Skip to main content
SpringerLink
Log in

An Open Debate on the Morphological Measurement Methodologies of the Infrapatellar Fat Pad to Determine Its Association with the Osteoarthritis Process

  • Osteoarthritis (M Goldring and T Griffin, Section Editors)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Introduction

Knee osteoarthritis (OA) is a disease affecting all the neighboring articular tissues including the infrapatellar fat pad (IPFP). Although not yet as widely studied as other tissues in the knee, the IPFP has been recognized to have important metabolic activities and is a key player in OA.

Methods

In this commentary, we will briefly describe the different methodologies employed for the MRI morphological measurement of this tissue and depict the findings in regard to OA.

Results

The morphology of this tissue, monitored mainly with the use of magnetic resonance imaging (MRI), demonstrates changes during OA. However, studies of the IPFP morphological alterations and their association with the OA process have shown conflicting results, including a detrimental or beneficial role or no role at all. Although many reasons could explain such mixed findings, one might be the different methodologies used for the MRI measurement of area, volume, or signal intensity. In addition, several techniques are also employed for measuring the volume and signal intensity. An additional level of complexity is related to the presence within the IPFP of two different types of signal intensities, hyper-intensity, and hypo-intensity.

Conclusion

A consensus of a procedure to measure the morphology of the IPFP is urgently needed to fully appreciate the role of this tissue in the pathology of OA, as well as its uses for clinical decision-making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of Data and Material

Not applicable.

Code Availability

Not applicable.

References

  1. Zeng N, Yan ZP, Chen XY, Ni GX. Infrapatellar fat pad and knee osteoarthritis. Aging Dis. 2020;11:1317–28.

    Article  Google Scholar 

  2. Ioan-Facsinay A, Kloppenburg M. An emerging player in knee osteoarthritis: the infrapatellar fat pad. Arthritis Res Ther. 2013;15:225.

    Article  Google Scholar 

  3. Harkey MS, Davis JE, Lu B, et al. Early pre-radiographic structural pathology precedes the onset of accelerated knee osteoarthritis. BMC Musculoskelet Disord. 2019;20:241.

    Article  Google Scholar 

  4. Zapata-Linares N, Eymard F, Berenbaum F, Houard X. Role of adipose tissues in osteoarthritis. Curr Opin Rheumatol. 2021;33:84–93.

    Article  CAS  Google Scholar 

  5. Ushiyama T, Chano T, Inoue K, Matsusue Y. Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids. Ann Rheum Dis. 2003;62:108–12.

    Article  CAS  Google Scholar 

  6. Conde J, Scotece M, Lopez V, et al. Differential expression of adipokines in infrapatellar fat pad (IPFP) and synovium of osteoarthritis patients and healthy individuals. Ann Rheum Dis. 2014;73:631–3.

    Article  CAS  Google Scholar 

  7. Favero M, El-Hadi H, Belluzzi E, et al. Infrapatellar fat pad features in osteoarthritis: a histopathological and molecular study. Rheumatology (Oxford). 2017;56:1784–93.

    Article  CAS  Google Scholar 

  8. Vera-Perez E, Sanchez-Bringas G, Ventura-Rios L, et al. Sonographic characterization of Hoffa’s fat pad. A pilot study. Rheumatol Int. 2017;37:757–64.

    Article  Google Scholar 

  9. Gutierrez LB, Morgan TA, Link T, Feeley B, Motamedi D. Utility of musculoskeletal ultrasound in the diagnosis and treatment of suprapatellar fat pad impingement: a case report. J Clin Case Rep. 2016;6:837.

    Article  Google Scholar 

  10. Kitagawa T, Nakase J, Takata Y, Shimozaki K, Asai K, Tsuchiya H. Use of ultrasonography to evaluate the dynamics of the infrapatellar fat pad after anterior cruciate ligament reconstruction: a feasibility study. J Med Ultrason. 2019;46:147–51.

    Article  Google Scholar 

  11. Basha MAA, Eldib DB, Aly SA, et al. Diagnostic accuracy of ultrasonography in the assessment of anterior knee pain. Insights Imaging. 2020;11:107.

    Article  Google Scholar 

  12. Dragoo JL, Johnson C, McConnell J. Evaluation and treatment of disorders of the infrapatellar fat pad. Sports Med. 2012;42:51–67.

    Article  Google Scholar 

  13. Draghi F, Ferrozzi G, Urciuoli L, Bortolotto C, Bianchi S. Hoffa’s fat pad abnormalities, knee pain and magnetic resonance imaging in daily practice. Insights Imaging. 2016;7:373–83.

    Article  CAS  Google Scholar 

  14. Roemer FW, Jarraya M, Felson DT, et al. Magnetic resonance imaging of Hoffa’s fat pad and relevance for osteoarthritis research: a narrative review. Osteoarthr Cartil. 2016;24:383–97.

    Article  CAS  Google Scholar 

  15. Han W, Cai S, Liu Z, et al. Infrapatellar fat pad in the knee: is local fat good or bad for knee osteoarthritis? Arthritis Res Ther. 2014;16:R145.

    Article  Google Scholar 

  16. Pan F, Han W, Wang X, et al. A longitudinal study of the association between infrapatellar fat pad maximal area and changes in knee symptoms and structure in older adults. Ann Rheum Dis. 2015;74:1818–24.

    Article  Google Scholar 

  17. Cowan SM, Hart HF, Warden SJ, Crossley KM. Infrapatellar fat pad volume is greater in individuals with patellofemoral joint osteoarthritis and associated with pain. Rheumatol Int. 2015;35:1439–42.

    Article  Google Scholar 

  18. Wallace KG, Pfeiffer SJ, Pietrosimone LS, et al. Changes in infrapatellar fat pad volume from 6 to 12 months following anterior cruciate ligament reconstruction and associations with patient-reported knee function. J Athl Train. 2021;56:1173–9.

    Article  Google Scholar 

  19. Bonakdari H, Tardif G, Abram F, Pelletier JP, Martel-Pelletier J. Serum adipokines/related inflammatory factors and ratios as predictors of infrapatellar fat pad volume in osteoarthritis: applying comprehensive machine learning approaches. Sci Rep. 2020;10:9993.

    Article  CAS  Google Scholar 

  20. Jacobson JA, Lenchik L, Ruhoy MK, Schweitzer ME, Resnick D. MR imaging of the infrapatellar fat pad of Hoffa. Radiographics. 1997;17:675–91.

    Article  CAS  Google Scholar 

  21. Saddik D, McNally EG, Richardson M. MRI of Hoffa’s fat pad. Skelet Radiol. 2004;33:433–44.

    Article  CAS  Google Scholar 

  22. Han W, Aitken D, Zhu Z, et al. Signal intensity alteration in the infrapatellar fat pad at baseline for the prediction of knee symptoms and structure in older adults: a cohort study. Ann Rheum Dis. 2016;75:1783–8.

    Article  Google Scholar 

  23. Davis JE, Ward RJ, MacKay JW, et al. Effusion-synovitis and infrapatellar fat pad signal intensity alteration differentiate accelerated knee osteoarthritis. Rheumatology (Oxford). 2019;58:418–26.

    Article  Google Scholar 

  24. Han W, Aitken D, Zhu Z, et al. Hypointense signals in the infrapatellar fat pad assessed by magnetic resonance imaging are associated with knee symptoms and structure in older adults: a cohort study. Arthritis Res Ther. 2016;18:234.

    Article  Google Scholar 

  25. Hunter DJ, Guermazi A, Lo GH, et al. Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthr Cartil. 2011;19:990–1002.

    Article  CAS  Google Scholar 

  26. Lu M, Chen Z, Han W, et al. A novel method for assessing signal intensity within infrapatellar fat pad on MR images in patients with knee osteoarthritis. Osteoarthr Cartil. 2016;24:1883–9.

    Article  CAS  Google Scholar 

  27. Teichtahl AJ, Wulidasari E, Brady SR, et al. A large infrapatellar fat pad protects against knee pain and lateral tibial cartilage volume loss. Arthritis Res Ther. 2015;17:318.

    Article  Google Scholar 

  28. Ragab E, Serag D. Infrapatellar fat pad area on knee MRI: does it correlate with the extent of knee osteoarthritis? Egypt J Radiol Nucl Med. 2021;52:1–9.

    Article  Google Scholar 

  29. Masaki T, Takahashi K, Hashimoto S, et al. Volume change in infrapatellar fat pad is associated not with obesity but with cartilage degeneration. J Orthop Res. 2019;37:593–600.

    Article  CAS  Google Scholar 

  30. Fontanella CG, Belluzzi E, Rossato M, et al. Quantitative MRI analysis of infrapatellar and suprapatellar fat pads in normal controls, moderate and end-stage osteoarthritis. Ann Anat. 2019;221:108–14.

    Article  Google Scholar 

  31. Cai J, Xu J, Wang K, et al. Association between infrapatellar fat pad volume and knee structural changes in patients with knee osteoarthritis. J Rheumatol. 2015;42:1878–84.

    Article  CAS  Google Scholar 

  32. Steidle-Kloc E, Culvenor AG, Dorrenberg J, Wirth W, Ruhdorfer A, Eckstein F. Relationship between knee pain and infrapatellar fat pad morphology: a within- and between-person analysis from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2018;70:550–7.

    Article  CAS  Google Scholar 

  33. Chuckpaiwong B, Charles HC, Kraus VB, Guilak F, Nunley JA. Age-associated increases in the size of the infrapatellar fat pad in knee osteoarthritis as measured by 3T MRI. J Orthop Res. 2010;28:1149–54.

    Article  Google Scholar 

  34. Han W, Aitken D, Zheng S, et al. Association between quantitatively measured infrapatellar fat pad high signal-intensity alteration and magnetic resonance imaging-assessed progression of knee osteoarthritis. Arthritis Care Res (Hoboken). 2019;71:638–46.

    Article  Google Scholar 

  35. Wang K, Ding C, Hannon MJ, Chen Z, Kwoh CK, Hunter DJ. Quantitative signal intensity alteration in infrapatellar fat pad predicts incident radiographic osteoarthritis: the Osteoarthritis Initiative. Arthritis Care Res (Hoboken). 2019;71:30–8.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to Santa Fiori for preparing the manuscript.

Funding

This work was supported in part by the Osteoarthritis Research Unit of the University of Montreal Hospital Research Centre and the Chair in Osteoarthritis from the University of Montreal.

Author information

Authors and Affiliations

  1. Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis Street, Pavilion R, Room R11.412, Montreal, Quebec, H2X 0A9, Canada

    Johanne Martel-Pelletier, Ginette Tardif & Jean-Pierre Pelletier

Authors
  1. Johanne Martel-Pelletier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ginette Tardif
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Pierre Pelletier
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors contributed to the study conception and design. Material preparation and data collection were performed by Johanne Martel-Pelletier and Ginette Tardif. The first draft of the manuscript was written by Johanne Martel-Pelletier and all the authors commented on the previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Johanne Martel-Pelletier.

Ethics declarations

Ethics Approval

Not applicable.

Consent to Participate

Not applicable.

Consent for Publication

Not applicable.

Conflict of Interest

Johanne Martel-Pelletier and Jean-Pierre Pelletier are shareholders in ArthroLab Inc. Ginette Tardif declares no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Osteoarthritis

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Martel-Pelletier, J., Tardif, G. & Pelletier, JP. An Open Debate on the Morphological Measurement Methodologies of the Infrapatellar Fat Pad to Determine Its Association with the Osteoarthritis Process. Curr Rheumatol Rep 24, 76–80 (2022). https://doi.org/10.1007/s11926-022-01057-7

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-022-01057-7

Keywords

Search

Navigation