Our patient was a 29-year-old male patient (BMI - 21.6) who presented with persistent RT knee pain over the period of 8 months. It was associated with occasional mechanical symptoms such as popping and locking while performing daily activities. The patient denied of any history of trauma and had been treated by a general practitioner with nonsteroidal anti- inflammatory drugs for the pain without any favorable outcome. On examination, the knee was found to be swollen with noticeable fullness of suprapatellar pouch. On palpation, there was no specific tender point or the presence of fluid in the joint. Examination revealed no instability with varus and valgus stress testing, negative posterior-anterior drawer tests, and negative Lachman and McMurray’s tests. He had free active knee range of motion without crepitus or clicking with normal patellar tracking. X-rays showed normal joint space and no abnormal soft tissue shadows, fractures, or osteochondral lesions. The MRI images showed high signal intensity villous or nodular foci on both T1- and T2-weighted images which were indicative of fat globules ( and ). They were predominantly found in huge number in suprapatellar pouch, and no other ligamentous or meniscal defect was found. Since the patient had clear MRI findings consistent with synovial lipomatosis, he was posted for arthroscopic synovectomy after all routine pre-operative investigations, which were found to be normal. On arthroscopy, a large number of fat globules was found in suprapatellar pouch and some in the medial and lateral gutter. They had typical “frond-” like appearance and found in multiple clusters ( and ). There was the absence of any ligamentous, meniscal, or osteochondral lesions. Arthroscopic synovectomy and extensive debridement of polyp-like fat projections of the right knee was performed. Approximately 40 cc of lobulated globules were removed, and some were sent to histopathology (). The reports confirmed the presence of benign synovial tissue and fragments of adipose tissue present beneath the synovial surface (). The patient was started with an active range of motion exercises from the first day and was discharged on the 5th day. On 1-year follow-up, the swelling was dramatically reduced, and the patient was free of pain and devoid of all mechanical symptoms.