Clinical tests for the diagnosis of Hoffa's fat pad syndrome associated within frapatellar plica
ESSKA Academy. Totlis T. Nov 8, 2019; 284458; epESMA-67 Topic: Sports Related Injuries
Assoc. Prof. Trifon Totlis
Assoc. Prof. Trifon Totlis
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Clinical tests for the diagnosis of Hoffa's fat pad syndrome associated within frapatellar plica

ePoster - epESMA-67

Topic: Sports Trauma

Totlis T., Manaki V., Terzidis I., Papasoulis E., Sideridis A., Papacostas E.
The-MIS Orthopaedic Center, Thessaloniki, Greece

Introduction: The Hoffa test and the modified Hoffa test are the clinical maneuvers which are currently used for the diagnosis of Hoffa's fat pad syndrome. Both clinical tests require the orthopaedic surgeon to perform a maneuver on the patient's knee. Observation that active hyperextension of the patient knee aggravates the symptoms, in cases associated with an infrapatellar plica, led us to launch the current research protocol. Purpose is to introduce the “active knee hyperextension” test as a potential clinical maneuver that may be included in the clinical examination of anterior knee pain.
Objectives: The active knee hyperextension test is expected to be positive in patients suffering from hoffitis associated with an infrapatellar plica.
Aims: This study aims to summarize and assess the sensitivity of three clinical maneuvers for the diagnosis of Hoffa's syndrome associated with an infrapatellar plica.
Methods: It was a retrospective study of 31 patients who underwent knee arthroscopy with the diagnosis of isolated Hoffa's syndrome and the surgical record included the presence of an infrapatellar plica that was arthroscopically resected. During the pre-operative clinical examination, the 3 maneuvers were performed and whether the test was positive or negative was recorded. The study was approved by the scientific committee of our hospital, which checked and ensured the anonymity of all participants.
Results: After exclusion of 5 cases because of a concomitant intra-operative finding, 26 patients were included in the study. Both Hoffa and active knee hyperextension tests were positive in all 26 patients (100%), while the modified Hoffa test was positive only in 19 patients (73%).
Conclusions: The hypothesis was confirmed and thus the active knee hyperextension test may be included in the clinical assessment of patients suffering from anterior knee pain. When a positive Hoffa test is associated with a positive active knee hyperextension test, then hoffitis due to infrapatellar plica should be suspected. MRI is useful to confirm the diagnosis. When conservative treatment fails, then arthroscopic resection of the plica and partial resection of the fat pad is indicated.
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