Introduction. High-volume image guided injections (HVIGI) followed by structured rehabilitation have been shown to be effective in various musculoskeletal conditions including Achilles tendinopathy and shoulder impingement syndrome. The aim was to explore the effect of a HVIGI in Hoffa's fat pad impingement, a common cause of anterior knee pain. Materials and Methods. 100 consecutive subjects who received a HVIGI followed by a standardised physiotherapy rehabilitation regime for Hoffa's fat pad impingement (diagnosed using clinical history, examination and magnetic resonance imaging) at one specialist MSK centre were sent a follow-up questionnaire. The questionnaire collected demographics, symptom length and the percentage improvement in symptoms following the HVIGI. All had received HVIGI consisting of 10ml of 0.5% Marcaine and 50mg of hydrocortisone followed by a structured rehabilitation programme with a focus on lower limb alignment control, flexibility, hip and knee strengthening in line with best practice. Data was analysed using SPSS version 20 at this interim stage; data collection is continuing. Results. The response rate at this point is currently 28%. Of the twenty-six subjects (9 female; 19 male; average age 37.8 ± 13.4) who completed the questionnaire 82% had had anterior knee pain symptoms for >6 months prior to receiving a HVIGI. The average percentage improvement in anterior knee pain was 45 ± 36.5% (range 0–100%). 48% of subjects reported a >6 month improvement in symptoms. No adverse effects were reported and no subject required anytime off work. Discussion. HVIGI with a structured rehabilitation programme should be considered in the short term management of Hoffa's fat pad impingement. Future research should be prospective, to improve the response rate, and consider longer term outcomes