A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa’s disease
- 433 Downloads
The infrapatellar fat pad of Hoffa is commonly injured but rarely discussed in the orthopaedic literature. Hoffa’s disease is the extension of various traumatic events due to impingement and inflammation of the infrapatellar fat pad and known as a vague reason for anterior knee pain. Inflammation is foreground during acute phase of the disease while impingement due to fibrosis and scar tissue of infrapatellar fat pad plays a major role in the chronic phase. The osteochondroma of the infrapatellar fat pad secondary to the Hoffa’s disease can be more problematic. Although, the fibrocartilaginous transformation and osteochondral metaplasia of infrapatellar fat pad was pointed out frequently in the literature, the published papers seem far from clarifying the relation between chronic impingement and formation of osteochondroma. We present a case of a giant ossifying chondroma in the infrapatellar fat pad that resulted from chronic Hoffa’s disease. Complete open resection was performed successfully after arthroscopic examination. The infrapatellar fat pad contains the entire progenitor cells for the development of an osteochondroma and chronic impingement may have promoter affect on this issue, thus, an osteochondroma may occur at the end-stage Hoffa’s disease.
KeywordsOsteochondroma Infrapatellar Fatpad Hoffa’s Disease
The authors extend thanks to Prof. Dr. Gökhan Gedikoğlu for his comments about pathologic sections in this case.
- 3.Steiner GC, Meushar N, Norman A, Present D (1994) Intracapsular and paraarticular chondromas. Clin Orthop Relat Res (303):231–236 (Review)Google Scholar
- 5.Hoffa A (1904) Influence of adipose tissue with regard to the pathology of the knee joint. JAMA 43:795–796Google Scholar
- 15.Milgram JW, Dunn EJ (1980) Para-articular chondromas and osteochondromas: a report of three cases. Clin Orthop Relat Res (148):147–151Google Scholar
- 16.Pavlov H, Torg JS (1986) The running athlete year book. Mosby, Chicago, p 213Google Scholar
- 17.Metheny JA, Mayor MB (1988) Hoffa disease: chronic impingement of the infra-patellar fat pad. Am J Knee Surg 1:134–139Google Scholar
- 19.Bohnsack M, Meier F, Walter GF, Hurschler C, Schmolke S, Wirth CJ, Ruhmann O (2005) Distribution of substance-P nerves inside the infrapatellar fat pad and the adjacent synovial tissue: a neurohistological approach to anterior knee pain syndrome. Arch Orthop Trauma Surg 125(9):592–597PubMedCrossRefGoogle Scholar
- 20.Wickham MQ, Erickson GR, Gimble JM, Vail TP, Guilak F (2003) Multipotent stromal cells derived from the infrapatellar fat pad of the knee. Clin Orthop Relat Res (412):196–212Google Scholar
- 25.Kautz FG (1948) Capsular osteoma of the knee joint. Report of four cases Radiology 45:162Google Scholar
- 26.Smillie IS (1980) Disease of the knee joint. Churchill Livingstone, London pp 161–71Google Scholar