Nadal Out with Chronic Knee Injury

Hoffa Syndrome keeps Nadal out of the US Open

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Tennis elbow, the typical culprit that plagues serious players, is not to blame in Rafael Nadal's withdrawal from the US Open, which starts today.

After withdrawing from the Olympic Games, Nadal remains absent from the court with a severe knee injury and is determined to get better before competing again.

"Take care of your knees."

The No. 3 seed reportedly has Hoffa syndrome, or inflammation of the knee cap's fatty pad, below his left kneecap.

The fat pad is located in the space between the knee cap and the patellar ligament, known as the Hoffa recess, in the knee. It is lined with fluid to create a buffer zone between the bones and help straighten the leg.

The fat pad, which is full of sensitive nerves, can be pinched through overuse and running abnormally. And Nadal's had a history of pain in his knees and legs over the last few years.

In 2009, he struggled to defend his Wimbledon title and was forced to quit after two sets of the Australian Open quarterfinal against Andy Murray, who's currently poised to take Nadal's spot in the rankings.

Although Roger Federer, Andy Roddick, and other tennis legends miss having Nadal on the court, he hasn't been MIA much at all. In total, Nadal has competed in 30 of the 32 past Grand Slams, and his absence in the US Open is just a necessity, he says.

"I miss the tournament but I must to practice to return," Nadal tweeted.

So what does this mean for Rafa?

There's hope to have it repaired through surgery if it's deemed necessary.

The study, led by Deepak Kumar in the Department of Trauma and Orthopaedics, found that those with Hoffa disease recover well in the long run after having surgery.

It included 34 parents with Hoffa's disease, ranging 19 to 62 years old. Thirty-two performed regular sporting activities, but only 23 described a definite injury to the knee.

After surgery, average improvement was 44.76 at three months, 55.68 at one year, and 53.97 at the latest follow up, according to the Lysholm score.

"We also recommend that surgery should not be delayed beyond three months if impingement of the fat pad is suspected on clinical grounds," the researchers said.

The authors note that they were unable to measure the success rate of treatments outside of surgery.

Another study, led by Pedro Carvalho, PhD student for 3B's Research Group, compares tissues in the knee in osteoarthritic patients and found that the fatty pad contains stem cells that could serve as a source for regrowing new tissue.

Although the study focuses on osteoarthritis patients, this could be applied to Nadal and his injury.

The 26-year-old Spaniard hasn't competed since losing in the second round of Wimbledon in June. This is the first US Open he will miss since he made his tournament debut in 2003.

But New Yorkers and tennis fans may be seeing him in 2013. Pending recovery, Nadal plans to play in the BNP Paribas Showdown in Madison Square Garden in March.

Jack Newman, CEO of Austin Tennis Academy and dailyRx Contributing Expert added, "The physical challenges of world class tennis are extreme. That combined with the incredibly tonadic nature of Nadal's game has kept his body under stress."

"The Men's professional tennis tour has a year round ranking system that rewards players for chasing points and dollars. Most pros cannot afford to build in suitable rest and recovery periods into their schedule."

"The demands of professional tennis have grown as the game has become populated with bigger and stronger athletes. All of the top tennis athletes have had bouts with injuries during their careers," said Newman.

Carvalho's study was published July 16 in the Journal of Tissue Engineering and Regenerative Medicine. Kumar's study was published in the November 2007 issue of Athroscopy: The Journal of Arthroscopic & Related Surgery. Neither authors report any conflicts of interest. 

Reviewed by: 
Review Date: 
August 27, 2012
Last Updated:
August 28, 2012