Hoffa’s fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice

Hoffa's (infrapatellar) fat pad (HFP) is one of the knee fat pads interposed between the joint capsule and the synovium. Located posterior to patellar tendon and anterior to the capsule, the HFP is richly innervated and, therefore, one of the sources of anterior knee pain. Repetitive local microtraumas, impingement, and surgery causing local bleeding and inflammation are the most frequent causes of HFP pain and can lead to a variety of arthrofibrotic lesions. In addition, the HFP may be secondarily involved to menisci and ligaments disorders, injuries of the patellar tendon and synovial disorders. Patients with oedema or abnormalities of the HFP on magnetic resonance imaging (MRI) are often symptomatic; however, these changes can also be seen in asymptomatic patients. Radiologists should be cautious in emphasising abnormalities of HFP since they do not always cause pain and/or difficulty in walking and, therefore, do not require therapy. Teaching Points • Hoffa's fat pad (HFP) is richly innervated and, therefore, a source of anterior knee pain. • HFP disorders are related to traumas, involvement from adjacent disorders and masses. • Patients with abnormalities of the HFP on MRI are often but not always symptomatic. • Radiologists should be cautious in emphasising abnormalities of HFP.