Hoffa’s disease: understanding your pain below the kneecap and getting back to your activity

What is Hoffa’s disease?

Hoffa’s fat pad anatomy

The infrapatellar fat pad, known as “Hoffa’s fat pad”, is a cushion of fatty tissue located just below the kneecap, between the patellar tendon and the knee joint. It acts as a shock absorber and helps the surrounding structures glide during knee movements. Hoffa’s disease is the irritation of this tissue, which then becomes a source of pain at the front of the knee.

Why does Hoffa’s fat pad become painful?

Hoffa’s fat pad is richly innervated and very sensitive to compression. It can be irritated by a direct impact (a fall onto the knee), by repeated hyperextension that pinches it between the tibia and femur, or by swelling linked to another knee condition (patellar tendinopathy, patellofemoral pain syndrome) that increases its volume and sensitivity to pressure.

Which sports contribute to Hoffa’s disease?

Sports involving knee hyperextension or exposing you to direct impacts carry a particular risk:

• Dance and gymnastics (knee hyperextension)
• Football (direct impacts, tackles)
• Volleyball and basketball (landing in hyperextension)
• Running with a hyperextended stride
• Contact sports with a risk of direct impact to the knee

Treating Hoffa’s disease in rehab with a sports physio

The goal of treatment is to reduce irritation and swelling of Hoffa’s fat pad, while correcting the movements or imbalances exposing it to repeated compression.

1. 1Reducing local irritation
2. 2Knee mobility while avoiding forced hyperextension
3. 3Strengthening the quadriceps within a controlled range
4. 4Correcting knee posture under load
5. 5Strengthening the posterior chain
6. 6Proprioceptive work
7. 7Progressive reintroduction of running
8. 8Light plyometrics
9. 9Progressive return to your sport
10. 10Return to competition

Why the physio’s initial assessment matters

During the initial assessment, the physiotherapist looks for a history of direct impact to the knee, sporting activity involving repeated hyperextension, or another associated knee pain that could have caused secondary swelling of Hoffa’s fat pad.

“Hoffa’s fat pad doesn’t like being pinched: giving the knee back its space often matters more than strengthening it straight away.”

Strengthening, the cornerstone of treatment

Once local irritation has calmed down, strengthening the quadriceps and posterior chain better stabilises the knee and helps avoid uncontrolled hyperextension movements that stress Hoffa’s fat pad. The work is done within a controlled range, avoiding fully locking the knee until sensitivity has decreased.

In brief

• Reducing local irritation first
• Strengthening the quadriceps within a controlled range
• Avoiding forced hyperextension during the acute phase
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Total rest isn’t essential. It’s better to temporarily limit forced hyperextension movements and prolonged kneeling, while keeping up suitable physical activity and starting rehab as soon as possible to reduce local swelling.

When should you see a specialist for Hoffa’s disease?

If pain persists for more than two to three weeks despite adapting your activities, or if the knee shows clear, persistent swelling, a medical opinion is recommended. An ultrasound or MRI can help confirm involvement of Hoffa’s fat pad and rule out another cause of anterior knee pain.

The HOPP care programmes to treat your Hoffa’s disease and get back to sport

To heal durably, Hoffa’s disease requires a progressive reduction of local irritation followed by rebalancing the knee. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible. By combining stretching, mobility, strengthening and training management, HOPP supports you all the way back to the field for an optimal, confident return.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your knee is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

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