Fat Pad Impingement

Fat pad impingement is a controversial diagnosis and has been implicated as a cause of anterior knee pain. The infrapatellar fat pad may be repeatedly entrapped between the extensor mechanism and the femur or tibia from recurrent hyperflexion or hyperextension. Direct trauma has also been implications. Pain is said to be just distal to the inferior pole of the patella with localised tenderness here with the knee extended or hyperextended.
There may be overlap with proximal patellar tendinopathy for which there is no good surgical solution. Asymptomatic knees (or those with a problem elsewhere) may have incidental increased signal in their fat pad and MRI scans are not necessarily diagnostic of the problem.
Most cases settle with time, activity modification and physiotherapy. Corticosteroid injection is probably not a good idea due to risk of tendon rupture. Other injection therapies do not have sufficient evidence to support their use. Surgical excision of a portion of the fat pad had been tried but the fat pad is richly innervated and surgical removal can result in increased pain.
To date there is no good evidence that surgery is effective for fat pad impingement and we do not offer surgery for this condition.