Hoffa's sign

Written by Dr Sheila Strover on March 14, 2025

Hoffa's sign is pain and distress when straightening the bent knee while an examiner presses deeply with the thumbs on either side of the patellar tendon. The Hoffa fat pad is the largest of several fatty regions in the knee. Page updated July 2023 by Dr Sheila Strover (Clinical Editor)

How to perform Hoffa's test

With the patient lying on their back, and the knees slightly bent to about 30 degrees, the examiner's thumbs are pressed firmly into the region of the infrapatellar or Hoffa fat pad behind the patellar tendon.

A helper then passively straightens the leg and it is noted whether there is an increase in pain.

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Relevance of a positive Hoffa's test

The test is known as the Hoffa's test. It is a test for non-specific irritation or inflammation of the Hoffa fat pad.

Because this fat pad is rich in nerve fibres, it is very sensitive to small traumas, which may also cause bleeding and scarring.

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