For patients with infrapatellar fat pad impingement syndrome in whom a structured conservative rehabilitation programme has not achieved resolution of anterior knee pain or restoration of fat pad mobility, a defined next-line protocol applies.
A first-line programme was completed, consisting of infrapatellar fat pad mobilization (medial and lateral glides), patellar mobilization (superior glide and superior tipping), quadriceps stretching, and anterior hip structure stretching. The intended goals — resolution of anterior knee pain and restoration of infrapatellar fat pad mobility — were not reached, indicating escalation to the next treatment line.
The targets remain the same: resolution of anterior knee pain and restoration of infrapatellar fat pad mobility. Alterations in fat pad mobility result in pain and disability across a variety of patient populations, making restoration of normal mobility a primary endpoint.
When conservative measures have failed to meet these targets, an arthroscopic surgical approach to the anterior interval of the knee is indicated — one that addresses fibrotic tissue while preserving healthy infrapatellar fat pad tissue. Surgical release of anterior interval scarring has been shown to improve patient-reported outcomes. The complete protocol, including the operative decision criteria and procedural steps, is available via the regimen below.