Advertisement - Hide this advert





Author Topic: Hoffa Pad  (Read 5671 times)

0 Members and 1 Guest are viewing this topic.

Offline 6102DAVE

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Hoffa Pad
« on: December 14, 2014, 09:49:01 PM »
My ten year old daughter has been diagnosed with Patellofemoral Pain Syndrome and Chondromalacia (she never runs).  After three weeks there was little healing and an MRI revealed Hoffa Pad inflammation that was not a part of the initial diagnosis.  He says that the treatment will be the same - conservative treatment and give it time.  But I have not seen many wonderful success stories on the internet about Hoffa Pad injuries. 

She has also been either ranked first or second in among breaststrokers her age in America for the past three years.  We want this to go away.  We don't know what the initial mechanism of the injury was.  We think it was some combination of trampoline tricks (it is going in the garbage) and maybe pushing off the wall when swimming.  As the injury became apparent the only swimming activity that was somewhat affected was pushing off the wall.  But now breaststoke kick is not happening and the other kicks hurt too, especially when hyperextending the knee in butterfly and freestyle kick (we don't hyperextend anymore).  She is doing a token amount of swimming now with no painful actions whatsoever.  The doctor encourages swimming and if anything we are doing less than the recommended amount.

Will we know this is healed when it is no longer sore to touch?   How can we know when healing is complete without reinjuring it?

Any help would be appreciated.  Thanks.


Offline Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4188
  • Liked: 75
  • Neil TheElephant knee packed up carrying his trunk
Re: Hoffa Pad
« Reply #1 on: December 20, 2014, 04:04:45 PM »
Hi There,

I can only give you some advice through my own personal experiences with similar problems that your ten year old daughter is currently going through right now. I not been diagnosed with Chondromalacia but I do have maltraking and Patella femoral syndrome in both knees with the main problems in my right knee.

I have had 3 MRI scans since 2003 and have always had knee pain on and off since childhood and my 2nd MRI scan in 2009 came up ok of my right knee apart from an inflammation of the fat pad with some fluid around it. My knee pain is mainly anterior knee pain around the bottom of the kneecap.

I do know that it more common amongst females that diagnosed with Patellofemoral Pain Syndrome and Chondromalacia that can be supported and kept under control having a full gait analysis with the correctly costume made orthotics insoles by a podiatrist can be beneficial. Also a knee support can be beneficial.

It always a good sign if an OS goes for conservative methods of treatment 1st as an exploratory scope should be the very last option to take. PT is usually the 1st step and then as I mentioned seeing a podiatrist for a gait analysis that can contribute to PFS pain.

When I had problems with my fat pad My OS tried out PT and orthotics that did not help ease the pain so then had ultrasound therapy that was also unsuccessful so then had a cortisone injection. The injection was not working and the only option left was to have an exploratory scope done to see what is going on inside my right knee!

Here is a link to what was found on my MRI scan

Anterior herniation of synovium into Hoffas fat!

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=24287.0

Swimming is an excellent way to keep fit and without putting too much strain onto the joints and breaststrokes kicks can put strain onto a knee that is not 100% as I can feel pain when doing breastroke kicking and know it is scar tissue from two knee surgeries that's causing the pain and discomfort.

If the OS says swimming is ok then it ok to do it in small measures not overdoing it and could maybe your daughter could try going to a hydrotherapy pool that a good alternative to going to a swimming pool if your daughter is feeling knee pain while swimming.

Hopefully your daughter’s knee pain will improve over a period of time as she is still young and still developing and will just be going into the early stages of puberty with growing pain and joint pain often associated amongst older children and adolescents.   

Good luck and hopefully your daughter’s knee problems are just a temporary and short term problem, hopefully it should resolve over a certain time period taking things slowly and listening to what the OS suggests and not overdoing it too much that I often end up doing and made my right knee even worse for not be patient enough!

[email protected]

RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Kdem

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Hoffa Pad
« Reply #2 on: January 18, 2015, 11:10:30 PM »
Hi there,
This is my first time posting. But I am in a similar situation to you. My 11 year old has just been diagnosed with Hoffa pad inflammation and likely impingement (edema seen on second mri last week). This started from a bone bruise on the medial femoral condyle in late August of 2014. She has felt pain since mid-September on and, indeed, it was 1.5 hours at a trampoline party that seemed to put her in this cycle. The pain subsides, but always comes back as soon as she starts any repetitive motion involved extension--walking, running, even aqua jogging. It took us months to figure out that it was the knee extension doing this--only once we got the second mri result and found out about the fat pad. Her patella has a moderate lateral tilt and has a pretty good anterior-posterior tilt, which causes it to dig into the fat pad. It is maltracking. Plus she tends to stand with that leg in full, almost hyper-extension.
How is your daughter? I hope she is getting healed. My advice would be to be cautious of doctors and PT telling you she can do repetitive activity until you know it is healed and supposedly it can take a very long time (but there is so little info out there--it's hard to know for sure). I wish we had known this was more complicated than simple patella maltracking and had given her rest from repetitive activities all this time. Now we are four months in and just coming to that realization. She has been pretty much housebound except for little bouts of trying to reintroduce repetitive activity, but that repetitive activity always flares her up and now I'm worried that she may not heal.

I wish your daughter all the best and hope all is well.

Offline Clarkey

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 4188
  • Liked: 75
  • Neil TheElephant knee packed up carrying his trunk
Re: Hoffa Pad
« Reply #3 on: January 29, 2015, 07:18:08 PM »
Hi Kdem,

Your daughter knee problems sound similar to what I went through with my ongoing right knee problems with inflammation of the fat pad that was surrounded by fluid. I could feel catching rather like a meniscus tear and with a low lying patella and maltracking I felt more of the catching sensation.

I would always advice to stay away from surgical procedures as this should always be the last resort as soft tissue problems inside the knee that are hard to fix and get right again as you are then at a higher risk of forming excessive scarring inside the knee.

My medial femoral condyle also showed up bruising before my 2nd scope that turned out to be arthrofibrosis and had to have AIR surgery Anterior Interval Release to remove the scar tissue from 1st scope! Your daughter has not got AF as she not had any surgery yet.

When I saw my OS yesterday he mentioned edema might show up when I have another MRI scan in a few weeks time. It does sound very alarming when you hear bone bruising or bleeding of the bone inside the knee joint that can get better over time! One has to be extremely patient to see improvements.

I feel pain instantly at the bottom of my knee if I try to run kneel or squat! It is a postive sign that your daughter can run and jog ok with some discomfort afterwards. I am 36 and my knee issues have caught up with me.

I would tell any youngsters out there listen to your knee pain and do not overdo it and get proper training and advice from a personal trainer so you do not damage your knee. A knee problem can never be reversed again! I overdid it running at quick pace on a hard surface and ignored the knee pain while I was running as I did not stretch before or after! Also eating the right food for long distance running helps.

I do not want to start worrying you as my knee problem different to what your daughter experiencing even though her MRI results came up with similar symptoms. Bone bruising is a common knee problem for all age ranges that usually heals up over a long period. 

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming















support