(Fig 4-C.04) Postoperative Changes of Hoffa’s Fat Pad

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📌Postsurgical Changes at the Fat Pad

 

• Postsurgical changes at the fat pad are significant considerations in postoperative assessments, particularly after arthroscopic procedures. 
• These changes primarily include fibrosis and tissue metaplasia, which can affect the patient’s recovery and functional outcomes.

 

✅ Fibrosis Post-Arthroscopy

• Postarthroscopy fibrosis is often subtle and may present as thin regions of linear fibrosis related to the arthroscopic portals. 
• These fibrotic changes typically occur at the superficial fat pad adjacent to the medial patellar retinaculum. 
• The initial post-arthroscopy appearance is usually characterized by a linear and horizontal fibrotic reaction along the arthroscopic portal site through the Hoffa fat pad.

 

✅ Arthrofibrosis

• Arthrofibrosis is a common complication following ACL reconstruction. 
• Patients may experience stiffness or restricted extension, which can mimic graft impingement symptoms. 
• This condition can manifest as a cyclops lesion, a fibrotic nodular mass in the anterior intercondylar notch . 
• Additionally, arthrofibrosis can surround the graft or appear as low-signal scarring within the Hoffa fat pad.

✅ Focal and Diffuse Arthrofibrosis

• The focal form of arthrofibrosis is more common in ACL reconstruction cases and is identified as a nodule of low signal just anterior to the distal end of the graft between the femur and tibia. 
• Localized anterior arthrofibrosis, or the "cyclops" lesion, is observed in approximately 1%–10% of patients with ACL reconstruction . 
• The diffuse form, on the other hand, can appear as an ill-defined spiculated area of low signal within the Hoffa fat pad or a mass-like area of decreased signal anterior and posterior to the graft. 
• This form can extend to the joint capsule, potentially leading to synovial hypertrophy and capsular thickening.

 

References

1. RadioGraphics 2018; 38:2069–2101
2. Indian J Radiol Imaging. 2021 Nov 30;31(4):961-974
3. Magn Reson Imaging Clin N Am. 2022 May;30(2):261-275
4. AJR 2010; 194:476–484

 

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