Infrapatellar (knee) fat pad impingement is a condition that causes dysfunction of the knee. An individual suffering from pain, instability, or reduced range of motion in their knee may be experiencing infrapatellar fat pad impingement.
The best defense to combat any condition is to learn more about its anatomy, causal factors, and treatment options.
To learn more about infrapatellar fat pad impingement, how it begins, and what treatment options are available, read on.
Anatomy of Knee Fat Pad Impingement
The knee relies on a series of soft tissues to cushion the force placed on it during everyday movement. The knee fat pad, or infrapatellar fat pad, is one of these structures.
Located beneath and under the kneecap, the infrapatellar fat pad is a soft, dynamic structure that alters position and shifts shape to accommodate the movements of the knee and surrounding muscles. The infrapatellar fat pad is richly innervated and is thus one of the most sensitive structures within the knee.
The infrapatellar fat pad helps to ensure that there is smooth motion between the knee and its anterior bones, muscles, ligaments, and tendons. In addition to facilitating smooth movements, the infrapatellar fat pad also cushions the impact a person’s upper body weight has on the knees and lower legs.
As the knee bends and flexes, the fat pad becomes relaxed and freely expansive, filling the spaces in the knee and cushioning the load it experiences. In extension, the infrapatellar fat pad sits nested between the lower kneecap (lateral patella facet) and the tendon which connects it to the muscles in the lower leg (quadriceps tendon).
infrapatellar fat pad impingement occurs when the structures of the knee begin to “pinch” the infrapatellar fat pad and apply an irregular amount of pressure to the nerves within it. This pinching and added pressure induce pain and discomfort and may lead to a number of unwanted symptoms.
When the knee is in its extended position, the infrapatellar fat pad feels the most amount of pressure, therefore, the most common symptoms of infrapatellar fat pad impingement occur in this position. Though infrapatellar fat pad impingement symptoms are most common in extension, the pain may be provoked in flexion (bending the knee) as the infrapatellar fat pad becomes trapped within the structures in the knee.
Causes of Knee Fat Pad Impingement
The infrapatellar fat pad can become impinged due to a variety of reasons. Some of the most common causes of infrapatellar fat pad impingement are:
- Acute injury to the front of the knee
- Over-pronounced quadriceps
- Gen Recurvatum (chronic over-extension of the knee)
- Osteoarthritis of the knee
- Irregular bone structures
If one or more of these causes occur, certain portions of the infrapatellar fat pad may have undue pressure placed on them. Over time, if the structures in the knee fail to heal properly, the irregularities become the norm and lead to a permanent case of infrapatellar fat pad impingement.
Symptoms and Signs of Knee Fat Pad Impingement
Infrapatellar fat pad impingement is a progressive dysfunction meaning that the signs and symptoms will develop and worsen over time as knee movements continue to pinch and damage the fat pad. Though an individual may experience episodic symptoms at first, over time these symptoms will become a part of their daily lives. Some of these signs and symptoms can include:
- Pain in the lower front of the knee
- Inflammation below and around the knee
- Pain with full extension of the knee
- Pain with prolonged walking, squatting and kicking activities
- Reduced range of flexion for the knee
- Instability and knee weakness
These symptoms may be indicative of other knee conditions such as patellar tendonitis and patellofemoral joint pain syndrome and are not limited to infrapatellar fat pad impingement. In order to determine if the infrapatellar fat pad is truly the issue, a consultation with a doctor will be best.
Diagnosing Knee Fat Pad Impingement
Typically, a consultation for infrapatellar fat pad impingement will begin with a physical examination and move on to one or various imaging tests for a closer look at the structures within the knee.
A physical examination for issues involving the infrapatellar fat pad is known as Hoffa’s Test.
A patient will lie on their back with the knee slightly bent. The doctor will apply pressure to the sides of the knee where the infrapatellar fat pad is exposed and passively bend and extend the knee. Afterward, the patient will be asked to actively bend and extend their knee while the doctor applies pressure to the same location.
Hoffa’s test is meant to incite the same pain which infrapatellar fat pad impingement would. Based on the patient’s reaction to this and other physical exams, they should be able to conclude fairly accurately which portion of the knee the symptoms stem from. Nonetheless, they will progress the evaluation to imaging tests to get a more accurate picture of how developed the issue is.
The next step in diagnosing infrapatellar fat pad impingement is to look at the inner structures of the knee. Imagining tests help provide doctors will a depiction of the muscles, bones, ligaments, and other soft tissues within the knee, including the infrapatellar fat pad. The doctor may use one or several of the following to get an inside view of the knee:
- X-rays to examine the structure of the bones in the knee
- Magnetic Resonance Imaging (MRI) for the soft tissues within the knee
- computed tomography (CT) to examine bones, muscles, and blood vessels of the knee
In some cases, doctors will perform a minimally invasive procedure known as arthroscopy to further examine the condition of the infrapatellar fat pad. An arthroscopy involves a small incision to the knee followed by the insertion of a small, tube-like camera (arthroscope) which snakes its way through the knee to the infrapatellar fat pad. Additionally, tools may be attached to the arthroscope in order to operate directly on the knee without a more invasive procedure.
If the diagnosis comes out positive and the source of a patient’s symptoms is the infrapatellar fat pad, the doctor will recommend a treatment plan to help the patient reach their functional goals and limit the effect of their symptoms.
Conventional Treatments for Knee Fat Pad Impingement
Depending on the severity of a patient’s infrapatellar fat pad impingement, a doctor will recommend one or more of the following conventional treatments.
Physical therapy is an umbrella term for any treatment by physical means. Massage, hot/cold therapy, yoga and other guided exercises would all fall into this category. In some cases these treatments will be all a patient needs in order to reduce their pain enough to continue daily activity.
While physical therapy will not be enough to eliminate the issue, it can certainly help manage the symptoms a patient may experience.
Over-the-counter medications such as ibuprofen, acetaminophen, and naproxen are some of the first lines of defense for any pains caused by over-compressed nerves. These medications reduce swelling and increase bloodflow to the site of impingement thereby reducing the pressure against the nerves in the infrapatellar fat pad.
If such medications fail to alleviate the patient’s pain, doctors can prescribe higher dosages of the same or may move on to more drastic medications which limit the brains response to pain. Prescribed medication has a high chance of abuse and may create other issues within the body.
It is always best to research any medications your doctor recommends before starting a routine.
Like medication, steroid injections help alleviate pain by reducing the swelling caused by infrapatellar fat pad impingement. Steroid injections have a high success rate at treating the symptoms of infrapatellar fat pad impingement but come with a range of unwanted side effects after prolonged use.
These injections have been known to break down surrounding tissues and may worsen the current condition of the impingement as well as create issues in the surrounding tissues. Cartilage, a critical component in healthy knee function, is especially susceptible to the effects of steroid injections.
Long recovery periods, in addition to subpar success rates, make surgery a last resort when dealing with infrapatellar fat pad impingement. Surgery will typically involve shaving off a portion of the bones in the knee to open up space for the infrapatellar fat pad.
After the surgery, the patient will be asked to limit knee movement or load bearing for up to 3 weeks. Additionally, the patient will have to undergo physical therapy supplemented by routine medication in order to restore function to the knee in a controlled environment.
Typically, surgery will not restore full knee function. Patients will have a limited range of motion and may experience instability due to the extracted tissues.
Surgery is typically reserved for chronic conditions in which a patient can not function properly due to the severity of their pain. While surgery may reduce the pain a patient experiences, these effects are minimal compared to the extensive side-effects.
While these are the most studied and recommended treatments, they may not be the most effective at combatting the issues caused by infrapatellar fat pad impingement. Moreso, these treatments rarely treat the actual cause of a patient’s pain but instead attempt to reduce it by restructuring a patient’s lifestyle.
If these treatments do not sound ideal, there are several alternative treatments for infrapatellar fat pad impingement which may be more appropriate given the patient’s lifestyle and functional goals. One such alternative treatment which has started to gather acclaim for ailments involving soft tissue damage is regenerative therapy.
Regenerative Therapy for Knee Fat Pad Impingement
Regenerative therapies have been used to treat soft tissue related pains for several decades. Initially reserved for the wealthy, advancements in regenerative therapy sciences have made these treatments more accessible to the general public. At CELLAXYS, we specialize in two forms of regenerative therapy – Platelet Rich Plasma (PRP) therapy and Stem Cell therapy.
PRP is the process of isolating the cells in the blood responsible for healing injuries and reinjecting those isolated cells back into damaged tissue. Once in the body, these isolated platelets attach to the damaged tissue and send chemical impulses which trigger a healing response from the body.
From here, the body sends proteins and other building blocks to help regenerate the injured tissue. The platelets use this material to help restore portions which have degenerated over time.
Stem Cell Therapy
In the same way that PRP uses isolated tissues from within the patient’s body to create an injection that helps restore tissue, stem cell therapy takes adipose (fat) tissue or bone marrow from a patient, processes it, and does the same.
By processing these tissues, doctors have discovered a way to induce a state in them where they become pseudo-stem cells known as mesenchymal stem cells. Once injected into the site of injury, these cells help regulate the healing factors in our bodies to amplify their effects. Even if an injury is years old, stem cell therapy can still reinvigorate the body’s healing response and treat the issue.
The benefit to the above treatments over conventional methods is that they not only treat the pain but manage to treat the source of it as well. Infrapatellar fat pad impingement may be caused by the pinching of the tissue, but over time, as this tissue breaks down, the daily pain an individual will experience is caused by the degenerated condition of the infrapatellar fat pad.
By amplifying the body’s healing factors, regenerative therapies help restore damaged tissues in the infrapatellar fat pad and reduce the number of flare-ups of pain an individual experiences. Additionally, these therapies are outpatient procedures with minimal downtimes and their effects tend to last anywhere from six months to a year.
Infrapatellar fat pad impingement can cause a number of mobility issues and may impede a person’s ability to continue their daily activity. Over time, the problem becomes worse and the severity of the symptoms increases as well. While conventional treatments provide relief to these symptoms, they may not be the most effective when factoring in a patient’s functional goals and lifestyle. Alternatives such as regenerative therapies exist to fill this gap.