Quiz: Hoffa's Syndrome

PUBLISHED : Tuesday, 28 August, 2012, 12:00am
UPDATED : Tuesday, 28 August, 2012, 6:11pm

With Rafael Nadal pulling out of the US Open and the ATP tour indefinitely, the burning question - probably second to "When will he return?" - is: what exactly is
Hoffa's syndrome?

The Spanish ace announced this month that the injury keeping him away from the game was not the same as the knee tendonitis that had plagued him previously.

Hoffa's syndrome, also known as fat pad irritation, is when the shock-absorbing fatty soft tissue below the kneecap gets pinched between the patellar tendon (attached to the kneecap) and the end of the shin bone.

This may lead to pain, swelling and restricted motion of the knee. Knee tendonitis, on the other hand, happens when repeated stress on the patellar tendon causes it to become inflamed.

As the fat pad is the most sensitive part of the knee, Hoffa's syndrome usually brings extreme pain and tenderness around the bottom of the kneecap.

The condition is typically caused by the hyperextension of the knee - when it's forced beyond its fully straightened position. Direct trauma to the knee due to a fall or knock can also lead to the syndrome.

Nadal's aggressive and tenacious style of play has earned him 11 tennis majors, but has also led to a string of physical problems throughout his career, including a foot injury in 2005.

The latest injury, he says, started in February this year. The pain was under control until after he won the French Open, when it became "impossible to continue competing".

"It is uncomfortable and painful, but it is not serious," Spanish tennis federation doctor Angel Ruiz Cotorro told the Spanish sports newspaper,

Test yourself on Hoffa's syndrome.

1. Who was it named after?

a. Albert Hoffa, a German orthopaedic surgeon

b. Jimmy Hoffa, an American labour union leader

c. Reese Hoffa, an American shot put athlete

2. Which of the following could cause Hoffa's syndrome?

a. prolonged standing

b. wearing high-heeled shoes

c. tight quadriceps (front thigh)

3. Ice is often used as initial treatment to manage the swelling and inflammation of the fat pad. Therapists advise to apply ice for

a. 15-20 minutes at a time, 2-3 times a day, about an hour apart

b. 60 minutes, once a day

c. as long as you can

4. Which of the following is not a treatment option for the syndrome?

a. taping the knee, and stretching and strengthening the muscles that support it

b. cortisone injections, and possibly surgery to trim the fat pad

c. replace the fat pad altogether

Answers: 1. a (he first reported the condition in 1904); 2. all are correct; 3. a; 4. c