Quadriceps fat pad impingement: where patellofemoral maltracking meets the metabolic-inflammatory axis

Our study aimed to clarify the relationship between quadriceps fat pad impingement (QFPI) syndrome and lipid profiles as well as hematologic inflammatory markers.

Between 01.01.2024 and 31.08.2025, patients aged 18-65 years who presented with anterior knee pain, had a knee MRI, and had a hemogram, biochemistry, hormone, and lipid profile within the last 6 months were retrospectively analyzed. Trochlear angle, Insall-Salvati ratio, patellar tilt and facet angles, contact surface, quadriceps and infrapatellar fat pad thicknesses, quadriceps and patellar tendon thicknesses, Tibial tubercle-trochlear groove (TT-TG) distance, lateral condyle angle, amount of patellar translation, and femoro-tibial posterior rotation were measured on MRI. VAS scoring as a clinical parameter, along with thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), lactate dehydrogenase (LDH), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride, hemoglobin, neutrophil, lymphocyte, platelet counts, and Systemic immune-inflammation index (SII) were recorded. Data were compared between both groups.

A total of 179 patients were evaluated, with 99 patients in the study group and 80 patients in the control group. LDL level was elevated in the QFPI group (p = 0.0038). Lymphocyte and platelet counts were elevated in QFPI; nevertheless, SII remained comparable between the two groups (p = 0.0096; p = 0.0004; p = 0.6464, respectively). Radiologically, the suprapatellar (quadriceps) fat pad thickness, Insall-Salvati ratio, and patellar tilt angle were higher in the QFPI group (p = 0.0003; p = 0.0009; p = 0.0342, respectively); no significant differences were seen in other parameters (p > 0.05). Following multiple comparison adjustments, the LDL level, platelet count, suprapatellar fat pad thickness, and Insall-Salvati ratio parameters maintained their significance, while the lymphocyte parameter and the difference in patellar tilt angle lost their significance. After adjusting for age, gender, and BMI in the multivariate logistic regression analysis, LDL level and platelet count remained independently associated with QFPI.

Our study suggests that QFPI can be evaluated in conjunction with certain parameters associated with patellofemoral maltracking and metabolic-inflammatory markers. This study suggests that there may be a relationship between QFPI and LDL levels and certain hematological parameters; nevertheless, the retrospective cross-sectional design precludes the inference of causality.

Level III, Retrospective Comparative Case-Control Study.