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Intra-articular tumours are uncommonly encountered in routine practice and may present diagnostic challenges to pathologists. Challenges unique to this site include distinction from more common reactive synovial conditions, which are far more common; histologic variability; superimposed reactive changes; and often, lack of provided clinicoradiological context. This article reviews the pathology of the synovial tumours and tumour-like lesions, including diagnostic pearls, pitfalls and rare entities. [ABSTRACT FROM AUTHOR]

Background: To study the functional outcome of surgical management in Hoffa's disease. Methods: This prospective study was conducted in the Department of Orthopaedics in a tertiary health care centre between 1st January 2020 and 31st December 2021. A total of three patients (2 males and 1 female) with Hoffa's disease were included in the study. Results: "Tegner-Lysholm score" was used for evaluation of function, and the mean Tegner–Lysholm score was 93. All the three patients had normal range of motion at 1 year follow-up. Conclusion: Hoffa's disease has low incidence, and hence diagnosing the condition correctly is of utmost importance for its proper management. [ABSTRACT FROM AUTHOR]

Background/Aim: Hoffa's disease is anterior knee pain presumably stemming from inflammatory fibrous hyperplasia of the infrapatellar fat pad (Hoffa's pad). The etiology and pathogenesis are unclear, however, and no genetic information about the disease has been published. We report the genetic findings in cells from the fat pad of a patient with Hoffa's disease. Materials and Methods: Infrapatellar fat pad cells from a patient with Hoffa's disease were examined using cytogenetic, RNA sequencing, reverse transcription-polymerase chain reaction, and Sanger sequencing techniques. Results: Cytogenetic examination of short-term cultured cells from the Hoffa's pad revealed a balanced t(12;18)(q14;q21) translocation as the sole chromosomal aberration. RNA sequencing detected an outof-frame fusion of exon 3 of the gene coding for high mobility group AT-hook 2 (HMGA2) with exon 9 of the gene coding for WNT inhibitory factor 1 (WIF1). The fusion was subsequently verified by reverse transcription-polymerase chain reaction together with Sanger sequencing. Conclusion: Our data indicate that Hoffa's disease is a neoplastic process with acquired genetic aberrations similar to those found in many benign tumors of connective tissues. The genetic aberrations are presumably acquired by mesenchymal stem cells of the infrapatellar fat pad inducing proliferation and differentiation into adipocytes or other mature connective tissue cells. [ABSTRACT FROM AUTHOR]

Introduction Hoffa's disease is a common condition, and is a severe pathology of the knee joint in many cases. Ultrasound with its capabilities and advantages can be a convenient method of primary diagnosis of this pathology. However, in the literature there is almost no description of the characteristic ultrasound picture of Hoffa’s disease and an analysis of the most common and pathognomonic symptoms. Objective To study ultrasound signs of Hoffa's disease and present the characteristic sonographic complex of its symptoms. Methods Ultrasound examination of the knee joint and arthroscopy of 37 patients diagnosed with Hoffa's disease, confirmed by a comprehensive clinical and instrumental study, was conducted. Results The most characteristic signs of Hoffa's disease in terms of pathological changes are hypertrophy of the Hoffa’s fat pad and changes in its structure, which were detected by ultrasound in 62 % and 84 % of cases, respectively. A new symptom, displacement of the patellar ligament, was identified by ultrasound examination of the knee joint according to the standard protocol in 32 % of the examined. The same percentage comprised the patients who had non-specific sonographic symptoms: an increase in the amount of synovial fluid, as well as signs of infrapatellar bursitis. Ultrasound data were compared with the results of arthroscopic examination, their correspondence was determined. Conclusion It has been established that the ultrasound examination of the knee joint according to the standard method enables to identify a complex of symptoms that are pathognomonic for Hoffa’s disease. It is recommended to introduce it in the protocol of the conclusion.

The infrapatellar fat pad (IFP) of Hoffa's fat pad is the main adipose structure within the knee joint. It is located between the joint capsule and the synovial membrane, which lines its posterior aspect. The IFP is composed chiefly of adipocytes and receives an abundant supply of blood vessels and nerves. Immune cells can infiltrate the IFP, which can become a major source of numerous proinflammatory mediators (cytokines and adipokines). The physiological role for the IFP remains unclear but may involve shock absorption and the protection of adjacent tissues. Hoffa's disease is characterized by inflammation, hypertrophy, and fibrosis of the pad in response to repetitive trauma. Anterior knee pain is the most common symptom. In advanced forms, metaplasia of the IFP may result in the development of a sometimes sizable osteochondroma. The IFP may also contribute to the pathophysiology of knee osteoarthritis, in particular via procatabolic and proinflammatory effects on its synovial lining. Finally, in patients with knee osteoarthritis, inflammation of the IFP may be a source of pain. [ABSTRACT FROM AUTHOR]

Résumé Situé sous la patella, le tissu adipeux de Hoffa (TAH) est le principal corps adipeux intra-articulaire du genou. Il est intracapsulaire mais extrasynovial. Richement vascularisé et innervé, il est tapissé sur sa face postérieure par la membrane synoviale. Constitué principalement d’adipocytes, il peut être le siège d’infiltrats de cellules immunitaires et représente une source importante de nombreux médiateurs inflammatoires (cytokines et adipokines). Son rôle physiologique reste méconnu mais il pourrait jouer un rôle d’amortisseur et de protection des tissus contigus. La maladie de Hoffa ou Hoffite correspond à une hyperplasie inflammatoire et fibreuse du TAH secondaire à des traumatismes répétés et se manifeste le plus souvent par des douleurs antérieures du genou. Dans les formes tardives, le TAH peut être le siège d’une métaplasie avec formation d’un ostéochondrome parfois volumineux. Il pourrait également contribuer à la physiopathologie de l’arthrose notamment par un effet procatabolique et pro-inflammatoire sur la membrane synoviale qui lui est contiguë. Enfin, au cours de la gonarthrose, l’inflammation du Hoffa pourrait participer à la symptomatologie douloureuse. Located under the patella, the infrapatellar fat pad (IFP) or Hoffa's fat pad is the main intra-articular adipose tissue within the knee. The IFP is described as intracapsular but extrasynovial, the synovial membrane lining its posterior surface, and has substantial innervation and vascularisation. Mainly composed of adipocytes, the IFP may be infiltrated by immune cells and is a major source of pro-inflammatory factors (cytokines and adipokines). Its physiological role remains unknown, but it might act as a shock absorber and protect the surrounding tissue. Hoffa's disease is an inflammatory and fibrous hyperplasia of the IFP induced by repeated trauma and results in anterior knee pain. In chronic disease, local metaplasia within IFP may lead to the development of an osteochondroma. It could also contribute to the pathophysiology of osteoarthritis, by a procatabolic and pro-inflammatory effect on the synovial membrane, which is adjacent to the IFP. Finally, in knee OA, its inflammation may also contribute to the painful symptoms. [ABSTRACT FROM AUTHOR]

The morphology of painful impingement of the infrapatellar fat pad (Hoffa’s disease), which is characterized by inflammation, swelling, hypertrophy, fibrosis, and/or calcifications, has been well described. The purpose of this study was to investigate whether corresponding characteristic MRI findings could be assessed in patients with infrapatellar fat pad impingement. This study includes 62 patients with secondary symptomatic Hoffa’s fat pad impingement. In these patients, the fat pad was partially resected until no impingement could be determined at full knee movement. Within a maximum of 3 months before arthroscopic surgery, patients had standardized MR imaging using a 1.5 Tesla unit with the following sequences: sagittal T1-TSE, coronal STIR-TSE, transversal fat-suppressed PD-TSE, and sagittal fat-suppressed PD-TSE (Siemens Magnetom Avanto syngo MR B 15). In this case series, the preoperative MRI appearance of the fat pad was evaluated and compared with a cohort of 255 patients without fat pad impingement but with various knee disorders at arthroscopy as well as the same standardized MRI protocol. In patients with Hoffa’s fat pad impingement, morphologic changes such as localized edema of the superior and/or posterior part of the fat pad, a deep fluid-filled infrapatellar bursa, non-visualization of vertical and/or horizontal clefts, fibrosis, and calcifications were noted on MR imaging with remarkable frequency. Besides a significant enlargement of the fat pad, each of these MRI findings was significantly associated with impingement of Hoffa’s fat pad ( P < 0.05). Besides a moderate kappa score for the detection of intrahoffatic calcifications and vertical clefts, kappa values for each finding showed good inter-observer agreement. Results of logistic regression revealed that edema of Hoffa’s fat pad was one of the most important diagnostic MRI criteria for the diagnosis of Hoffa’s fat pad impingement. MR imaging allows identification of several changes that may be related to a symptomatic impingement of Hoffa’s fat pad. In patients who are suspected of having infrapatellar fat pad impingement, such MRI findings should be considered and distinguished from other causes of anterior knee pain. [ABSTRACT FROM AUTHOR]

Purpose: We performed a retrospective cohort study with prospective data collection to assess clinical and functional outcomes of painful impingement of the infrapatellar fat pad (Hoffa’s disease) treated with high-portal arthroscopic resection. Methods: Hoffa’s disease as an isolated lesion was confirmed by arthroscopy in 34 patients with recalcitrant anterior knee pain. The visualization portals were made high in the soft spot above the level of the lower pole of the patella. Patients were treated by resection of the affected part of the fat pad and assessed via the Lysholm knee and Tegner activity level scales preoperatively and at 3 months and at 1 year postoperatively, as well as at the conclusion of this study. Results: The mean age of the patients was 38 years (range, 19 to 62 years). The mean duration of symptoms before surgery was 10 months (range, 1 to 22 months). Twelve patients had one or more previous failed arthroscopies at other centers. The mean follow-up period was 68 months (range, 49 to 95 months). The mean improvement in Lysholm score was 44.76, 55.58, and 53.97 at 3 months, at 1 year, and at the latest follow-up, respectively. On the basis of the Tegner activity level, all but 4 patients returned to their preinjury status. A statistically significant negative correlation was found between duration of symptoms and gain in Lysholm score after surgery (Pearson r = −0.58). Three types of lesion were identified. After resection, patients with acute lesions (type 1) had a quicker return to their previous level of activity according to the Tegner scale as compared with patients with chronic lesions (types 2 and 3) (P = .05 and .03, respectively). Conclusions: Patients with Hoffa’s disease without any other concomitant pathology can expect resolution or long-term improvement in their symptoms and function after arthroscopic resection. Level of Evidence: Level IV, therapeutic case series. [Copyright &y& Elsevier]

Early follow-up (15.8 months;1-48) of 230 knee replacements with an LCS A/P Glide component indicated an increased occurrence of anterior knee pain due to a fat-pad impingement, necessitating early revision surgery. Unsatisfactory results were observed in 28 knees (12.2%). Thirteen knees (5.7%) were revised on finding the fat-pad impingement, and four knees (1.7%) were scheduled for later revision surgery; the remaining 11 subjects (4.8%) had revision surgery for a different reason. Twenty-six subjects (11.3%) complained about milder but typical symptoms of a fat-pad impingement, and 22 subjects (9.6%) had unspecific mild symptoms. 151 knees (65.7%) were free of pain and demonstrated an excellent result. The total revision rate of 10.4% (24 knees) is higher than described for other implant systems. However, the revision needed to treat the fat-pad impingement (5.7%) consisted of minor surgery only, such as exchange of the mobile bearing or reduction of the fat pad by arthroscopy. The femoral and tibial components were able to be left untouched. Resection of the Hoffa's fat pad is recommended when such an implant system is used, and possible impingement should be investigated intraoperatively before closure. [ABSTRACT FROM AUTHOR]

Lipoma arborescens is a rare lesion wherein abnormal proliferation of adipocytes in the subsynovial region is seen. Whether it is neoplastic or not is still not entirely clear. Usually, Lipoma arborescens is seen unilaterally around knee joint but it can also be seen around tendon sheaths or bursa in adults. Multiple lesions are also reported. Involvement of wrist is extremely rare. We are presenting a case with bilateral wrist involvement by Lipoma arborescens which to the best of our knowledge is first one in English literature. There are a host of co-morbid/associated conditions reported with Lipoma arborescens out of which chronic irritation and inflammation appears to be most significant. We are proposing a novel perspective on etiopathogenesis of Lipoma arborescens based on extant understanding of cellular differentiation and information gleaned from fetal autopsies. The new perspective also explains the predilection for knee joint. [ABSTRACT FROM AUTHOR]

We report the case of a 40-year female patient, with no previous pathological history, presenting with right unilateral mechanical gonalgias with progressive onset, which increased climbing and going down stairs associated with hydarthrosis on clinical examination. After normal standard X ray, MRI showed a grease of hypertrophied Hoffa's grease with heterogeneous hyposignal on T1 (A), hypersignal on T2 with grease saturation (B), heterogeneously enhancing after gadolinium injection. The diagnosis of Hoffa's disease was made and the patient, after failure of a medical treatment, underwent arthroscopy for ablation of the Hoffa's grease with good evolution. Hoffa's disease, a cause poorly known of pain of the anterior compartment of the knee, is an acute or chronic inflammation of the infrapatellar adipose tissue. The physiopathologic theory speaks of repeated micro traumas resulting in inflammatory, hemorrhagic and fibrous changes of the adipose body of Hoffa; at the final stage of the disease osteochondroma occurs. MRI is the test of choice in the early forms. It shows poorly limited edematous infiltrate with hypersignal on T2 and hyposignal on T1, in a hypertrophic infrapatellar fat body. Treatment is based on general or local non-steroidal antiinflammatory drugs, icing, and physiotherapy, associated with immobilization. In the case of failure of conservative treatment or of osteochondroma, arthroscopic resection is the treatment of choice. [ABSTRACT FROM AUTHOR]

We report the case of a 40-year female patient, with no previous pathological history, presenting with right unilateral mechanical gonalgias with progressive onset, which increased climbing and going down stairs associated with hydarthrosis on clinical examination. After normal standard X ray, MRI showed a grease of hypertrophied Hoffa's grease with heterogeneous hyposignal on T1 (A), hypersignal on T2 with grease saturation (B), heterogeneously enhancing after gadolinium injection. The diagnosis of Hoffa's disease was made and the patient, after failure of a medical treatment, underwent arthroscopy for ablation of the Hoffa's grease with good evolution. Hoffa's disease, a cause poorly known of pain of the anterior compartment of the knee, is an acute or chronic inflammation of the infrapatellar adipose tissue. The physiopathologic theory speaks of repeated micro traumas resulting in inflammatory, hemorrhagic and fibrous changes of the adipose body of Hoffa; at the final stage of the disease osteochondroma occurs. MRI is the test of choice in the early forms. It shows poorly limited edematous infiltrate with hypersignal on T2 and hyposignal on T1, in a hypertrophic infrapatellar fat body. Treatment is based on general or local non-steroidal anti-inflammatory drugs, icing, and physiotherapy, associated with immobilization. In the case of failure of conservative treatment or of osteochondroma, arthroscopic resection is the treatment of choice., (© Taoufik Africha et al.)

Background: Anterior knee pain (AKP) encompasses a range of pathologies. As a result, there are a number of therapeutic options used to treat AKP. The non-operative treatments have been analysed in a number of randomised controlled trials and systematic reviews. There is however a scarcity of such publications covering the surgical management of AKP. There are no systematic reviews that have investigated surgical interventions for AKP due to pathology of the infrapatellar fat pad (IFP). The aims of this study were to review the literature systematically, to establish which surgical procedures have been used to treat IFP disease and to determine their efficacy., Methods: The review was conducted in accordance with the PRISMA reporting guidelines. A search of the literature was performed on 1st January 2014 using multiple databases including CENTRAL, MEDLINE, EMBASE, PubMed, and Google Scholar. The quality of the studies was assessed using Oxford Evidence-Based Medicine Levels of Evidence guidelines and the GRADE approach., Results: Twenty-four eligible studies were found and included. The critical appraisal identified that the current evidence-base has low methodology quality. The clinical findings indicated that there is a positive trend towards the surgical management of IFP disease for AKP symptoms. Excision of IFP tumours and resection of the IFP in Hoffa's disease can lead to improvements in symptoms and function., Conclusions: Truly robust evidence to support the surgical management of IFP pathology requires randomised controlled trials; however the expenses involved to design such trials means that they are unlikely to be undertaken for this uncommon disorder. Consequently well-designed and well-reported case series need to be undertaken to improve our current understanding that includes recording quantitative measures such as range of knee motion, VAS Pain scores and a validated scoring system., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

We report the case of five patients referred to our department with Hoffa's disease: three patients were at the initial stage of the disease and the two others had reached the chronic stage. This condition is one of the less well-documented causes of pain in the anterior compartment of the knee. The pathophysiological mechanism is still unclear. It is probably caused by repetitive micro trauma resulting in inflammatory, haemorrhagic and fibrous changes to Hoffa's fat pad. The final outcome of the disease is an osteochondroma. The diagnosis is established by MRI, which demonstrates inflammation of the fat pat. At the chronic stage, a standard X-ray is sufficient to demonstrate ossification of the fat pad., (Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)