Rafa's Press Conference ...

Yesterday, Rafa announced that he would be holding a press conference today in Manacor. Of course, the great unknown does set off a bit of panic, although I expected that we probably wouldn’t end up knowing much more than what has been released already.

Well, I think following the presser, we might have learnt a bit more about the condition he’s actually suffering from now, and whilst Rafa is still currently doing the media rounds as I’m even typing this, I thought I’d just bring a summary of what is being released on Twitter.

Firstly, thanks to @genny_ss @RAFAddicted @RafaelNadalFC @athena1949 and @david_j_nadal who between them have brought the combination of what you will see below.

Firstly, let’s hear from Rafa …

"I'll return when the knee is healed. I won't force ... I've already missed many important things and I won't risk any more."

"I work very hard every day to be ready as soon as possible. I'm really motivated to compete as soon as I can."

"For 6 months this year, I was competing to become #1 in the ATP ranking, but I'm not worried about being #3 or #4."

"I won't put deadlines for my return. Right now I follow my knee's orders."

A brief summary understanding is from the presser is that Team Nadal don't know when Rafa’s coming back and there's no invasive procedure in their plans.

Via @Rafael_Plaza this link has been provided where a Dr Gonazalez explained more on AS.com about Rafa's injury (symptoms and recovery). I can’t tell you who this doctor is, and I can’t tell you how he’s qualified to even to discuss it, but the following is a Google mangle summary of the article …

According to Gonzalez, Rafa played infiltrated Roland Garros 2012.

The extensor mechanism responsible for the stability of the joint, sometimes deteriorates as a result of intense exercise.

The patellar tendon is damaged, and will not burn but begins to degenerate

The quadriceps tendon as a defence mechanism, are also affected and there may be pain in the back of the knee.

Sometimes the only real alternative for the cure is rest. And complete rest can be extended beyond three months.

If you play, you risk playing well below, and in the longer run the risk of rupturing the tendon in any braking.

Even having to undergo surgery, with a sluggish recovery and uncertain results.

But I think the biggest thing to come out of the presser is that Rafa’s condition actually has a name … he’s got a rare condition called Hoffa’s Syndrome or Hoffa’s disease.  David Nadal has stated this in a tweet and  @RAFAddicted provided this detail about it …

Hoffa's Syndrome or Disease: An obscure cause of anterior knee pain resulting from impingement and inflammation of the infrapatellar fat pad, was first reported by German surgeon Albert Hoffa in 1904 (Albert Hoffa, 1859-1907). This condition is characterized by traumatic and inflammatory changes occurring in the infrapatellar fat pad in young athletes, which may lead to pain, swelling and restricted motion of the knee. Hypertrophy of the fat pad may cause it to become trapped between the tibia and femur when the flexed knee is extended suddenly. Eventually fibrosis may ensue. On MR images, acute findings indicate the presence of fluid and chronic findings resemble those of scarring after knee arthroscopy. In some patients, rupture of the overlying synovial fold and haemarthrosis may occur after an injury to the infrapatellar fat pad.

Hoffa's fat pad disease is characterised by chronic knee pain which is mainly infrapatellar. Acute cases are generally post-traumatic: the clinical picture includes anterior pain and functional problems, often in the presence of effusion. In chronic cases, recurrent swelling, infrapatellar discomfort and knee weakness are the usual features. Clinically, Hoffa's syndrome is difficult to diagnose, but Hoffa's test can be quite helpful: with the patient lying on the couch, and with the examiner standing by the patient's knee, the examiner takes up the bent knee, pressing the thumbs of both hands deeply along the sides of the patellar tendon just below the patella. The patient is then instructed to straighten the leg. This causes pain behind the tendon, in the fat pad region. Extending a flexed knee tenses the patellar tendon across the fat pad and elicits a sharp pain. MRI is generally very helpful: it clearly depicts Hoffa's infrapatellar fat pad and its findings may suggest Hoffa's syndrome. MR imaging is also important as routine arthroscopy does not visualize the fat pad well enough and it does not give sufficient morphological and intrinsic information.

In summary …

Hoffa's illness is the inflammation of accumulation of fat inside the knee, behind patella tendon.

The symptoms are pain in the front of the knee that increases walking and playing on the tendon.

It is treated with rest and anti-inflammatories. In cases where the disease becomes chronic (pain lasting more than 6 months), there's treatment by surgery, removing part of the fat. The latter is what Rafa wants to avoid.

At the end of all this, Rafa concludes …

"I'll be back when I'm ready for a comeback. I want to be back with guarantees of victory."

Entirely the correct attitude, Rafa. And once again … we’ll be waiting. VAMOS!!

If any further, simpler information comes out, then I’ll bring it over here. My thanks once again to the above-mentioned tweeters and to all those other contributors that are trying to keep us informed.