Magnetic resonance imaging of impingement and friction syndromes around the knee. am zdemir M, Ekin E, Sari K, Yalnkaya E, Kazc Z. After a direct blow to the kneecap, the fat pad might end up becoming impinged between the kneecap and the distal thigh bone. Check for errors and try again. Ulnar Nerve Compression. One reviewer then retrospectively evaluated the referring physician's notes for clinical indicators of anterior or patellofemoral knee pain as determined by history and physical examination. First described in 1904, acute or repetitive trauma to the fat pad causes internal hemorrhage leading to an inflammatory cascade with edema and hypertrophy of the fat pad. 11. 5. Repeat this process 1 - 3 times depending on the amount of support required. With regard to the other fat pads about the knee, the prefemoral fat pad was equal to fat signal in 99% (91/92), intermediate signal in 0% (0/92), and fluid signal in 1% (1/92) on proton densityweighted MRI sequences. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, El-Feky M, Bell D, et al. Infrapatellar fat pad (aka Hoffa's fat pad): A fluid filled sack that sits below the patella, and can be felt on either side of the patellar tendon (the patellar tendon connects the patella to the tibia). The purpose of this investigation was to characterize the MRI appearance of the quadriceps fat pad and to correlate these findings with other knee abnormalities, anatomic measurements of the extensor mechanism, and findings in the patient's history and at physical examination. K Distance: 472 kms. This finding could suggest a developmental cause related to the anatomy of the extensor mechanism or possibly abnormal mechanics. Jarraya M, Diaz LE, Roemer FW, Arndt WF, Goud AR, Guermazi A. MRI Findings Consistent with Peripatellar Fat Pad Impingement: How Much Related to Patellofemoral Maltracking?. As the fat pad is one of the most sensitive structures in the knee, this injury is known to be extremely painful. An additional reviewer retrospectively measured various structures on the MR images. Do Patients Really Have Pain with Quadriceps Fat Pad Edema? 2) and absent in 2% (2/92). Dalaman is a district, as well as the central town of that district, situated on the southwestern coast of Turkey, in the Mula Province.. Dalaman Stream (Dalaman ay) forms much of the western border of the district, where its neighbors are Kyceiz and Ortaca districts. The patient denied any history of major trauma, fracture or infection. Because the exact cause of quadriceps fat pad enlargement associated with anterior knee pain at physical examination is not known, a treatment for this problem is also not known. Other effective treatments include shoe modification or orthotics and soft tissue massage. Unable to process the form. Increased signal intensity of the suprapatellar fat pad, with a convex posterior border and mass effect over the suprapatellar joint recess. Like the impingement syndrome of the infrapatellar fat pad, also known . Anterior suprapatellar fat pad impingement syndrome, anterior suprapatellar fat pad impingement syndrome, Fat pad impingement syndromes of the knee. Koyama S, Tensho K, Shimodaira H, Iwaasa T, Horiuchi H, Kato H, Saito N. A Case of Prefemoral Fat Pad Impingement Syndrome Caused by Hyperplastic Fat Pad. The results of this study show that mass effect of the quadriceps fat pad on the suprapatellar recess was identified in 12% (11/92) of consecutive knee MRI examinations, and the quadriceps fat pad was of intermediate or fluid signal intensity in 54% (50/92) on proton densityweighted images with fat saturation. One final theory of quadriceps fat pad enlargement is that of a primary or intrinsic cause. The quadriceps tendon showed normal appearance in 60% (55/92), tendinosis in 40% (37/92), partial-thickness tear in 0% (0/92), and full-thickness tear in 0% (0/92). Semantic Scholar extracted view of "Quadriceps fat pad" by A. Murphy et al. QFP edema characterized by diffuse enlargement on magnetic resonance imaging (MRI) may be analogous to Hoffa's disease of the infrapatellar fat pad [ 2 ]. The term "quadriceps fat pad edema" has been used to describe an inflammatory process within the suprapatellar fat, manifested on magnetic resonance imaging (MRI) as high T2 signal, low T2 signal, and mass effect on the quadriceps tendon. At the distal thigh, the tendons of these muscles merge to form the quadriceps tendon. References Jacobson JA, Lenchik L, Ruhoy MK, et al . ADVERTISEMENT: Supporters see fewer/no ads. Enter the email address you signed up with and we'll email you a reset link. In the first manuver, keeping the leg straight, flex the hip up to 90 degrees, looking for pain in the posterior/buttocks region. You can use Radiopaedia cases in a variety of ways to help you learn and teach. AJR Am J Roentgenol. Surgery could be considered in cases with persistent symptoms by laparoscopic resection 7. 17 (3): 195-202. It normally measures 6 mm (range, 48 mm) in women and 7 mm (range, 59 mm) in men [5]. MR images were retrospectively reviewed by two fellowship-trained radiologists (experience, 8 and 9 years) with an opinion rendered by consensus. Although the cause of this finding is unclear, the high prevalence and lack of significant correlation with anterior knee pain suggest that it may be a physiologic phenomenon related to knee movement or mechanics. Loss of Council on Sports Medicine and Fitness eccentric quadriceps strength in the postopera- (Table 3.1) is most commonly used and quite use- tive phase of anterior cruciate ligament . In the absence of anterior knee pain, quadriceps fat pad edema diagnosis cannot be made based solely on MRI findings 2,10. 9. Posted on 06th Feb 2018 / Published in: Knee. The purpose of this investigation was to characterize the MRI appearance of the quadriceps fat pad and to correlate the findings with other knee abnormalities, anatomic measurements of the extensor mechanism, and findings from history and at physical examination. Professional Treatment for Fat Pad Impingement Resting the knee while avoiding all activities that apply pressure to the anterior knee and/or increase symptoms. Institutional review board approval was obtained before the initiation of this investigation. The quadriceps (suprapatellar) fat pad (QFP) is an extrasynovial structure bordered anteriorly by the quadriceps tendon and posteriorly by the suprapatellar recess of the knee joint [ 1 ]. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-90124, fat pad impingement syndromes of the knee, Anterior knee fat pad impingment syndrome, Supratrochleal fat pad impingment syndrome, Posterior suprapatellar fat pad impingment syndrome, prominent suprapatellar osteophyte, with the edema usually in the superior aspect close to the midline, patellar tendon-lateral femoral condyle friction syndrome, with the edema, usually occurs in the inferolateral aspect of the fat pad secondary to lateral patellar dynamic subluxation, edema and enlargement of the prefemoral fat pad with high signal intensity on fluid sensitive images. 2). 1 Link to video demonstrating this. In our practice, we noted that the quadriceps fat pad may show enlargement or mass effect on the adjacent suprapatellar recess. The data pertaining to the quadriceps fat pad (mass effect, signal intensity, and anteroposterior thickness) were compared with all other data using the chi-square or Student's t test to determine any statistically significant association. However, the range (5.612.2 mm) of quadriceps fat pad thickness in patients with anterior knee pain at physical examination did overlap the range (410.5 mm) of those patients without anterior pain and the data (49 mm) of earlier studies [5]. Quadriceps fat pad edema or impingement syndrome is an inflammatory process within the quadriceps fat pad and may be analogous to Hoffa disease of the infrapatellar fat pad. 2012;2012(dec09 1):bcr2012007643-bcr2012007643. The infrapatellar fat pad is an intracapsular structure and plays a role in stabilizing the patella in extremes of flexion and extension. It fills the gap between the posterior part of the quadriceps tendon insertion and the retropatellar cartilage covering the proximal pole of the patellar base [ 3 ]. When we evaluated the presence or absence of quadriceps fat pad mass effect, no significant differences were found in the measurements of patellar length (p = 0.4164), patellar articular length (p = 0.5859), patellar tendon length (p = 0.7587), and anterior femoral sulcus angle (p = 0.8350). All our patients with quadriceps fat pad enlargement and anterior knee pain at physical examination were prescribed physical therapy. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Bas A, Tutar O, Yanik I, Samanci C. Quadriceps Fat-Pad Impingement Syndrome: MRI Findings. Figure 1a shows a gadolinium-enhanced transverse MRI scan at the level of the coracoid. There were no significant associations between quadriceps fat pad mass effect and chondromalacia of the trochlea (2 = 4.3879, p = 0.3561), medial facet (2 = 4.9683, p = 0.2906), or lateral facet (2 = 3.9645, p = 0.4108). With regard to measurements of anatomic structures, the average patellar length was 41.2 mm (range, 32.851.4 mm), the average patellar articular length was 30.6 mm (range, 21.537.9 mm), and the average patellar tendon length was 45.7 mm (range, 30.460.9 mm). The quadriceps or suprapatellar fat pad is a normal fat pad, positioned between the distal quadriceps tendon anteriorly and the suprapatellar recess posteriorly. Right: normal anterior suprapatellar fat pad Case Discussion The anterior suprapatellar fat pad is an intracapsular, but extrasynovial structure, located just posterior to the quadriceps tendon, anterior to the prepatellar joint recess, and superior to the patellar base and retropatellar cartilage, usually triangular in shape. Quadriceps fat pad impingement should be considered in chronic anterior knee pain. Another limitation is lack of histologic or pathologic data regarding quadriceps fat pad abnormalities. The term 'quadriceps fat-pad impingement' has been used to describe an inflammatory process within the anterior suprapatellar fat, manifested on MRI as high T2 signal, low T1 signal and mass effect on the quadriceps tendon. Series: Medical Radiology Title: Imaging of Orthopedic Sports Injuries Edition: 2nd ed. [7] described the MRI findings of curvilinear or globular fluid signal in the Hoffa fat pad in five patients. Hold a light weight (for example a tin of beans), palm up. Imaging Key Wrist Ligaments: What the Surgeon Needs the Radiologist to Know, Original Research. Infrapatellar Fat Pad Impingement: A Systematic Review. (2018) Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine. T - Delayed exacerbation with activity S - Severe; out of proportion to PE . The town of Dalaman is located in the coastal plain, whereas the rest of the district - towards Fethiye district on . It can become impinged and inflamed resulting in anterior knee. -. . MRCS Revision. The anterior femoral sulcus angle was 117.8 (range, 100.5137.1). Abnormal conditions that involve the Hoffa fat pad include trauma or inflammation to the infrapatellar plica, which may appear as abnormal fluid signal in the Hoffa fat pad [7]. 2). Each has shown mild improvement of his or her symptoms. This morphologic change in the fat pad results in mechanical impingement between the femur and the tibia. Am J Orthop (Belle Mead NJ). In addition, predominant quadriceps fat pad signal intensity was characterized as fat intensity, intermediate intensity (equal to muscle or hyaline cartilage), or fluid intensity on proton densityweighted fat-saturation MR images. Compression of the ulnar nerve as it passes the inner aspect of the elbow (figure 10) often due to a direct impact or. Because of the small number of patients with anterior knee pain and quadriceps fat pad enlargement, no conclusions can be drawn from these clinical data. dr.ahmetbas@hotmail.com Subhawong TK, Eng J, Carrino JA, Chhabra A. Superolateral Hoffa's fat pad edema: association with patellofemoral maltracking and impingement. In fat pad impingement syndromes, the etiologies are different for each knee fat pad.. Skeletal Radiol. Skeletal Radiol. However, we found no association between quadriceps fat pad enlargement and patellar length, patellar tendon length, patellar articular length, and femoral sulcus angle. By using our flight comparison tool, you'll be able to find your flight selection at the cheapest price available on the market. The pre-femoral fat pad or the posterior suprapatellar fat pad is located anterior to the distal femur and superior to the trochlea, separated from the quadriceps fat pad by the suprapatellar bursa. Suprapatellar fat pad impingement as an unusual cause of knee pain. Pitfalls and Pearls in MRI of the Knee, Quadriceps Fat Pad Signal Intensity and Enlargement on MRI: Prevalence and Associated Findings. Each of the MR images was prospectively interpreted, and the findings were reported by one of six musculoskeletal fellowship-trained radiologists as part of their daily clinical assignment. Quads control exercises may be prescribed to correct this. Differential Diagnosis List Quadriceps fat pad impingement syndrome with focal tendinosis of the distal quadriceps tendon In a recent article, Cothran et al. Skeletal Radiol. Last, assessment of quadriceps fat pad characteristics on MR images in control subjects with normal findings was not possible because each patient had a clinical indication for knee MRI. Anterior knee pain at physical examination was also significantly associated with an abnormal medial collateral ligament (2 = 4.83, p = 0.0031) and anterior knee pain by history (2 = 22.76, p < 0.0001). In addition, the maximal anteroposterior thickness of the quadriceps fat pad was measured and recorded. In addition, one patient had intraarticular corticosteroid injection followed by three Synvisc injections (hylan G-F 20, Wyeth-Ayerst Pharmaceuticals), and another had an intraarticular injection of some unknown medication. 6. 1. Original Research. Dislocated Elbow . The femoral sulcus angle (angle of the anterior trochlear groove) was measured on the axial sequence at a space approximately 10 mm above the distal femur. PMID: 19546338 DOI: 10.7863/jum.2009.28.7.959 Publication types When inflamed, the infrapatellar fat pad can be pinched between the patella and the femur, or the femur and tibia. The quadriceps tendon and patellar tendon were characterized as having full-thickness tear (tendon discontinuity and retraction), partial-thickness tear (intratendinous fluid signal but no complete disruption), or tendinosis (intratendinous intermediate signal equal to muscle). Insights into imaging. The articular muscle was visualized in 80% (74/92), ranging from 1- to 8-mm anteroposterior thickness. Retrospective review of clinical notes indicated the presence of defined anterior knee pain by history in 18% (17/92) and at physical examination in 15% (14/92). European Congress of Radiology - ECR 2017. Superolateral Hoffa's Fat Pad Edema: Association With Patellofemoral Maltracking and Impingement, Review. With regard to the quadriceps fat pad, the presence of mass effect on the suprapatellar recess was recorded, evident by convex posterior contour. 2. With regard to joint effusion and synovitis, joint fluid was considered physiologic or absent in 39% (36/92), small in 37% (34/92), and large in 24% (22/92). Suprapatellar fat pad edema may be analogous to Hoffa's disease, is rare, and may be a cause of anterior knee pain, however, this finding is not infrequent and its precise association with symptoms remains unclear. There were no significant associations between quadriceps fat pad mass effect and the signal intensity of the prefemoral fat pad (2 = 0.1358, p = 0.7125) or the Hoffa fat pad (2 = 0.4430, p = 0.8013). Quadriceps fat pad oedema and impingement syndrome are different entities. Anterior knee pain can result from abnormal pressure on the small fat pad that lies above the patella and behind the distal quadriceps tendon. The relationship between quadriceps fat pad syndrome and patellofemoral morphology: a case-control study. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 8. A 32-year-old man was referred to a radiology department for intermittent anterior knee pain and swelling for approximately 6 months. 3. The Hoffa fat pad was equal to fat in 89% (82/92), intermediate signal in 3% (3/92), and fluid signal in 8% (7/92) (Fig. This would have to be proven with histologic or pathologic evaluation, which was not available in this study. However, most of the time that the Infrapatellar Fat Pad is removed/debrided is to aid visualization of the joint for whatever else is being treated intra-articularly, but/and it may also be a portion of an Arthroscopic Synovectomy (Limited or Extensive) for some synovial disease/disorder. Enlargement of the quadriceps fat pad on MRI has a prevalence of 12% and is significantly associated with intermediate or fluid signal intensity of the quadriceps fat pad and anterior knee pain. They found that this abnormality represented injury or inflammation of the infrapatellar plica (or ligamentum mucosum) and can be a potential cause for knee pain or hemarthrosis [7]. However, none of the patients with enlargement of the quadriceps fat pad had direct trauma or overuse. https://epos.myesr.org/poster/esr/ecr2017/C-1672, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, Anterior suprapatellar fat pad impingement syndrome. The patellar tendon showed normal appearance in 67% (62/92), tendinosis in 32% (29/92), partial-thickness tear in 1% (1/92), and full-thickness tear in 0% (0/92). Case Reports. Khaled M. Sarraf, BSc (Hons), MBBS, MRCS Specialist Registrar in Trauma and Orthopaedic Surgery, North West Thames Rotation - London Deanery, Chelsea and Westminster Hospital NHS Foundation Trust . The quadriceps fat pad lies above the patella in the anterior knee. The finding of quadriceps fat pad mass effect on the suprapatellar recess was significantly associated with anterior knee pain at physical examination. Indications and Specications for Ultrasound Guided Procedures Ultrasound has become an indispensable tool for image guidance of interventional procedures within the MSK system. Retrospective review of MRI reports showed medial meniscus abnormalities in 51% (47/92) (equivocal tear in 1/92 and definite tear in 46/92), lateral meniscus abnormalities in 29% (27/92) (equivocal tear in 3/92 and definite tear in 24/92), and no significant association with quadriceps fat pad mass effect (2 = 1.1416, p = 0.5651 and 2 = 1.5917, p = 0.4512, respectively). AJR. As quadriceps fat pad signal increased to intermediate signal and fluid signal on fluid-sensitive sequences, mass effect was more likely to be present. Anterior suprapatellar fat pad impingement syndrome. A fat pad apron extends from the retropatellar fat pad to compartmentalize the bursa partially. fall from a height or due to a collision in contact sports) with severe elbow pain, loss of function, swelling, deformity and often associated with one or more fractures. Complete pain resolution can be achieved with ultrasound-guided injection of anesthetic or corticosteroid followed by physical therapy 6. This technique is designed to tilt the patellar so the top half of the knee cap moves towards the thigh bone, with the lower half subsequently moving further away from the shin bone, reducing compression of the patella on the fat pad. In addition, impingement of the Hoffa fat pad, also known as Hoffa's disease, is characterized in the acute stage by an edematous and hemorrhagic-appearing infrapatellar fat pad often with mass effect [4]. Presence or absence of prepatellar edema (fluid signal on proton densityweighted MR images) was noted. With regard to the trochlea of the femur, 66% (61/92) were normal; 8% (7/92) showed grade 1 chondromalacia; 10% (9/92), grade 2; 4% (4/92), grade 3; and 12% (11/92) showed grade 4 chondromalacia on MRI. 1. Each of these abnormalities is effectively assessed and diagnosed on MR images. This MR appearance is analogous to Hoffa's disease described in the infrapatellar fat pad. . There were no significant associations between quadriceps fat pad mass effect and joint effusion (2 = 4.8530, p = 0.0883), synovitis (2 = 0.0404, p = 0.8408), or prepatellar edema (2 = 2.7803, p = 0.3534). 2). 49 (6): 823. ORTHOPEDIC MCQS BANK WITH ANSWER ANATOMY 02. MRI reports were reviewed for meniscal and ligament abnormalities. Categorization of sports estab-landing of the heel, where the quadriceps mus- lished by the American Academy of Pediatrics cle contracts, protecting the knee. Separation of the elbow joint due to traumatic forces (e.g. Borja M, Jose J, Vecchione D, Clifford P, Lesniak B. Prefemoral Fat Pad Impingement Syndrome: Identification and Diagnosis. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. Associated minimal effusion in the suprapatellar recess. ADVERTISEMENT: Supporters see fewer/no ads. Differential Diagnosis List The imaging findings are edema and convex posterior surface of the anterior suprapatellar fat pad. However, none of the patients in the study by Roth had a history of direct trauma or overuse. 2018;38(7):2069-101. Anterior tendon abnormalities include quadriceps and patellar tendon tear and degeneration [1, 2]. The chi-square and Student's t tests were used to determine significant associations. 2017;47(3):329-39. Anterior suprapatellar fat pad signal abnormalities and mass effect (indicating edema), with no other significant findings, and the clinical presentation in this case, are compatible with anterior suprapatellar fat pad impingement syndrome. Fat Pad Impingement. In addition, surgical proof of the data gathered from MRI reports was not obtained. DOI: 10.53347/rid-77638; In this syndrome, the posterior border of the anterior suprapatellar (quadriceps) fat pad is high signal . Anterior suprapatellar (quadriceps) fat pad impingement syndrome is a controversial cause of anterior knee pain although anterior suprapatellar fat pad edema may often, and possibly more commonly, be incidental 1,2 . However, no association suggested this cause. Quadriceps fat pad edema: sonographic depiction and sonographically guided steroid injection J Ultrasound Med. Hyperintense Signal Alteration in the Suprapatellar Fat Pad on MRI is Associated with Degeneration of the Patellofemoral Joint over 48 months: Data from the Osteoarthritis Initiative. From the case: Quadriceps fat pad impingement syndrome mri Sagittal PD fat sat Sagittal T1 Axial PD fat sat MRI Sagittal PD fat sat The anterior suprapatellar fat pad shows edema with increased signal intensity with a slightly convex posterior surface. American journal of roentgenology. Left: anterior suprapatellar fat pad edema, Right: normal anterior suprapatellar fat pad. Associated minimal effusion in the suprapatellar recess. Our results show that this subjective assessment is useful because of a significant association between mass effect and measured anteroposterior thickness. Prefemoral fat pad impingement is caused either by: prominent suprapatellar osteophyte, with edema usually in the superior aspect close to the midline Prefemoral fat pad impingement syndrome, also known as supratrochlear / posterior suprapatellar fat pad impingement syndrome, is one of the fat pad impingement syndromes of the knee, specifically involving the prefemoral fat pad. (2020) Skeletal Radiology. An additional anterior knee structure, the articular muscle, is found deep relative to the quadriceps muscle, is present in all individuals, and is routinely visualized on MR images [9]. We theorized that excessive knee flexion at high angles may be a cause; however, we found no evidence for such association. anterior suprapatellar fat pad impingement syndrome, Fat pad impingement syndromes of the knee, Anterior suprapatellar fat pad impingement syndrome. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-53598. In this setting, sagittal MR images best . The patient denied any history of major trauma, fracture or infection. 2018: 3583049. Fat pad impingement is normally a long-term, chronic condition. Diagnosis History: O - Acute, sub-acute L - Infrapatellar (not patellar tendon) D - Chronic C - Burning, aching pain even at baseline A - Ice cupping A - Terminal extension, standing, easily provoked R - Medial thigh, suprapatellar pouch (synovitis, low-grade effusion?) This information was recorded without knowledge of the clinical history. The anterior suprapatellar fat pad is edematous compared to the prefemoral fat pad, enlarged (10 mm AP diameter) with a mass effect on the adjacent suprapatellar recess (i.e. Imran Khan, Tanweer Ashraf, Asif Saifuddin. A recent study reported an association with patellofemoral joint degeneration 9. Ultrasonography-Guided Injection for Quadriceps Fat Pad Edema: Preliminary Report of a Six-Month Clinical and Radiological Follow-Up. The cause of the quadriceps fat pad abnormalities in this study is unknown. 2013;200(3):W291-W296. OBJECTIVE. Author profile Search articles by ORCID 0000-0002-3805-4245 Yuksel Y1, Tarkan Ergun Therefore, the posterior surface of the quadriceps fat pad and a segment of the distal quadriceps tendon are lined with synovium [5]. 2. Elbow-flexion exercises (for example, Figure 1) primarily involve flexing your elbow against resistance, with differences between the exercises including where you keep your elbow (either in front of your body, by your side, behind your body, or out to your side) and which type of grip you use (either a supinated, neutral, or . These treatments include exercise therapy to reduce the forces on the fat pads, leg stretching to relieve tightness, and taping or bracing the knee. The quadriceps or suprapatellar fat pad is a normal fat pad, positioned between the distal quadriceps tendon anteriorly and the suprapatellar recess posteriorly. Objective: While clinically reading magnetic resonance (MR) images of the knees we have occasionally noted edema within the suprapatellar fat pad, with mass effect both on the suprapatellar joint recess posteriorly, and on the quadriceps tendon anteriorly. Magn Reson Med Sci. Draghi F, Ferrozzi G, Urciuoli L, Bortolotto C, Bianchi S. Hoffa's fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Prepatellar edema was present in 98% (90/92) (Fig. Twelve percent (11/92) of MRI examinations showed quadriceps fat pad mass effect on the suprapatellar recess, which was associated with intermediate or fluid signal intensity of the quadriceps fat pad (2 = 7.19, p = 0.0274) but with no other findings on knee MRI. Another potential theory for quadriceps fat pad enlargement is that these changes are secondary to adjacent knee abnormalities, such as chondromalacia, tendon abnormalities, or synovitis. Pathology Prefemoral fat pad impingement is caused either by: prominent suprapatellar osteophyte, with the edema usually in the superior aspect close to the midline patellar tendon-lateral femoral condyle friction syndrome, with the edema, usually occurs in the inferolateral aspect of the fat pad secondary to lateral patellar dynamic subluxation 10. Patients present with anterior knee pain exacerbated by hyperextension. Authors Brian Van Le 1 , Srinivasan Harish Affiliation 1 Department of Radiology, McMaster University, Ontario, Canada. The suprapatellar recess, an extension of the knee joint, does not possess a capsule. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Scola F, Anterior suprapatellar fat pad impingement syndrome. MR imaging of the infrapatellar fat pad of Hoffa. 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