End Stage Hoffa s Disease Presented as a Giant Osteochondroma: Case Report and Literature Review

Case Report

Austin J Orthopade & Rheumatol. 2023; 10(2): 1122.

End Stage Hoffa’s Disease Presented as a Giant Osteochondroma: Case Report and Literature Review

El Mokhtari Kamal*

Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Rabat, Morocco

*Corresponding author: El Mokhtari Kamal Department of Orthopedic Surgery and Traumatology, Military Hospital Mohammed V, Rabat, Morocco. Email: kamalelmokhtari@yahoo.com

Received: October 30, 2023 Accepted: November 30, 2023 Published: December 07, 2023

Abstract

Introduction: Hoffa’s disease appears to be an under-recognized ailment according to an extensive comprehensive literature assessment. Predisposing factors in sports training include torsion and hyperextexion at the knee should be taken into consideration when evaluating patients with chronic knee pain. We present the case of a young soldier suffering from left knee pain as a result of Hoffa’s disease

Case report: A 29-year-old male patient admitted to orthopedic department to assess an anterior mechanical pain on the left knee. He reported that he had a sport accident with notion of hyperextension and anterior direct trauma to the left knee. On physical examination we found a painful mass that seems located under the patellar tendon, passive flexion of the left knee triggered a sharp pain from 100°. On X ray we found bone-like mass located behind the silhouette of the patellar tendon without attachment to the bones of the leg. MRI identified a 4.2 osseous tumor with no attachment to the patellar tendon. A surgical excision was preformed

Conclusion: Hoffa disease is relatively a rare illness, its physiopathology is not yet completely clear. But many cases have been reported in literature. Its clinical presentation is not very specific, and its surgical excision which remains unavoidable, guarantees satisfying clinical and functional results. However, it remains to be determined whether it is a definitive solution in the context of “Hoffa’s disease”.

Keywords: Hoffa; Knee; Patella; Anterior; Pain

Introduction

Even though the Hoffa infrapatellar fat pad is usually injured, it is rarely described in the orthopedic literature. The infrapatellar fat pad (Hoffa) is an intracapsular extra synovial structure. Although the exact function of the Hoffa fat is unknown, it is clinically significant because it is the source of a variety of tumors and tumor-like abnormalities like osteochondroma and Hoffa's Disease.

We report the case of a patient who had a giant osteochondral tumor in association with Hoffa’s disease. A review of the literature reveals one case report which questions whether or not the latter was the outcome of end-stage Hoffa’s disease [1]. Our patient was informed that data concerning this case would be submitted for publication.

Case Report: Data and Findings

A 29-year-old patient, with no particular pathological history, admitted to our department for therapeutical management of mechanical gonalgia becoming resistant to the usual analgesic and anti-inflammatory treatment. He had a history of severe hyper-extension knee trauma due to an anterior crush 4 years ago during a football game. After clinical and radiological examination at the time, no ligament or bone lesion was identified. But he indicated that a progressive stiffness and anterior knee pain had occurred after the regression of the oedema following conservative treatment with oral and topical anti-inflammatory agents and physical rehabilitation. Because of these complaints he sought consultation in our department. The initial physical evaluation, on inspection we found a normal aspect of both knees, with no clearly visible deformation, on palpation of the left knee we noted a slight joint effusion with a tender mass next to the patellar tendon, painful and fixed to the surrounding soft tissue , concerning joint mobility, in active: 0° of extension at 100° of flexion was possible without pain, in passive nevertheless the sector of mobility was not reduced but a sharp pain was triggered from 110° of flexion. A patella compression test with direct palpation of the medial and lateral aspects of the fat pad with the knee in extension also elicited pain. Lachman’s, McMurray’s, and pivot shift tests were all negative.

The standard radiological assessment showed a bone-like mass located behind the silhouette of the patellar tendon without attachment to the bones of the leg (Figure 1). Magnetic Resonance Imaging (MRI) of the left knee revealed a 4.2 cm diameter osseous tumor (Figure 2). Furthermore, the biological evaluation revealed no significant abnormalities.