The knee joint contains three primary anterior fat pads: the infrapatellar (Hoffa’s) fat pad, located behind the patellar tendon; the quadriceps fat pad, situated superior to the patella; and the prefemoral fat pad, which lies deep to the quadriceps tendon against the distal femur. These structures serve as flexible buffers that accommodate joint movement while housing essential neurovascular and synovial elements. Hoffa’s fat pad is an intracapsular yet extrasynovial structure located posterior to the patellar tendon and anterior to the femoral condyles and tibial plateau.  Despite its strategic anatomical location and rich innervation, the pathology of knee fat pads remains under-recognized and frequently misdiagnosed when suspected as a cause of anterior knee pain. Clinical presentation is often nonspecific, overlapping with patellofemoral disorders, meniscal pathology, ligamentous injury, or early osteoarthritis. As a result, these lesions may commonly be overlooked on initial imaging assessment or reported descriptively without probable etiological categorization.

The literature on Hoffa’s fat pad pathology is both limited and fragmented, with most radiology texts addressing these lesions briefly, and existing classifications either incomplete, clinically impractical, or insufficiently correlated with modern MRI protocols. Furthermore, there is difficulty in confidently differentiating inflammatory, traumatic, degenerative, tumorous, and postoperative conditions affecting the fat pads, particularly in early or subtle disease. Given the increasing utilization of high-resolution MRI in knee evaluation, there is a growing need for a systematic, imaging-driven approach to Hoffa’s fat pad lesions that simplifies diagnosis, aids in improving reporting confidence, and enhances clinicoradiological correlation.