yogabook / pathologie / hoffa-syndrome

Hoffa (-Kastert) Syndrome / Infrapatellar Fat Pad Syndrome / Hoffaitis

Definition of

Partialimpingement of the hypertrophied infrapatellar intracapsular extrasynovial Hoffa’s fat body, which lies ventrally subpatellar in front of the joint space. Kastert has shown that changes in the fat body are almost always secondary to (frequently traumatic), often inflammatory knee damage. Important primary causes: Meniscus damage, arthritis, iatrogenic (arthroscopy). In addition to inflammation of the Hoffa body, hardening, calcification and adhesion to surrounding tissue are possible. The fat body is well supplied with blood and rich in nerve cells, which makes it the most pain-sensitive part of the knee area. If the causative damage persists, the fat body can harden and later also partially calcify.

ICD M79.4

Cause

1. Traumatic
2. Internal knee damage
3. Infections
4. Overuse, incorrect loads
5. Distortion with hemorrhage and hemarthrosis

Predisposing

1. Internal knee damage: meniscus damage, arthritis, iatrogenic (arthroscopy)
2. Ligament weaknesses as with genu recurvatum
3. Patellar dysplasia
4. Secondary for meniscus damage, cruciate ligament damage

Diagnosis

Tests and signs must be performed in a side-by-side comparison. Due to the high density of nociceptors, some signs may also be slightly positive on the healthy side.

1. clinically rather than with imaging. Soft to rough pressure-painful thickening medial and lateral to the lig. Patellae.
2. Tests and signs: Hoffa test, bounce test (passive hyperextension of the knee shows pain); medial and lateral joint line tenderness (similar to meniscus complaints), tenderness on both sides of the patellar ligament
3. X-ray may show calcification
4. MRI confirms the diagnosis

Symptoms

1. Symptoms occur spontaneously or after knee trauma (85%, although it is often no longer possible to obtain anamnesis)
2. Swelling around the patellar ligament and below it
3. Pain on movement and pressure at the lower patellar pole subpattellar or retropatellar. The pressure pain may be less (or disappear) when the knee joint is flexed than when it is fully extended.
4. Restriction of flexibility (softer than with meniscus entrapment), especially during flexion
5. Painful final extension of the knee
6. Feeling of tension when flexing the knee
7. Exertion/training worsens
8. Slightly raised caudal patellar pole if necessary
9. In case of entrapment of hypertrophic villi of the fat body: bloody joint effusion
10. Pain-induced flash-like buckling of the knee joint(giving way phenomenon) in the event of entrapment phenomena
11. Crepitations
12. Pain on exertion, e.g. when climbing stairs, getting up from a sitting position; especially after prolonged rest. This applies to all movements that compress the fat body (between the tibia and patella)
13. Low tendency to heal spontaneouslywithout an eliminated cause, usually progression instead
14. Possible pain at rest

Complications

1. Fibrosis can affect the joint capsule
2. Transformation into fibrocartilage and subsequent calcification (corresponds to ossification or soft tissue chondroma)
3. Synovitis with hyperplastic synovial membrane, with a tendency to adhesions, e.g. on the menisci, tibial plateau, lig mucosum; alteration of the synovial vessels

Therapy

1. Various approaches to muscular intervention: quadriceps (especially vastus medialis) and gluteus training, stretching
2. Avoid overextension
3. Cryotherapy, tape
4. Treatment of the cause usually only leads to normalization of the fat body
5. If necessary, surgery with removal of the primary knee damage
6. Arthroscopic partial resection of the Hoffa body is only necessary in exceptional cases
7. organic sulphur, local injection of platelet-rich plasma
8. No Cortision injection if possible!