What Is It?

Anterolateral fat pad impingement is a common cause of knee pain, especially in younger females. The fat pad is a soft cushion of fatty tissue at the front of the knee, just below and to the side of the kneecap (patella).

In this condition, the fat pad becomes pinched or irritated because the kneecap is not moving in its normal position. This often happens due to a muscle imbalance around the knee and hip, which pulls the kneecap slightly off track.

Who Gets It?

• Most commonly affects active younger females, but it can also occur in males.
• People who do sports or activities that involve running, jumping, or squatting are more prone to it.
• Poor posture, weak hip muscles, or flat feet can also increase the risk.

Symptoms

• Pain at the front and side of the knee (usually just next to or below the kneecap).
• Pain made worse by squatting, running, climbing stairs, or prolonged sitting.
• Swelling or tenderness around the kneecap.
• Sometimes a feeling of the knee “catching” or discomfort when straightening the leg.

Diagnosis

A proper clinical examination is essential. Your doctor may:

• Take a medical history and ask about your symptoms and activities.
• Perform a physical exam to check for tenderness and abnormal kneecap movement.
• Request x-rays to rule out other causes of pain.
• Order an MRI scan to confirm the diagnosis and assess the extent of fat pad irritation.

Watch video of Patellofemoral Pain Syndrome

Treatment Options

Non-Surgical Management (First Choice)

Most patients recover well without surgery. Treatment usually includes:

• Targeted low-dose steroid injection into the inflamed fat pad to reduce pain and swelling.
• Specialized physiotherapy and rehabilitation program to correct the muscle imbalance. This focuses on:
  • Strengthening the quadriceps muscles (front of the thigh).
  • Strengthening the hip and glute muscles (to stabilize leg movement).
  • Improving posture, walking, and running mechanics.
• Activity modification reducing or adjusting sports/activities that worsen the pain.
• Pain relief with anti-inflammatory medication or ice packs as needed.

Surgical Management (For Resistant Cases)

A very small number of patients do not respond to non-surgical treatments. In such cases, surgery may be recommended:

• Realignment surgery of the kneecap – this helps the patella move more normally and reduces irritation of the fat pad.
• Surgery is usually successful in relieving pain and restoring knee function.

Prognosis (What to Expect)

• Most patients recover fully with physiotherapy and targeted injections.
• Surgery is rarely needed, but when performed, it has a high success rate.
• Long-term outlook is very good if muscle imbalances are corrected and rehabilitation is followed consistently.

Key Takeaway

• Anterolateral fat pad impingement is a common but treatable cause of knee pain in younger people.
• The mainstay of treatment is non-surgical, focusing on injections and physiotherapy.
• Surgery is only needed for a small minority of patients.
• With the right treatment plan, most patients can return to normal activity and sport without lasting problems.

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