Letters
Maltracking and Impingement of
Superolateral Hoffa’s Fat Pad
We read with interest the excellent article
by Subhawong et al. [1] in the December
2010 issue of the AJR. This study explores
the association of certain patellar maltrack-
ing parameters with the frequently seen ede-
ma in the superolateral portion of Hoffa’s fat
pad on knee MR images. We agree that the
method to test this association is by compar-
ing patellar maltracking indicators between
two groups: one with Hoffa’s fat pad edema
and a second group without this feature.
However, in our opinion, there were a few
weaknesses in the methodology that have re-
sulted in perhaps a less-conclusive outcome.
Chung et al. [2] described the MRI fea-
tures of infrapatellar fat pad impingement
and found evidence of patellofemoral mal-
tracking in 38 of 42 patients who presented
with anterior or anterolateral knee pain. Both
patellar maltracking and Hoffa’s fat pad im-
pingement are recognized causes of anterior
knee pain [3, 4].
In the study by Subhawong et al. [1], the
clinical presentation of the patients included
was not taken into account, and we do not
know whether the finding of edema in the su-
perolateral aspect of Hoffa’s fat pad was clini-
cally relevant. The lack of clinical correlation
could have reduced the differences in the mea-
sured maltracking indicators between the two
AJR 2011; 197:W1164 0361–803X/11/1976–W1164 © American Roentgen Ray Society
W1164 AJR:197, December 2011
groups. Although the authors mention that the
MRI request forms did not provide sufficient
clinical information, we think it would have
been worthwhile to look at the subgroup of pa-
tients presenting with anterior knee pain.
Subhawong et al. [1] made a comparison
between the two groups in relation to the
presence or absence of patella alta. We think
that a similar comparison should have been
performed in relation to the other maltrack-
ing indicators by using a cutoff value to de-
fine normal and abnormal variables—for
example, a sulcus depth of 3 mm or a tibial
tuberosity-trochlear groove distance of 2 cm.
This would have allowed categoric data com-
parison between the two groups in relation to
the presence or absence of abnormal patellar
maltracking indicators.
As the authors acknowledge in their study
[1], we think that the sample size was perhaps
too small to prove or deny the relationship be-
tween Hoffa’s fat pad edema and patellar mal-
tracking. In addition, the proportion of knees
in each group that had at least one abnormal
patellar maltracking indicator was not stated
in the article, and such a comparison between
the two groups might be of interest. Again, us-
ing cutoff values for the measurements would
have allowed an interesting comparison be-
tween the two groups to be made.
Patellar maltracking is possibly associated
with Hoffa’s fat pad impingement, but the ev-
idence supporting this hypothesis is scarce.
This article [1] has therefore addressed an
important issue and may offer more support
for such an observation. The use of a larger
sample size, including patients who present-
ed with anterior knee pain, and providing
categoric data comparison could probably
have helped in providing more conclusive
and informative outcomes.
Zaid Adil Jibri
Sridhar Kamath
University Hospital of Wales,
Cardiff, South Glamorgan, UK
DOI:10.2214/AJR.11.7003
WEB—This is a Web exclusive article.
References
1. Subhawong TK, Eng J, Carrino JA, Chhabra A.
Superolateral Hoffa’s fat pad edema: association
with patellofemoral maltracking and impinge-
ment. AJR 2010; 195:1367–1373
2. Chung CB, Skaf A, Roger B, Campos J, Stump X,
Resnick D. Patellar tendon-lateral femoral con-
dyle friction syndrome: MR imaging in 42 pa-
tients. Skeletal Radiol 2001; 30:694–697
3. McNally EG. Imaging assessment of anterior
knee pain and patellar maltracking. Skeletal Ra-
diol 2001; 30:484–495
4. Biedert RM, Sanchis-Alfonso V. Sources of ante-
rior knee pain. Clin Sports Med 2002; 21:335–347