Objective: The objective of the study was to evaluate the association between Hoffa’s fat pad morphology and Magnetic resonance imaging (MRI)-based posterior horn meniscal grade and to determine whether this association remained after adjustment for age, sex, and body mass index (BMI).
Materials and
Methods: In this retrospective cross-sectional MRI study, 144 adults were intentionally selected using a grade-balanced sampling strategy, with 36 patients assigned to each MRI-based posterior horn meniscal grade (Grades 0–3). Hoffa fat pad thickness and sagittal cross-sectional area (CSA) were measured. Spearman’s analysis was used to examine correlations. Group differences were tested by Kruskal–Wallis and Dunn’s multiple comparison tests. Ordinal logistic regression was performed to identify factors independently associated with higher MRI-based posterior horn meniscal grade after adjustment for age, sex, and BMI.

Results: Hoffa’s fat pad thickness and CSA decreased progressively with increasing meniscal grade. Both parameters showed significant negative correlations with grade severity, stronger for CSA (r=−0.483, p=0.001) than thickness (r=−0.254, p=0.002). Age showed a weak positive correlation with MRI grade (r=0.191, p=0.022); however, this association was not retained after multivariable adjustment. Hoffa’s fat pad CSA (odds ratio [OR]=0.985, 95% confidence interval [CI]: 0.980–0.990, p<0.001) and male sex (OR=4.323, 95% CI: 1.921–9.728, p<0.001) were independently associated with higher MRI-based posterior horn meniscal grade. The proportional odds assumption was satisfied. No statistically significant differences in Hoffa fat pad morphology were observed between isolated medial and combined medial+lateral posterior horn involvement.

Conclusion: Hoffa fat pad CSA was inversely associated with MRI-based posterior horn meniscal grade and may represent an imaging feature associated with structural meniscal abnormalities.