Archives of Orthopaedic and Trauma Surgery

, Volume 128, Issue 5, pp 515–519 | Cite as

A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa’s disease

  • Egemen TurhanEmail author
  • Mahmut Nedim Doral
  • Ahmet Özgür Atay
  • Murat Demirel
Arthroscopy and Sports Medicine


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.


Osteochondroma Infrapatellar Fatpad Hoffa’s Disease 



The authors extend thanks to Prof. Dr. Gökhan Gedikoğlu for his comments about pathologic sections in this case.


  1. 1.
    Bostman O, Karaharju E, Heikkonen L, Holmstrom T (1985) Extraskeletal ossifying chondroma in the knee. A case report Acta Orthop Scand 56(1):87–89PubMedCrossRefGoogle Scholar
  2. 2.
    Bansal M, Goldman AB, DiCarlo EF, McCormack R (1993) Soft tissue chondromas: diagnosis and differential diagnosis. Skeletal Radiol 22(5):309–315PubMedCrossRefGoogle Scholar
  3. 3.
    Steiner GC, Meushar N, Norman A, Present D (1994) Intracapsular and paraarticular chondromas. Clin Orthop Relat Res (303):231–236 (Review)Google Scholar
  4. 4.
    Sakai H, Tamai K, Iwamoto A, Saotome K (1999) Para-articular chondroma and osteochondroma of the infrapatellar fat pad: a report of three cases. Int Orthop 23(2):114–117PubMedCrossRefGoogle Scholar
  5. 5.
    Hoffa A (1904) Influence of adipose tissue with regard to the pathology of the knee joint. JAMA 43:795–796Google Scholar
  6. 6.
    Palumbo RC, Matthews LS, Reuben JM (1994) Localized pigmented villonodular synovitis of the patellar fat pad: a report of two cases. Arthroscopy 10(4):400–403PubMedCrossRefGoogle Scholar
  7. 7.
    Kenan S, Abdelwahab IF, Klein MJ, Lewis MM (1993) Case report 817: synovial chondrosarcoma secondary to synovial chondromatosis. Skeletal Radiol 22(8):623–626. ReviewPubMedCrossRefGoogle Scholar
  8. 8.
    Comert RB, Aydingoz U, Atay OA, Gedikoglu G, Doral MN (2004) Vascular malformation in the infrapatellar (Hoffa’s) fat pad. Knee 11(2):137–140PubMedCrossRefGoogle Scholar
  9. 9.
    Yilmaz E, Karakurt L, Ozercan I, Ozdemir H (2004) A ganglion cyst that developed from the infrapatellar fat pad of the knee. Arthroscopy 20(7):e65–e68PubMedGoogle Scholar
  10. 10.
    Yilmaz E, Karakurt L, Akpolat N, Ozdemir H, Belhan O, Incesu M (2005) Intra-articular lipoma of the knee joint in a girl. Arthroscopy 21(1):98–102PubMedCrossRefGoogle Scholar
  11. 11.
    Ogilvie-Harris DJ, Giddens J (1994) Hoffa’s disease: arthroscopic resection of the infrapatellar fat pad. Arthroscopy 10(2):184–187PubMedCrossRefGoogle Scholar
  12. 12.
    Krebs VE, Parker RD (1994) Arthroscopic resection of an extrasynovial ossifying chondroma of the infrapatellar fat pad: end-stage Hoffa’s disease? Arthroscopy 10(3):301–304PubMedCrossRefGoogle Scholar
  13. 13.
    Magi M, Branca A, Bucca C, Langerame V (1991) Hoffa disease. Ital J Orthop Traumatol 17(2):211–216. ReviewPubMedGoogle Scholar
  14. 14.
    Milgram JW, Jasty M (1983) Case report 238: para-articular osteochondroma of the knee. Skeletal Radiol 10(2):121–125PubMedCrossRefGoogle Scholar
  15. 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. 16.
    Pavlov H, Torg JS (1986) The running athlete year book. Mosby, Chicago, p 213Google Scholar
  17. 17.
    Metheny JA, Mayor MB (1988) Hoffa disease: chronic impingement of the infra-patellar fat pad. Am J Knee Surg 1:134–139Google Scholar
  18. 18.
    Ushiyama T, Chano T, Inoue K, Matsusuoe Y (2003) Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids. Ann Rheum Dis 62:108–112PubMedCrossRefGoogle Scholar
  19. 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. 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
  21. 21.
    Li C, Arger PH, Dalinka MK (1989) Soft tissue osteochondroma. A report of three cases Skeletal Radiol 18(6):435–437PubMedCrossRefGoogle Scholar
  22. 22.
    Robillard GL (1941) Ossification of infrapatellar bursa and fat pad. Am J Surg 51:442CrossRefGoogle Scholar
  23. 23.
    Zlatkin MB, Lander PH, Begin LR, Hadjipavlou A (1985) Soft-tissue chondromas. AJR Am J Roentgenol 144(6):1263–1267PubMedGoogle Scholar
  24. 24.
    Sarmiento A, Elkins RW (1975) Giant intra-articular osteochondroma of the knee. J Bone Joint Surg Am 57(4):560–561PubMedGoogle Scholar
  25. 25.
    Kautz FG (1948) Capsular osteoma of the knee joint. Report of four cases Radiology 45:162Google Scholar
  26. 26.
    Smillie IS (1980) Disease of the knee joint. Churchill Livingstone, London pp 161–71Google Scholar
  27. 27.
    Chung EB, Enzinger FM (1978) Chondroma of soft parts. Cancer 41(4):1414–24PubMedCrossRefGoogle Scholar
  28. 28.
    Dahlin DC, Salvador AH (1974) Cartilaginous tumors of the soft tissues of the hands and feet. Mayo Clin Proc 49(10):721–6PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Egemen Turhan
    • 1
    Email author
  • Mahmut Nedim Doral
    • 2
  • Ahmet Özgür Atay
    • 2
  • Murat Demirel
    • 3
  1. 1.Department of Orthopaedics and TraumatologyZonguldak Karaelmas University School of MedicineZonguldakTurkey
  2. 2.Department of Orthopaedics and TraumatologyHacettepe UniversityAnkaraTurkey
  3. 3.Department of Orthopaedics and TraumatologyBayındır Private HospitalAnkaraTurkey

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