Position of the thumbs when performing the Hoffa's test.
Position of the thumbs when performing the Hoffa's test.
How to perform Hoffa's Test
With the patient lying on the couch, and the examiner standing by the patient's knee, the examiner takes up the bent knee, pressing the thumbs of both hands deeply along the sides of the patellar tendon just below the patella.
The patient is then instructed to straighten the leg. If there is inflammation of the fat pad, this causes pain in the fat pad region.
See YouTube video of a patient performing the Hoffa's test on themself.
Peer-reviewed paperQuote from peer-reviewed paper:
"....Fat pad restrictions are common following knee surgery but can be seen in nonsurgical patients with anterior knee pain as well....If fibrosis or scarring of the IFP occurs, it can lead to adhesions in the anterior interval, which can decrease excursion of the patellar tendon...."
Citation: Hannon J, Bardenett S, Singleton S, Garrison JC. Evaluation, Treatment, and Rehabilitation Implications of the Infrapatellar Fat Pad. Sports Health. 2016 Mar-Apr;8(2):167-71. doi: 10.1177/1941738115611413. Epub 2015 Oct 20. PMID: 26502189; PMCID: PMC4789926.
What does the Hoffa fat pad do?
Side view of the knee joint, showing the situation of the Hoffa (or infrapatellar) fat pad in the space behind the patellar tendon.The infrapatellar or Hoffa fat pad acts as a flexible cushion within the knee joint inside the capsule where it cushions the important structures of the front of the knee.
It contains blood vessels and nerves and is covered by the same layer of cells (synovium) that lines the rest of the capsule and which provides lubrication for the joint. It is intimately related anatomically to the ligamentum mucosum (infrapatellar plica).
Quick linksWhat is the fat pad syndrome?
The fat pad syndrome is irritation or inflammation of the fat pad, giving rise to pain in the front of the knee.
If the fat pad is swollen, part of it may impinge between the bones and lead to sudden acute pain. This may be reproducible during the Hoffa test.
Peer-reviewed paperQuote from peer-reviewed paper:
"....the IFP [is] an extremely sensitive structure capable of producing severe pain...."
Citation: Hannon J, Bardenett S, Singleton S, Garrison JC. Evaluation, Treatment, and Rehabilitation Implications of the Infrapatellar Fat Pad. Sports Health. 2016 Mar-Apr;8(2):167-71. doi: 10.1177/1941738115611413. Epub 2015 Oct 20. PMID: 26502189; PMCID: PMC4789926.
Forum discussions
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Patients struggle for clarification regarding fat pad pain.