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magazine 2012/1
A complex sensory organ that is so much more than just fatty tissue – this is how orthope-
dic specialist Prof. h.c. PD Dr. med. Matthias Steinwachs sees the infrapatellar fat pad. In
an interview the head physician at the department of Orthobiology & Cartilage Regenera-
tion at Schulthess Clinic in Zurich explains why the sensitive knee joint structure is once
again up for discussion.
“Supervisory authority of the knee”
The infrapatellar fat pad
So why is it that the infrapatellar fat pad is
involved in almost every action of the knee
PD Dr. Steinwachs:
The main reasons for
its high irritability are its microstructure
and its central position. The infrapatel-
lar fat pad lies in a triangle between the
kneecap, the condyles and the tibia artic-
ular surface. It is touched and deformed
every time the joint is bent or extended.
It can register all mechanical changes in
the joint. This is thanks to a network of
supply lines. Because the infrapatellar
fat pad consists not only of fat. It has an
intensive blood circulation and, thanks to
its high proportion of monocytes, is also
involved in immune responses. In addi-
tion it is heavily innervated. The rapid C
fibres are evidence of a regulatory func-
tion of the infrapatellar fat pad.
Like a spider in a web, you might say. But
some things require further research, don’t
PD Dr. Steinwachs:
It’s true that we don’t
yet know all there is to know about this
highly sensitive structure behind the
kneecap. But that’s not surprising. If we
consider even a relatively well-researched
structure such as the meniscus, we will
see that not all aspects have been fully
explained. It’s true we have known about
the existence of the infrapatellar fat pad
for a long time. But only a few years ago
was it shown in a self-examination that this
is the site of the most intensive perception
of pain in the entire knee joint. The pain
map that arose from this study is still doing
good service for us today in locating the
region where pain is triggered in arthros-
copies. Incidentally, there are many new
findings to be discussed in this area.
Could you give us an example?
PD Dr. Steinwachs:
In the past it was
normal to remove a part of the infrapatellar
fat pad when performing procedures in the
knee joint. When in a chronically irritated
state, in particular, it thickens and hampers
visibility in arthroscopic procedures. Today
I would recommend injuring it as little as
possible as otherwise heavy scarring can
occur. However, if it is chronically inflamed
and causes pain at every step, a partial
resection is often unavoidable.
But in case of doubt, leave the infrapatellar
fat pad because of its presumed regulatory
PD Dr. Steinwachs:
This is what I would
argue. It represents a sort of supervisory
authority in the knee and appears to be
responsible for its internal climate. We be-
lieve that in addition to acting as a trigger
point for pain it also takes on the tasks of
muscle control: What is the position of the
joint partners in relation to each other?
What is the patellar tendon doing? How
high is the mechanical load on the joint?
To what extent must the musculature
counter the extension of the infrapatellar
fat pad, to achieve stability? It falls to the
infrapatellar fat pad to answer these sen­
sorimotor questions. It thus also serves to
protect against mechanical irritations.
To target the related sensorimotor functions
of the infrapatellar fat pad, pressure points
are incorporated into the new GenuTrain ...
PD Dr. Steinwachs:
... which makes sense.
After all, this represents a different way of
addressing the infrapatellar fat pad. Like
in acupressure. From this we are familiar
with the positive effect upon defined pres-
sure points. In this way we can link in a
myocutaneous therapy concept. There are
often problems with the sensorimotor sys-
tem after operations. The support triggers
certain processes in the musculature by
stimulation of the skin and also provides
stability – a useful combination.
Chief physician
Prof. h.c. PD
Dr. med. Mat-
thias Steinwa-
chs, Schulthess
Clinic Zurich.
Innovative detail of the seventh generation of
GenuTrain: Two Hoffa pads placed on the Omega
pad exert pressure on the infrapatellar fat pad
(Hoffa’s fat pad) beneath the patella. The mod-
erate compression relieves strain on the patella,
thus reducing pain.