Introduction: The infrapatellar fat pad was first described in 1904 by Albert Hoffa. Sometimes disregarded, it is apparent that the infrapatellar fat pad is of importance to knee joint function as fat at this site is only lost in severely emaciated individuals. Also, recent MRI studies have described various pathological changes affecting the fat pad. This study examined the anatomy of the infrapatellar fat pad in relation to knee symptoms and surgical approaches.

Materials and Methods: 8 preserved knees were dissected via semicircular parapatellar incisions extending from the tibial tubercle to the superior patellar border and including the quadriceps muscle 13 cm above the superior border of the patella. The synovial membrane of the joint and the ligamentum mucosum were divided and the tibial tubercle was then excised. The resultant tissue complex was removed and the fat pad dissected away from surrounding structures. The appearance, volume and presence of any clefts in the pad were recorded. The cadaveric dissections were then compared to direct observation of the fat pad during total knee replacement, during arthroscopy and on MR imaging.

Results: The infrapatellar fat pad was found to be present in all cases. It had a consistent shape consisting of a central mass with medial and lateral extensions. The ligamentum mucosum was attached to the intercondylar notch of the femur in all cases and measured an average of 15.7mm at its base. A horizontal cleft was found in 6 cases and a vertical cleft was found in 7 cases. Both have been previously noted. A tag extended superiorly from the posterior aspect of the fat pad in 7 cases. The volume of the fat pad had quite a large range among individual cadavers (average volume was 24 ml, range: 12–36ml). The intra-individual variation was smaller with an average difference of 4ml (range:2.7ml) between knees.

Discussion: The infrapatellar fat pad has been implicated in a wide variety of conditions affecting the knee joint. It has been shown to be involved in arthofibrosis of the knee following surgery, patellar tendonitis, formation of intra-articular fibrous bands, and a site of an ossifying chondroma. It seems that fat pad pathology is usually secondary to other knee joint pathology and primary involvement is rare. The presence of clefts in the fat pad is of importance as a distended cleft may mimic an abnormality and an abnormality in the cleft may be overlooked on imaging of the knee joint. The appearance of the fat pad on direct visualisation in the living person presented a fat pad with a more globular appearance than that seen in the cadaver. The clefts were clearly visualised on MRI.

Conclusion: The infrapatellar fat pad is a structure that is consistently present in the knee joint. It consists of a central body with medial and lateral and medical extensions. It usually contains a vertical cleft located superiorly and a horizontal cleft located inferiorly as well as a tag of fat extending superiorly, which forms the roof of the vertical cleft. The infrapatellar fat pad is attached to the intercondylar notch of the femur by the ligamentum mucosum and is firmly anchored to the patella by dense fibrous tissue.