Hoffa's Disease Research Articles

Late Stage Hoffa Disease

A 50-year-old man consulted in March 2019 for left anterior gonalgia that had been evolving for several years. During the interrogation, a notion of old trauma was found. On clinical examination, an anterolateral mass was palpated, the patient had active and passive limitation of knee flexion and extension movements. A standard radiological assessment revealed opacity in the infrapatellar adipose body. MRI showed ossification of the subpatellar fat as well as infiltration of the latter.

End Stage Hoffa’s Disease Presented as a Giant Osteochondroma: Case Report and Literature Review

Introduction: Hoffa’s disease appears to be an under-recognized ailment according to an extensive comprehensive literature assessment. Predisposing factors in sports training include torsion and hyperextexion at the knee should be taken into consideration when evaluating patients with chronic knee pain. We present the case of a young soldier suffering from left knee pain as a result of Hoffa’s disease Case report: A 29-year-old male patient admitted to orthopedic department to assess an anterior mechanical pain on the left knee. He reported that he had a sport accident with notion of hyperextension and anterior direct trauma to the left knee. On physical examination we found a painful mass that seems located under the patellar tendon, passive flexion of the left knee triggered a sharp pain from 100°. On X ray we found bone-like mass located behind the silhouette of the patellar tendon without attachment to the bones of the leg. MRI identified a 4.2 osseous tumor with no attachment to the patellar tendon. A surgical excision was preformed Conclusion: Hoffa disease is relatively a rare illness, its physiopathology is not yet completely clear. But many cases have been reported in literature. Its clinical presentation is not very specific, and its surgical excision which remains unavoidable, guarantees satisfying clinical and functional results. However, it remains to be determined whether it is a definitive solution in the context of “Hoffa’s disease”.

Hoffa’s fat pad, Hoffa’s disease, Hoffa’s fracture: the history of eponyms

Albert Hoffas is associated with three popular eponymous terms: the infrapatellar fat pad (Hoffas fat pad), the pathology of this anatomical development (Hoffas disease), and a frontal fracture of the lateral condyle of the femur (Hoffas fracture). Issues of priority about the mentioned eponyms continue to be debated. The authors searched for information in domestic and foreign publications, traumatology and orthopedics manuals, periodicals, and Internet resources Scopus, WoS, Google Scholar, and eLibrary to collect reliable data on the history of the emergence of the eponyms Hoffs fatty body, Hoffs disease, Hoffs fracture and to determine the role of the German orthopedist and his priority in the origin of these copyright names. Professor John Goodsirs paper in 1855 contains one of the earliest mentions of the infrapatellar fat pad but without revealing the anatomy and morphology of the structure itself. In 1904, Albert Hoffa published an article describing fully the syntopic and macroscopic anatomy of the infrapatellar fat pad and the disease associated with infrapatellar fat pad pathology. A German physician, Friedrich Busch, first described the frontal fracture of the lateral condyle of the femur in 1869. A similar was described by Albert Hoffa in the first edition of the Textbook of Fractures and Dislocations for Doctors and Students in 1888. Albert Hoffas priority in describing the infrapatellar fat pad and its pathology is recognized by representatives of various medical specialties. As for the frontal fracture of the lateral condyle of the femur, Albert Hoffa may only be considered a co-author of the frontal fracture of the lateral condyle of the femur.

Presence of a t(12;18)(q14;q21) Chromosome Translocation and Fusion of the Genes for High-mobility Group AT-Hook 2 (HMGA2) and WNT Inhibitory Factor 1 (WIF1) in Infrapatellar Fat Pad Cells from a Patient With Hoffa’s Disease

Hoffa's disease is anterior knee pain presumably stemming from inflammatory fibrous hyperplasia of the infrapatellar fat pad (Hoffa's pad). The etiology and pathogenesis are unclear, however, and no genetic information about the disease has been published. We report the genetic findings in cells from the fat pad of a patient with Hoffa's disease. Infrapatellar fat pad cells from a patient with Hoffa's disease were examined using cytogenetic, RNA sequencing, reverse transcription-polymerase chain reaction, and Sanger sequencing techniques. Cytogenetic examination of short-term cultured cells from the Hoffa's pad revealed a balanced t(12;18)(q14;q21) translocation as the sole chromosomal aberration. RNA sequencing detected an out-of-frame fusion of exon 3 of the gene coding for high mobility group AT-hook 2 (HMGA2) with exon 9 of the gene coding for WNT inhibitory factor 1 (WIF1). The fusion was subsequently verified by reverse transcription-polymerase chain reaction together with Sanger sequencing. Our data indicate that Hoffa's disease is a neoplastic process with acquired genetic aberrations similar to those found in many benign tumors of connective tissues. The genetic aberrations are presumably acquired by mesenchymal stem cells of the infrapatellar fat pad inducing proliferation and differentiation into adipocytes or other mature connective tissue cells.

PREVALENCE OF POTENTIAL MRI-BASED EXCLUSIONARY FINDINGS IN OSTEOARTHRITIS CLINICAL TRIALS: DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

PREVALENCE OF POTENTIAL MRI-BASED EXCLUSIONARY FINDINGS IN OSTEOARTHRITIS CLINICAL TRIALS: DATA FROM THE OSTEOARTHRITIS INITIATIVE (OAI)

Role of MRI in Evaluation of Anterior Knee Pain

Abstract Background: MRI is well known for being particularly useful for scanning and detecting abnormalities in soft tissue structures like the cartilage tissues, tendons, and ligaments. Moreover, MRI can also aid in determining those patients with knee injuries who will require surgical intervention. MR imaging is recognized as a standard procedure and has replaced diagnostic arthroscopy as the primary diagnostic modality for many knee pathologies. Furthermore, MR images can be used to assess anatomic variants that may contribute to chronic patellar instability. Aim of Study: To go over several of the most common causes of Anterior Knee Pain (AKP), with emphasis on their MRI findings with the goal of allowing diagnosis that is more accurate and grading of some of the most common pathologies, for interpreting, reaching an efficient treatment and drastic improvement of this common complaint. Patients and Methods: This study included 25 patients (8 females and 17 males). Their ages ranging between 10-60 years (average age 30 years). All presented by anterior knee pain and were referred to Radiology Department of Ain Shams University Hospital or private centers for MRI examination after orthopedic consultation. This descriptive study was done to detect the role of MRI in the evaluation of anterior knee pain and apply advanced MRI techniques such as sagittal T2 mapping to visualize the articular cartilage of the knee. Most patients were subjected to MR imaging of the affected knee joints on high field strength scanners using Philips scanners Achieva or Intera (1.5T). Results: The present study revealed that 26% patellar tendon disorders which included (patellar Tendinopathy 21% and Osgood Schlatter disease 5%). Quadriceps tendon disorders represented 10% and they are including (Quadriceps Tendin-opathy 5% and Quadriceps tendon tear 5%). 69% of the sample size showed Patellar disorders represent and they are including (chondromalacia patella 32%, patellar instability 21%, transient patellar dislocation 11% and painful bipartite patella 5%). Hoffa's disease was demonstrated in 21% of the sample size and they are including (Hoffa impingement syndrome and Hoffa ganglion cyst), finally we have torn anterior horn of the lateral meniscus and they represent 5%. Conclusion: MRI is generally safe, accurate, and specific modality, which has been proven to be the modality of choice in the diagnosis of different knee pathologies that cause anterior knee pain in different age groups. Also it has a high specification in detecting the grades and types of some of these diseases or factors predispose to them as patella Alta and trochlear dysplasia.

Hoffa Hastalığı: Diz Ön Ağrısının Artroskopik Tedavisinin Sonuçları

Hoffa Hastalığı: Diz Ön Ağrısının Artroskopik Tedavisinin Sonuçları

Возможности ультразвукового исследования коленного сустава в диагностике болезни Гоффа

Introduction Hoffa's disease is a common condition, and is a severe pathology of the knee joint in many cases. Ultrasound with its capabilities and advantages can be a convenient method of primary diagnosis of this pathology. However, in the literature there is almost no description of the characteristic ultrasound picture of Hoffa’s disease and an analysis of the most common and pathognomonic symptoms. Objective To study ultrasound signs of Hoffa's disease and present the characteristic sonographic complex of its symptoms. Methods Ultrasound examination of the knee joint and arthroscopy of 37 patients diagnosed with Hoffa's disease, confirmed by a comprehensive clinical and instrumental study, was conducted. Results The most characteristic signs of Hoffa's disease in terms of pathological changes are hypertrophy of the Hoffa’s fat pad and changes in its structure, which were detected by ultrasound in 62 % and 84 % of cases, respectively. A new symptom, displacement of the patellar ligament, was identified by ultrasound examination of the knee joint according to the standard protocol in 32 % of the examined. The same percentage comprised the patients who had non-specific sonographic symptoms: an increase in the amount of synovial fluid, as well as signs of infrapatellar bursitis. Ultrasound data were compared with the results of arthroscopic examination, their correspondence was determined. Conclusion It has been established that the ultrasound examination of the knee joint according to the standard method enables to identify a complex of symptoms that are pathognomonic for Hoffa’s disease. It is recommended to introduce it in the protocol of the conclusion.

Osteochondroma of Hoffa’s fat pad

Infrapetellar osteochondroma is a rare benign osteochondromatous proliferation involving the infrapatellar fat pad. The pathogenesis of these lesions is unclear, but is thought to result from metaplasia of mesenchymal cells as a consequence of chronic infra-patella fat pad infringement or end stage of Hoffa’s disease1. Given its uncommon occurrence, it can be mistaken for more common conditions about the knee. The extra-articular location is distinct from cartilaginous loose bodies and synovial chondromatosis, which involve the joint space. Despite the name, this condition is not related to osteochondroma of bone. We report a case of infrapatellar fat pad osteochondroma and discuss features to distinguish this condition from morphologically similar lesions. Reference 1.Turhan E, Doral MN, Atay AO, et al. A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa's disease. Arch Orthop Trauma Surg 2008; 128: 515–9.

Recorded Case of Hoffa's Disease without Specific Known Etiology

Recorded Case of Hoffa's Disease without Specific Known Etiology

Hoffa's disease

We report the case of a 40-year female patient, with no previous pathological history, presenting with right unilateral mechanical gonalgias with progressive onset, which increased climbing and going down stairs associated with hydarthrosis on clinical examination. After normal standard X ray, MRI showed a grease of hypertrophied Hoffa's grease with heterogeneous hyposignal on T1 (A), hypersignal on T2 with grease saturation (B), heterogeneously enhancing after gadolinium injection. The diagnosis of Hoffa's disease was made and the patient, after failure of a medical treatment, underwent arthroscopy for ablation of the Hoffa's grease with good evolution. Hoffa's disease, a cause poorly known of pain of the anterior compartment of the knee, is an acute or chronic inflammation of the infrapatellar adipose tissue. The physiopathologic theory speaks of repeated micro traumas resulting in inflammatory, hemorrhagic and fibrous changes of the adipose body of Hoffa; at the final stage of the disease osteochondroma occurs. MRI is the test of choice in the early forms. It shows poorly limited edematous infiltrate with hypersignal on T2 and hyposignal on T1, in a hypertrophic infrapatellar fat body. Treatment is based on general or local non-steroidal anti-inflammatory drugs, icing, and physiotherapy, associated with immobilization. In the case of failure of conservative treatment or of osteochondroma, arthroscopic resection is the treatment of choice.

Inflammation of the infrapatellar fat pad

The infrapatellar fat pad (IFP) of Hoffa's fat pad is the main adipose structure within the knee joint. It is located between the joint capsule and the synovial membrane, which lines its posterior aspect. The IFP is composed chiefly of adipocytes and receives an abundant supply of blood vessels and nerves. Immune cells can infiltrate the IFP, which can become a major source of numerous proinflammatory mediators (cytokines and adipokines). The physiological role for the IFP remains unclear but may involve shock absorption and the protection of adjacent tissues. Hoffa's disease is characterized by inflammation, hypertrophy, and fibrosis of the pad in response to repetitive trauma. Anterior knee pain is the most common symptom. In advanced forms, metaplasia of the IFP may result in the development of a sometimes sizable osteochondroma. The IFP may also contribute to the pathophysiology of knee osteoarthritis, in particular via procatabolic and proinflammatory effects on its synovial lining. Finally, in patients with knee osteoarthritis, inflammation of the IFP may be a source of pain.

Inflammation du tissu adipeux de Hoffa

Located under the patella, the infrapatellar fat pad (IFP) or Hoffa's fat pad is the main intra-articular adipose tissue within the knee. The IFP is described as intracapsular but extrasynovial, the synovial membrane lining its posterior surface, and has substantial innervation and vascularisation. Mainly composed of adipocytes, the IFP may be infiltrated by immune cells and is a major source of pro-inflammatory factors (cytokines and adipokines). Its physiological role remains unknown, but it might act as a shock absorber and protect the surrounding tissue. Hoffa's disease is an inflammatory and fibrous hyperplasia of the IFP induced by repeated trauma and results in anterior knee pain. In chronic disease, local metaplasia within IFP may lead to the development of an osteochondroma. It could also contribute to the pathophysiology of osteoarthritis, by a procatabolic and pro-inflammatory effect on the synovial membrane, which is adjacent to the IFP. Finally, in knee OA, its inflammation may also contribute to the painful symptoms.

Hoffa disease: Report of a case

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.

Traitement chirurgical de la pathologie du ligament adipeux infrapatellaire de Hoffa

BackgroundAnterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy. MethodsThe review was conducted in accordance with the PRISMA reporting guidelines. A search of the literature was performed on 1st January 2014 using multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, and Google Scholar. The quality of the studies was assessed using Oxford Evidence-Based Medicine Levels of Evidence guidelines and the GRADE approach. ResultsTwenty-four eligible studies were found and included. The critical appraisal identified that the current evidence-base has low methodology quality. The clinical findings indicated that there is a positive trend towards the surgical management of IFP disease for AKP symptoms. Excision of IFP tumours and resection of the IFP in Hoffa's disease can lead to improvements in symptoms and function. ConclusionsTruly robust evidence to support the surgical management of IFP pathology requires randomised controlled trials; however, the expenses involved to design such trials means that they are unlikely to be undertaken for this uncommon disorder. Consequently, well-designed and well-reported case series need to be undertaken to improve our current understanding that includes recording quantitative measures such as range of knee motion, VAS Pain scores and a validated scoring system. Level of evidenceLevel IV. PROSPERO registrationCRD42013006550.

Change in T2* relaxation time of Hoffa fat pad correlates with histologic change in a rat anterior cruciate ligament transection model.

The Hoffa fat pad (infrapatellar fat pad) is a source of post-traumatic anterior knee pain, and Hoffa disease is a syndrome leading to chronic inflammation of the fat pad. Herein, change in T2* relaxation time of the fat pad was measured in a rodent anterior cruciate ligament transection (ACLX) model in order to (i) examine the causal relationship of anterior cruciate ligament (ACL) deficiency and Hoffa disease and (ii) demonstrate the feasibility of using T2* as an imaging biomarker to monitor disease progression. Three groups of male Sprague Dawley rats (n = 6 each group), received either (i) no intervention; (ii) sham surgery at the right knee; or (iii) right ACLX. T2* relaxation time was measured and histology was examined in the Hoffa fat pad after surgery. At 13 and 18 weeks after surgery, T2* values were significantly higher in the right fat pad than the left (p < 0.001) and significantly higher in the ACLX group than the control and sham groups (p < 0.001). Histology showed fibrosis and degeneration of adipocytes in the right knees of the ACLX group. We conclude that ACL deficiency and Hoffa disease are causally related and that MRI T2* value can serve as an imaging biomarker of Hoffa disease progression.

The surgical treatment of anterior knee pain due to infrapatellar fat pad pathology: A systematic review

BackgroundAnterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy. MethodsThe review was conducted in accordance with the PRISMA reporting guidelines. A search of the literature was performed on 1st January 2014 using multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, and Google Scholar. The quality of the studies was assessed using Oxford Evidence-Based Medicine Levels of Evidence guidelines and the GRADE approach. ResultsTwenty-four eligible studies were found and included. The critical appraisal identified that the current evidence-base has low methodology quality. The clinical findings indicated that there is a positive trend towards the surgical management of IFP disease for AKP symptoms. Excision of IFP tumours and resection of the IFP in Hoffa's disease can lead to improvements in symptoms and function. ConclusionsTruly robust evidence to support the surgical management of IFP pathology requires randomised controlled trials; however the expenses involved to design such trials means that they are unlikely to be undertaken for this uncommon disorder. Consequently well-designed and well-reported case series need to be undertaken to improve our current understanding that includes recording quantitative measures such as range of knee motion, VAS Pain scores and a validated scoring system. Level of evidenceLevel IV. PROSPERO registrationCRD42013006550.

Hoffa's Disease in elderly patients

Hoffa's Disease in elderly patients

Hoffa's fat pad disease: A study

Introduction: German surgeon by name Albert Hoffa in 1904 described the condition which was producing severe anterior knee pain was called Hoffa’s fat pad disease. This disease is commonly encountered in athletes after the second decade. The lowest age present in the literature with symptomatic Hoffa’s fat pad disease is ten years. Most common pathology in Hoffa’s fat pad disease is impingement of fat pad between anterior margin of tibia and intercondylar notch of femur. Here we are done an attempt to know the aetiology, diagnosis and management of the Hoffa’s fat pad disease. Materials and methods: 150 cases of knee joint pain were evaluated in our institute. 107 cases were suffering from medial margin pain, twenty nine cases from lateral margin, seven over and adjacent to ligamentum patella, three from inferior pole of patella, three from tibial tuberosity and one had pain at superior pole of patella. We studied seven patients suffering from Hoffa’s fat pad disease from April 2011 to December 2014 in our hospital. Inclusion criteria were age group between ten to sixty years irrespective of sex suffering from anterior knee pain with tenderness and swelling over and adjacent to the ligamentum patella. The exclusion criteria were age less than ten and more than sixty, pain at the suprapatellar region, inferior pole, superior pole of patella, at tibial tuberosity only, along medial and lateral margin of knee, popliteal fossa were excluded from our study. We have done a study to know the causes, how to diagnose the problem and management. Conclusion: Hoffa’s disease is common after second decade, rare in children. Usually it is seen in athletes. Squatting, running, climbing stairs, trauma and postsurgical scarring are the causes encountered in our study. Diagnosis is by history, clinical examination and radiological investigations like X-ray and Magnetic resonance imaging. Conservative management is the first line of treatment for three to four months and if it fails most of them were treated by complete excision of Hoffa’s fat pad through anterior arthrotomy. Keywords: Hoffa’s disease, Anterior knee pain, X-Ray, MRI, Arthrotomy

Function of the Infrapatellar Fat Pad and Advanced Hoffa's Disease With Ossification

©2014 Turkish League Against Rheumatism. All rights reserved. Hoffa’s disease (or Hoffa’s fat pad syndrome) is a clinical condition, which develops as a result of impingement of the infrapatellar fat pad (IFP) between the femorotibial and femoropatellar spaces after inflammation and edema, and may cause knee pain.1 It generally begins with trauma at early ages. This condition can be confused with frequent meniscal pathologies of the knee joint. The infrapatellar fat pad is one of the three pads located on the anterior knee together with quadriceps and prefemoral fat pads.2 It is a tissue with known biomechanical functions. However, its endocrine functions are not fully understood.3