Skip to main content
Log in

Differential diagnosis of tumours and tumour-like lesions of the infrapatellar (Hoffa’s) fat pad: pictorial review with an emphasis on MR imaging

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

A variety of intrinsic and extrinsic tumours and tumour-like conditions may affect the infrapatellar (Hoffa’s) fat pad (IFP). MR imaging is the technique of choice in evaluating these conditions, but correlation with radiographs is important to identify those lesions producing mineralization. This pictorial review illustrates the spectrum of mass-like lesions that can affect the IFP, emphasizing the radiographic and MR findings that suggest a specific diagnosis.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Jacobson JA, Lenchik L, Ruboy MK, Schweitzer ME, Resnick D (1997) MR imaging of the infrapatellar fat pad of Hoffa. Radiographics 17:675–691

    CAS  PubMed  Google Scholar 

  2. González-Lois C, García-de-la-Torre P, SantosBriz-Terrón A, Vilá J, Manrique-Chico J, Martínez-Tello J (2001) Intracapsular and para-articular chondroma adjacent to large joints: report of three cases and review of the literature. Skeletal Radiol 30:672–676

    Article  PubMed  Google Scholar 

  3. Bansal M, Goldman AB, DiCarlo EF, McCormack R (1993) Soft tissue chondromas: diagnosis and differential diagnosis. Skeletal Radiol 22:309–315

    Article  CAS  PubMed  Google Scholar 

  4. Kransdorf MJ, Meis JM (1993) From the archives of the AFIP. Extraskeletal osseous and cartilaginous tumors of the extremities. Radiographics 13:853–884

    CAS  PubMed  Google Scholar 

  5. Zlatkin MB, Lander PH, Begin LR, Hadjipavlou A (1985) Soft tissue chondromas. Am J Roentgenol 144:1263–1267

    CAS  PubMed  Google Scholar 

  6. 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 23:114–117

    Article  CAS  PubMed  Google Scholar 

  7. Steiner GC, Meushar N, Norman A, Present D (1994) Intracapsular and paraarticular chondromas. Clin Orthop 303:231–236

    PubMed  Google Scholar 

  8. Schmidt-Rohlfing B, Staatz G, Tietze L, Ihme N, Siebert CH, Niethard FU (2002) Diagnosis and differential diagnosis of extraskeletal, para-articular chondroma of the knee. Z Orthop 140:544–547

    Article  CAS  PubMed  Google Scholar 

  9. Kudawara I, Ueda T, Araki N (2001) Extraskeletal chondroma around the knee. Clin Radiol 56:779–782

    Article  CAS  PubMed  Google Scholar 

  10. Cohen AP, Giannoudis PV, Hinsche A, Smith RM, Matthews SJE (2001) Post-traumatic giant intra-articular synovial osteochondroma of the knee. Injury 32:87–89

    Article  CAS  PubMed  Google Scholar 

  11. Matsumoto H, Kawakubo M, Otani T, Fujikawa K (1999) Extensive post-traumatic ossification of the patellar tendon. A report of two cases. J Bone Joint Surg Br 81:34–36

    Article  CAS  PubMed  Google Scholar 

  12. Mundy GM, Oni OOA (2003) Patellar tendon ossification treated with simple subcapsular excision. J Knee Surg 16:221–223

    CAS  PubMed  Google Scholar 

  13. Masih S, Antebi A (2003) Imaging of pigmented villonodular synovitis. Semin Musculoskelet Radiol 7:205–216

    Article  PubMed  Google Scholar 

  14. Moskovich R, Parisien JS (1991) Localized pigmented villonodular synovitis of the knee. Arthroscopic treatment. Clin Orthop 271:218–224

    PubMed  Google Scholar 

  15. Palumbo RC, Matthews LS, Reuben JM (1994) Localized pigmented villonodular synovitis of the patellar fat pad: a report of two cases. Arthroscopy 10:400–403

    CAS  PubMed  Google Scholar 

  16. Musculo DL, Makino A, Costa-Paz M, Ayerza MA (1995) Localized pigmented villonodular synovitis of the posterior compartment of the knee: diagnosis with magnetic resonance imaging. Arthroscopy 11:482–485

    PubMed  Google Scholar 

  17. Otsuka Y, Mizuta H, Nakamura E, Kudo S, Inoue S, Takagi K (1996) Tenosynovial giant-cell tumor arising from the anterior cruciate ligament of the knee. Arthroscopy 12:496–499

    Article  CAS  PubMed  Google Scholar 

  18. Williams AM, Myers PT (1997) Localized pigmented villonodular synovitis: a rare cause of locking of the knee. Arthroscopy 13:515–516

    Article  CAS  PubMed  Google Scholar 

  19. Lee BI, Yoo JE, Lee SH, Min KD (1998) Localized pigmented villonodular synovitis of the knee: arthroscopic treatment. Arthroscopy 14:764–768

    CAS  PubMed  Google Scholar 

  20. Mancini GB, Lazzeri S, Bruno G, Pucci G (1998) Localized pigmented villonodular synovitis of the knee. Arthroscopy 14:532–536

    CAS  PubMed  Google Scholar 

  21. Delcogliano A, Galli M, Menghi A, Belli P (1998) Localized pigmented villonodular synovitis of the knee: report of two cases of fat pad involvement. Arthroscopy 14:527–531

    CAS  PubMed  Google Scholar 

  22. De Visser E, Veth RP, Pruszczynski M, Wobbes T, Van de Putte LB (1999) Diffuse and localized pigmented villonodular synovitis: evaluation of treatment of 38 patients. Arch Orthop Trauma Surg 119:401–404

    Article  PubMed  Google Scholar 

  23. Bartlett MJ, Lavelle J (2000) Localized pigmented villo-nodular synovitis presenting as recurrent dislocation of the patella. Arthroscopy 16:767–769

    CAS  PubMed  Google Scholar 

  24. Choi NH (2000) Localized pigmented villonodular synovitis involving the fat pad of the knee: case report. Am J Knee Surg 13:117–119

    CAS  PubMed  Google Scholar 

  25. Kim SJ, Shin SJ, Choi NH, Choo ET (2000) Arthroscopic treatment for localized pigmented villonodular synovitis of the knee. Clin Orthop 379:224–230

    PubMed  Google Scholar 

  26. Muscolo DL, Makino A, Cost-Paz M, Ayerza M (2000) Magnetic resonance imaging evaluation and arthroscopic resection of localized pigmented villonodular synovitis of the knee. Orthopedics 23:367–369

    CAS  PubMed  Google Scholar 

  27. Akgün I, Ögüt T, Kesmezacar H, Dervisoglu S (2003) Localized pigmented villonodular synovitis of the knee. Orthopedics 26:1131–1135

    PubMed  Google Scholar 

  28. Khanduja V, Dannawi Z, Ng L, El-Zebdeh M (2004) Giant cell tumor of the tendon sheath arising from the patellar tendon: case report. J Knee Surg 17:28–29

    CAS  PubMed  Google Scholar 

  29. Bernstein AD, Jazrawi LM, Rose DJ (2001) Arthroscopic treatment of an intra-articular lipoma of the knee joint. Arthroscopy 17:539–541

    Article  CAS  PubMed  Google Scholar 

  30. Matsumoto K, Okabe H, Ishizawa M, Hiraoka S (2001) Intra-articular lipoma of the knee joint: a case report. J Bone Joint Surg Am 83A:101–105

    Google Scholar 

  31. Yeomans NP, Robertson A, Calder SJ (2003) Torsion of an intra-articular lipoma as a cause of pseudo-locking of the knee. Arthroscopy 19:E27

    Article  CAS  Google Scholar 

  32. Yamaguchi S, Yamamoto T, Matsushimata S, Yoshiya S, Matsubara N, Matsumoto T (2003) Solitary intraarticular lipoma causing sudden locking of the knee: a case report and review of the literature. Am J Sports Med 31:297–299

    PubMed  Google Scholar 

  33. Pudlowski RM, Gilula LA, Kyriakos M (1979) Intraarticular lipoma with osseous metaplasia: radiographic-pathologic correlation. Am J Roentgenol 132:471–473

    CAS  Google Scholar 

  34. Marui T, Yamamoto T, Kimura T et al (2002) A true intra-articular lipoma of the knee in a girl. Arthroscopy 18:E24

    Article  Google Scholar 

  35. Ryu KN, Jaovisidha S, Schweitzer M (1996) MR imaging of lipoma arborescens of the knee joint. Am J Roentgenol 167:1229–1232

    CAS  Google Scholar 

  36. Soler T, Rodríguez E, Bargiela A, Da Riba M (1998) Lipoma arborescens of the knee: MR characteristics in 13 joints. J Comput Assist Tomogr 22:605–609

    Article  CAS  PubMed  Google Scholar 

  37. Narváez JA, Narváez J, Aguilera C, De Lama E, Portabella F (2001) MR imaging of synovial tumors and tumor-like lesions. Eur Radiol 11:2549–2560

    Article  CAS  PubMed  Google Scholar 

  38. Khan AM, Cannon S, Levack B (2003) Primary intra-articular liposarcoma of the knee: case report. J Knee Surg 16:107–109

    PubMed  Google Scholar 

  39. Robertson PL, Schweitzer ME, Bartolozzi AR, Ugoni A (1994) Anterior cruciate ligament tears: evaluation of multiple signs with MR imaging. Radiology 193:829–834

    CAS  PubMed  Google Scholar 

  40. Apostolaki E, Cassar-Pullicino VN, Tyrrell PNM, McCall IW (1999) MRI appearances of the infrapatellar fat pad in occult traumatic patellar dislocation. Clin Radiol 54:743–747

    Article  CAS  PubMed  Google Scholar 

  41. Hoffa A (1904) Influence of adipose tissue with regard to the pathology of the knee joint. J Am Med Assoc 43:795–796

    Google Scholar 

  42. Olgilvie-Harris DJ, Giddens J (1994) Hoffa’s disease: arthroscopic resection of the infrapatellar fat pad. Arthroscopy 10:184–187

    PubMed  Google Scholar 

  43. Magi M, Branca A, Bucca C, Langerame V (1991) Hoffa’s disease. Ital J Orthop Trauma 17:211–216

    CAS  Google Scholar 

  44. Krebs VE, Parker RD (1994) Arthroscopic resection of an extrasynovial ossifying chondroma of the infrapatellar fat pad. End-stage Hoffa’s disease? Arthroscopy 10:301–304

    CAS  PubMed  Google Scholar 

  45. Tang G, Nitsu M, Ikeda K, Endo H, Itai Y (2000) Fibrous scar in the infrapatellar fat pad after arthroscopy. Radiat Med 18:1–5

    PubMed  Google Scholar 

  46. Recht MP, Piraino DW, Cohen MAH, Parker RD, Bergfield JA (1995) Localized anterior arthrofibrosis (cyclops lesion) after reconstruction of the anterior cruciate ligament: MR imaging findings. Am J Roentgenol 165:383–385

    CAS  Google Scholar 

  47. Bradley DM, Bergman AG, Dillingham MF (2000) MR imaging of cyclops lesions. Am J Roentgenol 174:719–726

    CAS  Google Scholar 

  48. McMahon PJ, Dettinger JR, Yocum LA, Glousman RE (1999) The cyclops lesion: a cause of diminished knee extension after rupture of the anterior cruciate ligament. Arthroscopy 15:757–761

    CAS  PubMed  Google Scholar 

  49. Huang GS, Lee CH, Chan WP, Lee HJ, Chen CY, Yu JS (2002) Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears. Radiology 225:537–540

    PubMed  Google Scholar 

  50. Chung CB, Skaf A, Roger B, Campos J, Stump X, Resnick D (2001) Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients. Skeletal Radiol 30:694–697

    Article  CAS  PubMed  Google Scholar 

  51. Kramer J, Recht M, Deely DM, Schweitzer M, Pathria MN, Gentili A, Greenway G, Resnick D (1993) MR appearance of idiopathic synovial chondromatosis. J Comput Assist Tomogr 17:772–776

    CAS  PubMed  Google Scholar 

  52. Wittkop B, Davies AM, Mangham DC (2002) Primary synovial chondromatosis and synovial chondrosarcoma: a pictorial review. Eur Radiol 12:2112–2119

    CAS  PubMed  Google Scholar 

  53. Bertoni F, Unni KK, Beabout JW, Sim FH (1991) Chondrosarcoma of the synovium. Cancer 67:155–162

    CAS  PubMed  Google Scholar 

  54. Kenan S, Abdelwahab IF, Klein MJ, Lewis MM (1993) Case report 817: synovial chondrosarcoma secondary to synovial chondromatosis. Skeletal Radiol 22:623–626

    CAS  PubMed  Google Scholar 

  55. Moon NE (1973) Synovial hemangioma of the knee joint. A review of previously reported cases and inclusion of two new cases. Clin Orthop 90:183–190

    CAS  PubMed  Google Scholar 

  56. Devaney K, Vinh TN, Sweet DE (1993) Synovial hemangioma: a report of 20 cases with differential diagnostic considerations. Hum Pathol 24:737–745

    Article  CAS  PubMed  Google Scholar 

  57. Price NJ, Cundy PJ (1997) Synovial hemangioma of the knee. J Pediatr Orthop 17:74–77

    Article  CAS  PubMed  Google Scholar 

  58. Lenchik L, Poznanski AK, Donaldson JS, Sarwark JF (1991) Case report 681: synovial hemangioma of the knee. Skeletal Radiol 20:387–389

    CAS  PubMed  Google Scholar 

  59. Llauger J, Monill JM, Palmer J, Clotet M (1995) Synovial hemangioma of the knee: MRI findings in two cases. Skeletal Radiol 24:579–581

    Article  CAS  PubMed  Google Scholar 

  60. Hawley WL, Ansell BM (1981) Synovial hemangioma presenting as monarticular arthritis of the knee. Arch Dis Child 56:558–560

    CAS  PubMed  Google Scholar 

  61. Ryd L, Stenström A (1989) Hemangioma mimicking meniscal injury. A report on 10 years of knee pain. Acta Orthop Scand 60:230–231

    CAS  PubMed  Google Scholar 

  62. Shapiro GS, Fanton GS (1993) Intraarticular hemangioma of the knee. Arthroscopy 9:464–466

    CAS  PubMed  Google Scholar 

  63. Pinar H, Bozkurt M, Baktiroglu L, Karaoglan O (1997) Intra-articular hemangioma of the knee. Arthroscopy 13:507–510

    Article  CAS  PubMed  Google Scholar 

  64. Petersen W, Rafii M, Ellwanger S, Laprell H (1999) Synovialhämangiom innerhalb des Hoffa’schen Fettkörpers als Ursache für vorderen Knieschmerz. Z Orthop 137:376–378

    CAS  PubMed  Google Scholar 

  65. Aynaci O, Ahmetoglu A, Reis A, Turhan AU (2001) Synovial hemangioma in Hoffa’s fat pad (case report). Knee Surg Sports Traumatol Arthrosc 9:355–357

    Article  CAS  PubMed  Google Scholar 

  66. Cotton A, Flippo RM, Herbaux B, Gougeon F, Lecomte-Houcke M, Chastenet P (1995) Synovial haemangioma of the knee: a frequently misdiagnosed lesion. Skeletal Radiol 24:257–261

    PubMed  Google Scholar 

  67. Wong K, Sallomi D, Janzen DL, Munk PL, O’Connell JX, Lee MJ (1999) Monoarticular synovial lesions: radiologic pictorial essay with pathologic illustration. Clin Radiol 54:273–284

    Article  CAS  PubMed  Google Scholar 

  68. Greenspan A, Azouz EM, Mathews J, Decarie JC (1995) Synovial haemangioma: imaging features in eight histologically proven cases, review of the literature, and differential diagnosis. Skeletal Radiol 24:583–590

    CAS  PubMed  Google Scholar 

  69. Comert RB, Aydingoz U, Atay OA, Gedikoglu G, Doral MN (2004) Vascular malformation in the infrapatellar (Hoffa’s) fat pad: case report. Knee 11:137–140

    Article  PubMed  Google Scholar 

  70. Schweitzer ME, Falk A, Berthoty D, Mitchell M, Resnick D (1992) Knee effusion: normal distribution of fluid. Am J Roentgenol 159:361–363

    CAS  Google Scholar 

  71. Schweitzer ME, Falk A, Pathria M, Brahme S, Hodler J, Resnick D (1993) MR imaging of the knee: can changes in the intracapsular fat pads be used as a sign of synovial proliferation in the presence of an effusion? Am J Roentgenol 160:823–826

    CAS  Google Scholar 

  72. Patel SJ, Kaplan PA, Dussault RG, Kahler DM (1998) Anatomy and clinical significance of the horizontal cleft in the infrapatellar fat pad of the knee: MR imaging. Am J Roentgenol 170:1551–1555

    CAS  PubMed  Google Scholar 

  73. Vahlensieck M, Linneborn G, Schild HH, Schmidt HM (2002) Hoffa’s recess: incidence, morphology and differential diagnosis of the globular-shaped cleft in the infrapatellar fat pad of the knee on MRI and cadaver dissections. Eur Radiol 12:90–93

    Article  CAS  PubMed  Google Scholar 

  74. Bui-Mansfield LT, Youngberg RA (1997) Intraarticular ganglia of the knee: prevalence, presentation, etiology, and management. Am J Roentgenol 168:123–127

    CAS  Google Scholar 

  75. Kim MG, Kim BH, Choi JA, Lee NJ, Chung KB, Choi YS, Cho SB, Lim HC (2001) Intra-articular ganglion cysts of the knee: clinical and MR features. Eur Radiol 11:834–840

    Article  CAS  PubMed  Google Scholar 

  76. Janzen DL, Peterfy CG, Forbes JR, Tirman PF, Genant HK (1994) Cystic lesions around the knee joint: MR imaging findings. Am J Roentgenol 163:155–161

    CAS  Google Scholar 

  77. Steiner E, Steinbach LS, Schnarkowski P, Tirman PF, Genant HK (1996) Ganglia and cysts around joints. Radiol Clin North Am 34:395–425 (xi–xii)

    CAS  PubMed  Google Scholar 

  78. Morrison JL, Kaplan PA (2000) Water on the knee: cysts, bursae and recesses. Magn Reson Imaging Clin N Am 8:349–370

    CAS  PubMed  Google Scholar 

  79. Tyrrell PNM, Cassar-Pullcino VN, McCall IW (2000) Intra-articular ganglion cyst of the cruciate ligaments. Eur Radiol 10:1233–1238

    Article  CAS  PubMed  Google Scholar 

  80. Stacy GS, Heck RK, Peabody TD, Dixon LB (2002) Neoplastic and tumorlike lesions detected on MR imaging of the knee in patients with suspected internal derangement. Part 2. Articular and juxtaarticular entities. Am J Roentgenol 178:595–599

    Google Scholar 

  81. Zantop T, Rusch A, Hassenpflug J, Petersen W (2003) Intra-articular ganglion cysts of the cruciate ligaments: case report and review of the literature. Arch Orthop Trauma Surg 123:195–198

    Article  PubMed  Google Scholar 

  82. Franceschi F, Rizzello G, Maffei MV, Papalia R, Denaro V (2003) Arthroscopic ganglion cyst excision in the anterolateral aspect of the knee. Arthroscopy 19:E32

    Article  Google Scholar 

  83. Gebhardt MC, Parekh SG, Rosenberg AE, Rosenthal DI (1999) Extraskeletal myxoid chondrosarcoma of the knee. Skeletal Radiol 28:354–358

    Article  CAS  PubMed  Google Scholar 

  84. Hur J, Damron TA, Vermont AI, Mathur SC (1999) Fibroma of tendon sheath of the infrapatellar fat pad. Skeletal Radiol 28:407–410

    Article  CAS  PubMed  Google Scholar 

  85. Pinar H, Ozkan M, Ozaksoy D, Pabuccuoglu U, Akseki D, Karaoglan O (1995) Intraarticular fibroma of the tendon sheath of the knee. Arthroscopy 11:608–611

    Article  CAS  PubMed  Google Scholar 

  86. Hardy P, Muller GP, Got C, Lortat-Jacob A, Benoit J (1998) Glomus tumor of the fat pad. Arthroscopy 14:325–328

    CAS  PubMed  Google Scholar 

  87. Van Slyke MA, Moser RP, Madewell JE (1995) MR imaging of periarticular soft tissue lesions. Magn Reson Imaging Clin N Am 3:651–667

    PubMed  Google Scholar 

  88. Llauger J, Palmer J, Rosón N, Bagué S, Camins A, Cremades R (2000) Nonseptic monoarthritis: imaging features with clinical and histopathologic correlation. Radiographics 20:S263–S278

    PubMed  Google Scholar 

  89. Narváez JA, Narváez J, Ortega R, De Lama E, Roca Y, Vidal N (2003) Hypointense synovial lesions on T2-weighted images: differential diagnosis with pathologic correlation. Am J Roentgenol 181:761–769

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. M. Davies.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Helpert, C., Davies, A.M., Evans, N. et al. Differential diagnosis of tumours and tumour-like lesions of the infrapatellar (Hoffa’s) fat pad: pictorial review with an emphasis on MR imaging. Eur Radiol 14, 2337–2346 (2004). https://doi.org/10.1007/s00330-004-2491-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-004-2491-1

Keywords

Navigation