Fat pads in your knee act as cushions to protect and support movement. When these pads become irritated or pinched, they can cause front knee pain and catching sensations.
Your knee contains small cushions of fatty tissue called fat pads that protect your joint and help it move smoothly. These fat pads fill small spaces around your kneecap (patella) and act like shock absorbers. When these pads become irritated, swollen, or get pinched, they can cause pain and affect how your knee works.
There are three main fat pads around the front of your knee: one above the kneecap (suprapatellar fat pad), one in front of the thighbone (prefemoral fat pad), and one below the kneecap (infrapatellar or Hoffa's fat pad). Any of these can become problematic and cause symptoms.
You may feel a burning or aching pain in the front of your knee, especially below the kneecap. Some people describe a catching or snapping sensation when moving their knee, which is usually worse when straightening your leg or standing for long periods.
You might notice that you naturally stand with your knee slightly bent or "locked back" rather than fully straight. If a fat pad becomes chronically inflamed, you may have swelling and feel that your knee doesn't move as freely as it should.
Fat pad irritation can develop from repetitive small injuries that cause inflammation and scarring of the tissue. This is sometimes called Hoffa's syndrome or fat pad syndrome. The condition may also develop from the way your knee tracks when you move—if your kneecap doesn't line up perfectly with your thighbone, it can put extra pressure on the fat pads.
Knee straightening and locking movements, along with prolonged standing or certain physical activities, can pinch or irritate these fat pads. Tightness in your hip or weak hip muscles may also contribute to the problem by affecting how your leg aligns.
Your doctor will examine your knee using a test called the Hoffa test. During this test, they press firmly with their thumb on either side of your patellar tendon (the tendon below your kneecap) while moving your knee from bent to straight. Pain in the fat pad area during this test may suggest fat pad irritation.
MRI imaging is the best way to see fat pad problems. The scan can show swelling, scarring, and inflammation of the fat pads. Your doctor may order an MRI if your symptoms don't improve with initial treatment or if they want to confirm the diagnosis.
Most fat pad problems improve with physical therapy. Your physical therapist may use special taping techniques to reduce pressure on your kneecap, and recommend exercises to strengthen your thigh muscles, especially the quadriceps (the large muscle on the front of your thigh).
Stretching your hip muscles and strengthening your hip abductors (the muscles on the outside of your hip) can help improve how your leg aligns and reduce stress on the fat pads. Avoiding positions that lock your knee straight back and improving the way you walk can also help long-term.
If physical therapy doesn't work, your doctor may suggest injecting local anesthetic and steroid medication directly into the fat pad to reduce inflammation and pain. This is usually done as an outpatient procedure.
For symptoms that don't improve after several months of conservative treatment, arthroscopic surgery (minimally invasive knee surgery) may be considered. During this procedure, your surgeon can remove or clean up the irritated or scarred fat pad tissue.
Most people improve with physical therapy and activity modification over several weeks to months. Focus on maintaining good knee alignment during daily activities and exercise, and gradually return to your normal activities as symptoms improve.
If you have surgery, recovery typically takes several weeks. Your physical therapist will guide you through exercises to regain strength and full range of motion in your knee.
Schedule an appointment with a sports medicine physician or orthopedic specialist if you have persistent front knee pain that doesn't improve with rest and over-the-counter pain relievers, or if you have catching or locking sensations in your knee that limit your activities. Seek immediate care if you experience sudden severe swelling, inability to bear weight, or signs of infection such as warmth, redness, or fever around your knee.
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