Hoffa disease: Report of a case

Abstract

Hoffa disease or hoffite is an intrinsic pathology of the infra-patellar fat body. It is defined as an acute or chronic inflammation of the infra-patellar fat. A 42-year-old woman consulted in December 2013 for pain of the right knee, located around the patella and lasting for several years. She described a trauma several years ago. On physical examination, an anterolateral mass was palpated, the patient had active and passive restriction of flexion and extension movements of the knee. A standard radiological showed an opacity in the infra-patellar fat body. CT showed an ossification of the infra-patellar fat and an infiltration of it. Conservative treatment was proposed as first-line with cryotherapy, NSAIDs orally associated with an immobilization by orthosis, resulting in an improvement in pain. Inflammation of Hoffa originates in crushing of the Hoffa fat between the femur and the tibia during extension. Several mechanisms are involved: acute trauma, strain, overuse. It will consequently occur an hypertrophy of fat, causing a vicious cycle of bleeding, inflammation. The Hoffa's disease affects mostly young women. The classic symptoms of anterior knee pain occurs preferently when climbing and descending stairs (patella syndrome). Conservative treatment will be offered in the first intent, including cold-packs, NSAIDs orally, more or less associated with an immobilization of the knee for a short period, followed by exercises in order to recover the range of motion. It can also be proposed a corticosteroid infiltration in the Hoffa fat. In case of failure of conservative treatment or if Hoffa's disease lasts too long, arthroscopic resection remains the treatment of choice.