(Kiosk 2) Patellar Tendon – Hoffa's Fat Hydrodissection for Patellar Tendinopathy in a College Track Hurdler : A Case Report

Case Diagnosis: A healthy 21-year-old college track hurdler presents with left knee pain due to patellar tendinopathy.

Case Description or Program Description: Patient is a college track hurdler with over one year of anterior left knee pain without any inciting injury. He described the pain as throbbing and 3/10 in severity, which rose to 6/10 after races. Landing on his left leg while hurdling also increased pain. Physical therapy with school athletic trainers, icing, and knee strapping provided no meaningful benefit. He denied receiving medications, injections, or surgery. He reported no swelling or mechanical symptoms. Physical exam was pertinent for 5/5 motor strength in bilateral lower extremities, full and painless range of motion of his left knee, and pain with palpation of left proximal patella tendon. Reproducible pain was noted with deep knee bend and single leg hop. Collateral and cruciate ligaments remained intact. Diagnostic ultrasound of his left knee showed minimal fluid in the suprapatellar recess as well as patella tendon thickening, intrasubstance degeneration, and tendinosis without tear. Ultrasound-guided patellar tendon – Hoffa’s fat pad (HFP) hydrodissection was performed.

Setting: Outpatient Sports Medicine Clinic.

Assessment/Results: The procedure was well tolerated with excellent pain relief at the site with provocative maneuvers. He competed in his track meet one week later without pain.

Discussion (relevance): Duri et al. found that pain intensity with patellar tendonitis was related to fat pad involvement. The HFP receives innervation by the femoral, common peroneal, and saphenous nerves, and thus may exacerbate anterior knee pain when impinged upon by patellar tendinopathy. Injury is commonly caused by direct trauma, post-surgical, or chronic overuse. When conservative treatments and therapy do not provide relief, a patellar tendon – HFP hydrodissection has shown to be an option to treat patellar tendon pain.

Conclusions: Patellar tendon – Hoffa's Fat Pad Hydrodissection is a useful and safe treatment option for chronic patellar knee pain.