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Performing and Processing FNA of Anterior Fat Pad for Amyloid

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Clinical decision algorithm for managing Hoffa's fat pad: Preservation, partial resection, or complete excision?

Horacio Rivarola¹, Marcos Meninato¹, Pablo Ramos²

¹Knee Division, Hospital Universitario Austral, Buenos Aires, Argentina.

Journal of Clinical Orthopaedics and Trauma

|March 9, 2026

Summary

This summary is machine-generated.

Preserving Hoffa's fat pad during knee arthroscopy yields better outcomes than resection. A new algorithm aids surgeons in deciding whether to preserve, partially resect, or fully excise the fat pad based on patient presentation and imaging.

Keywords:

Anterior knee pain Arthroscopy Decision algorithm Fibrosis Hoffa's fat pad Infrapatellar fat pad Knee surgery

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Area of Science:

Orthopedic Surgery
Knee Arthroscopy
Infrapatellar Fat Pad Management

Background:

Management of Hoffa's fat pad during knee arthroscopy is controversial.
Lack of standardized criteria for fat pad excision leads to inconsistent outcomes.
The infrapatellar fat pad's role in knee biomechanics and synovial function is critical.

Purpose of the Study:

Develop a clinical decision algorithm for managing Hoffa's fat pad.
Integrate clinical presentation, MRI findings, and intraoperative data.
Guide surgical choices: preservation, partial resection, or complete excision.

Main Methods:

Retrospective review of 60 patients undergoing arthroscopic infrapatellar fat pad procedures (2016-2024).
Categorization by surgical management: preservation, partial, or complete resection.
Correlation of demographic, clinical, and MRI parameters with functional outcomes (VAS, Kujala scores).

Main Results:

All surgical groups showed improvement, with preservation yielding superior outcomes (VAS 2.1, Kujala 92).
Partial resection (VAS 3.0, Kujala 86) and complete resection (VAS 3.8, Kujala 82) showed lesser improvements.
MRI findings predicted outcomes: diffuse edema (conservative), localized fibrosis (partial resection), nodular fibrosis (complete excision).
The developed algorithm achieved 90% accuracy in classifying satisfactory outcomes.

Conclusions:

A reproducible, evidence-informed algorithm for Hoffa's fat pad management is proposed.
Prioritize fat pad preservation to maintain biomechanical and synovial function.
Reserve resection for clearly defined fibrotic or mechanical lesions requiring intervention.