The surgical treatment of anterior knee pain due to infrapatellar fat pad pathology: A systematic review

Rooney, A. Denise; Wahba, Adam J; Smith, Toby; Donell, Simon

doi:10.1016/j.otsr.2015.01.019

Cited by 18 publications

(10 citation statements)

References 38 publications

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“… 40 – 42 Favorable results have been also shown for the management of the infrapatellar fat pad impingement and Hoffa’s disease. 43 , 44 Chronic complaints, previous surgical intervention, degenerative changes in two or three compartments, significant axis deviation, ligament imbalance, or severe cartilage destruction are among the characteristics of patients who may be candidates for unsatisfactory results after arthroscopy. 42…”

Section: Discussionmentioning

confidence: 99%

“…Due to this, viscosupplementation has been recommended as adjunctive therapy after arthroscopic surgery as a suitable way of achieving long-term stabilization of the treatment outcome. 40 , 44 , 46 …”

Section: Discussionmentioning

confidence: 99%

“…Procedures for clinical practice and the dosage described by the manufacturers have been used; according to the studies published, treatments with HA usually started 3 weeks after surgery. 3 , 35 , 44 , 48 , 49 In absence of recommendations in the literature, PRP injection was administered immediately after arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that, in this group, all patients had OA grade II as well as a greater number of overweight/obese patients – a characteristic that may also have influenced the results. 44 …”

Section: Discussionmentioning

confidence: 99%

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Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement

Vasavilbaso¹,

Bello²,

López³

et al. 2017

OARRR

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PurposeTo assess the effectiveness of viscosupplementation or platelet-rich plasma (PRP), compared to standard care, for pain relief after knee arthroscopic debridement in patients with meniscal pathology and osteoarthritis (OA), under normal clinical practice conditions.Patients and methodsWe conducted a prospective, randomized, evaluator-blind, pilot study. After arthroscopy, patients were randomized to receive 1) five injections of HA1 (Suprahyal®/Adant®); 2) four injections of HA2 (Orthovisc®); 3) three injections of HA3 (Synvisc®); 4) a single injection of PRP (GPS™ II); or 5) standard care (control). Patients were followed up for 18 months. Clinical outcomes were evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 3, 6, 12, and 18 months. Minimally Clinical Important Improvement (MCII), as relative improvement ≥20 for pain and function, was also calculated.ResultsFifty patients were included. At early follow-up (3 months), total WOMAC scores improved in all groups compared to baseline with reductions of 44.79% (HA1), 24.02% (HA2), 40.38% (HA3), 39.77% (PRP), and 27.64% (control) (p=0.002 HA1 compared to HA2). At 18 months, the higher improvement in total WOMAC was in HA1 with a 65.20% reduction, followed by PRP (55.01%), HA3 (49.57%), and HA2 (29.82%), whereas the control group had a 14.55% increase over baseline (p=0.001 control compared to HA1 and HA3). The percentage of patients achieving the MCII for both pain and function at 18 months was 100% (HA1), 80% (HA3), 60% (HA2), and 60% (PRP), whereas, in the control group, all patients returned to pre-arthroscopy levels. There were no adverse events attributable to surgery or to intraarticular administration.ConclusionViscosupplementation following arthroscopy is more effective than PRP in adequately selected patients with meniscal lesions occurring concomitantly with OA. Further controlled studies with a larger sample size and/or alternative regimens would be of interest for the scientific community.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement

Vasavilbaso¹,

Bello²,

López³

et al. 2017

OARRR

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“…Protocols of 86 MRI examinations of knee joints with anterior knee pain syndrome and no clearly defined traumatic history nor ТРАВМАТОЛОГИЯ И ОРТОПЕДИЯ РОССИИ / TRAUMATOLOGy AND ORTHOPEDICS OF RUSSIA 2019;25(2) введение жировое тело Гоффа -интракапсулярная экстрасиновиальная структура, увеличивающая площадь синовиальной поверхности и влияющая на распределение внутрисуставной жидкости [1][2][3]. Оно ограничено со всех сторон: спереди -собственной связкой надколенника, кверху и кпереди -нижней поверхностью надколенника, кверху и кзадихрящом блока бедренной кости, кзади -передней крестообразной связкой и синовиальной оболочкой, книзу -большеберцовой костью и передними рогами менисков, упираясь в глубокую инфрапателлярную сумку [4,5].…”

Section: Introductionunclassified

Magnetic Resonance Imaging of Hoffa’s Fat Pad

Stulov

Тарасов

2019

Traumatology and Orthopedics of Russia

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Background. Pathological changes in the size and structure of Hoffa’s fat pad can cause pain in the anterior section of the knee joint. Therefore, they should be diagnosed. The objective of the paper is to improve the diagnostics of Hoffa’s fat pad disease on the basis of a detailed study of the clinical anatomy of the infrapatellar (Hoffa’s) fat pad and magnetic resonance imaging (MRI) findings in normal and pathological conditions.Materials and Methods. Protocols of 86 MRI examinations of knee joints with anterior knee pain syndrome and no clearly defined traumatic history nor positive clinical tests indicating damage to the intra-articular and periarticular elements with identified structural changes in the fat pad were selected retrospectively. The control group consisted of data from 24 examinations of asymptomatic knee joints. In all cases, the pathology was confirmed during diagnostic and therapeutic arthroscopy.Results. The MRI findings showed the normal structure of the infrapatellar fat pad, as well as pathological changes in the form of tearing, local edema, diffuse edema, synovial proliferation and fibrosis. Depending on the location and type of changes, 4 pathological syndromes were identified: “classic” Hoffa’s disease — 49 (57%) cases, infrapatellar synovial fold syndrome — 11 (13%), infrapatellar synovial fold separation syndrome — 6 (7%), and impingent syndrome of upper lateral adipose tissue — 20 (23%) cases.Conclusions. To identify a pathology, a precise synchronization of clinical and morphological changes is required. Accurate differentiation of syndromes is possible due to knowledge of the detailed anatomical and magnetic-resonance features of the fat pad in normal and pathological conditions. This allows to diagnose the cause of pain in the anterior sections of the knee joint, specify the diagnosis, and choose the optimal plan of treatment.

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Fibrotic changes in the infrapatellar fat pad induce new vessel formation and sensory nerve fiber endings that associate prolonged pain

Onuma

Tsuji

Hoshino

et al. 2020

Journal Orthopaedic Research

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The infrapatellar fat pad (IFP) contains nerve fiber endings and is considered to play an important role in the perception of knee pain. However, it is unclear whether and to what degree prolonged pain influences the nociceptive role of the IFP. To answer this question, we established a novel rat model of knee pain in which inflammation is restricted to the IFP. Rats received a single intra‐IFP injection of monoiodoacetic acid (MIA) (0.2 mg/10 µL or 1.0 mg/10 µL) in the left knee and a phosphate‐buffered saline (10 µL) injection in the right knee as a control. Pain‐avoidance behavior and histological changes of the knee joint were measured at multiple time points up to 28 days after MIA injection. Histological analysis showed a transient inflammatory response in the IFP body in the 0.2‐mg model, whereas prolonged inflammation followed by fibrotic changes was observed in the 1.0‐mg model. Subtle histological alterations were observed in the articular cartilage and IFP surface regardless of the dose. The pain‐avoidance behavior test indicated the development of prolonged knee pain throughout the experimental period in the 1.0‐mg group. Histological assessments showed a significant increase in calcitonin gene‐related peptide (CGRP)‐positive nerve fiber endings inside IFPs with fibrosis in newly vascularized surrounding regions. These data suggest that irreversible fibrotic changes in the IFP induce the formation of new vessels and CGRP‐positive nerve fiber endings that associate prolonged pain in the joint.

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The surgical treatment of anterior knee pain due to infrapatellar fat pad pathology: A systematic review

Cited by 18 publications

References 38 publications

Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement

Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement

Magnetic Resonance Imaging of Hoffa’s Fat Pad

Fibrotic changes in the infrapatellar fat pad induce new vessel formation and sensory nerve fiber endings that associate prolonged pain

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