This article retrospectively reviews 53 patients with various knee joint conditions in which the fat pad was implicated. The patients were divided into four groups: patellar tendonitis, cruciate ligament surgery, meniscal surgery, and miscellaneous. Patient ages ranged from 17 to 67 years, and follow-up ranged from 4 weeks to 5 years. All of the patients presented with pain or stiffness that was related in part to the fat pad pathology. This finding was confirmed by an injection of local anesthetic and steroid into the fat pad itself, which was followed by transient although complete symptomatic relief. We conclude that fat pad pathology is usually secondary to other knee joint pathology, and its primary involvement is rare. The pain produced by the fat pad may have serious implications on knee joint function if not dealt with promptly. Appreciation of the source of pain in knee joint pathology will allow better management of the knee condition. The role of physical therapy and cooperation between the physical therapist and the surgeon is of paramount importance for the final outcome. More work is needed to correlate the relation of the anatomy of the fat pad to knee symptoms and function.