve supply.
Fat pad impingement is common in active individuals (dancers, athletes, footballers, runners) and those who kneel frequently (carpenters). It can be confused with patellar tendonitis (jumper’s knee), but the pain and swelling are typically below the kneecap. Differentiating these conditions is essential for effective treatment.
Causes of Knee Fat Pad Impingement
- Knee hyperextension: Over-straightening the knee reduces space for the fat pad, increasing risk.1
- Physical trauma: Direct falls or blows to the knee can damage the fat pad and meniscus.
- Sports injuries: Hyperextension injuries in footballers or athletes can damage the fat pad.
- Ligament injuries: ACL injuries destabilize the knee, increasing inflammation and risk of fat pad impingement.
- Chronic inflammation: Arthritis and other inflammatory conditions cause swelling, reducing space for the fat pad and increasing wear and tear.
Signs & Symptoms
- Pain around or below the kneecap, often worse with knee extension or going upstairs
- Swelling and outward bulging of the fat pad
- Difficulty moving the knee, increased pain with movement
- Grinding or creaking sounds during movement
- Tenderness and redness around the kneecap
If you experience these symptoms, consult your doctor to avoid complications.
Care & Treatment for Fat Pad Impingement
R.I.C.E. Method
Rest, Ice, Compression, and Elevation are first-line treatments. Rest the knee for 2 days, apply ice for 15–20 minutes every 2–3 hours, use elastic bandages for compression, and elevate the knee above heart level to reduce swelling.
Physical Therapy
- Soft tissue treatment: Relaxes tight muscles around the fat pad.
- Joint mobilization: Restores normal knee mobility.
- Strengthening exercises: Prevents muscle wasting and supports recovery.
Patella Taping
Patella taping can reduce pressure on the fat pad. Tape the upper surface, inside the lateral patella facet, and outside the patella in a V-shape to create more space for the fat pad.3
Medical Treatment
NSAIDs (ibuprofen, diclofenac) reduce pain and inflammation.4 Corticosteroid injections may be used if NSAIDs are insufficient.
Surgical Treatment
Surgery (arthroscopic resection of the fat pad) is rare and reserved for severe, unresponsive cases. X-rays and MRI help determine the extent of damage.5
Electrotherapy
Ultrasound and TENS can help reduce pain and swelling, especially if there is significant inflammation.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat knee pain.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with knee pain.
As prolotherapy is helping to treat the root cause of knee pain, it is deemed to be a permanent fix, preventing the symptoms from returning.
Disclaimer: The information provided in this section is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Prolotherapy may not be suitable for everyone, and outcomes can vary. Always seek the guidance of a qualified healthcare professional regarding your specific medical condition or treatment options. Never disregard professional medical advice or delay seeking it because of information you have read here.
Preventive Measures for Fat Pad Impingement
- Regular, moderate exercise to improve thigh muscle flexibility and strength6
- Avoid knee hyperextension and direct impact to the knees
- Land on feet with knees slightly flexed when jumping
- Use handrails on stairs and avoid slippery surfaces
- Check sports equipment before use
Conclusion
Fat pad impingement (Hoffa syndrome) is a painful but treatable knee condition. Early recognition, rest, physical therapy, and advanced options like prolotherapy can help you recover and return to normal activities. Athletes and active individuals should take preventive measures to protect their knees and seek medical advice if symptoms worsen.
Frequently Asked Questions
How is fat pad impingement diagnosed?
Diagnosis is based on physical exam, patient history, and imaging (X-ray, MRI). Hoffa’s test may be used to assess pain with knee extension.
What is the difference between fat pad impingement and jumper’s knee?
Fat pad impingement causes pain and swelling below the kneecap, while jumper’s knee (patellar tendonitis) involves pain at the patellar tendon attachment.
Can fat pad impingement heal without surgery?
Yes, most cases resolve with rest, physical therapy, and conservative care. Surgery is only needed for severe, persistent cases.
Is taping effective for fat pad impingement?
Patella taping can reduce pressure on the fat pad and relieve pain, especially in the short term.
What activities should I avoid with fat pad impingement?
Avoid knee hyperextension, kneeling, jumping, and activities that put direct pressure on the knees.
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Author Bio
Having performed over 10,000 procedures, Mr Oliver Eaton is one of the UK’s leading practitioners in the field of treating knee pain, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with knee pain and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Mr Eaton’s expertise has been featured in many national news and media publications, including The Telegraph, The Daily Mail, The Daily Express, Women’s Health Magazine, and The Scotsman.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
LinkedIn profile
References
- van Raaij, T. M., & de Waal Malefijt, J. (2006). Anterior opening wedge osteotomy of the proximal tibia for anterior knee pain in idiopathic hyperextension knees. International Orthopaedics, 30(4), 248–252. https://doi.org/10.1007/s00264-005-0063-x
- Ghate, S. D., et al. (2012). Tumor like swellings arising from Hoffa’s fat pad: A report of three patients. Indian Journal of Orthopaedics, 46(3), 364–368. https://doi.org/10.4103/0019-5413.96368
- Callaghan, M. J., et al. (2008). Effects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome. Manual Therapy, 13(3), 192–199. https://doi.org/10.1016/j.math.2006.11.004
- Genin, J., et al. (2017). Infrapatellar Fat Pad Impingement: A Systematic Review. The Journal of Knee Surgery, 30(07), 639–646. https://doi.org/10.1055/s-0037-1604447
- Roemer, F. W., et al. (2016). Magnetic resonance imaging of Hoffa’s fat pad and relevance for osteoarthritis research: a narrative review. Osteoarthritis and Cartilage, 24(3), 383–397. https://doi.org/10.1016/j.joca.2015.09.018
- Dragoo, J. L., et al. (2012). Evaluation and Treatment of Disorders of the Infrapatellar Fat Pad. Sports Medicine, 42(1), 51–67. https://doi.org/10.2165/11595680-000000000-00000
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice. Always consult your healthcare provider before making treatment decisions.