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Knee bursitis

Juan J Canoso, MD, MACR
Section Editor
Zacharia Isaac, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH


Bursae are synovial-lined virtual cavities that facilitate the interplay between tendon and bone, such as the anserine bursa and the deep infrapatellar bursa; between muscle and muscle, such as the gastrocnemius-semimembranosus bursa; between fascia and fascia, such as some bursal structures present in the prepatellar region; and between skin and deep fascia, such as the subcutaneous prepatellar bursa, the subcutaneous pre-tendinous (patellar tendon) bursa, and the olecranon bursa.

The term bursitis should only be used to describe inflammation of bursae. In this context, inflammation refers to bursal swelling with or without tenderness, redness, compression of neighboring structures, or documented rupture. However, some knee pain syndromes that have been commonly labelled "bursitis" are actually unrelated to bursae. One such example is that of pes anserine pain syndrome (PAPS), which was formerly referred to as anserine bursitis. This topic will review the diagnosis and management of PAPS, prepatellar and superficial infrapatellar bursitis, and other pain syndromes related to other bursae around the knee. An overview of bursitis as well as a discussion on septic bursitis are presented separately. (See "Bursitis: An overview of clinical manifestations, diagnosis, and management" and "Septic bursitis".)


Pes anserinus pain syndrome (PAPS), previously known as "anserine bursitis," is a common, clinically defined condition that features pain around the medial knee and tenderness over the upper medial tibia. "Pes anserinus" refers to the insertional footprint of the conjoined tendons of sartorius, gracilis, and semitendinosus, which is said to resemble the footprint of a goose ("anser" in Latin and old Spanish). Local swelling is rarely present [1,2].

The pathophysiology, treatment, and long-term course of PAPS are not well-defined. Ultrasonography (US) studies in PAPS have only rarely shown bursitis or tendonitis; therefore, PAPS should no longer be classified as a bursitis. However, there are rare cases of true anserine bursitis in which localized swelling, rather than pain, is the chief complaint [3]. The anserine bursa may also be the site of proliferative and inflammatory conditions, which are described below [4,5]. (See 'Differential diagnosis' below.)

Epidemiology — In a large, population-based study in Mexico with almost 13,000 surveyed individuals, PAPS had a prevalence of 0.34 percent [6]. In another study of 4240 subjects from three indigenous groups from Mexico and one from Argentina, the prevalence of PAPS was 0.54 percent of males and 0.7 percent of females [7]. Estimates of PAPS among patients with knee osteoarthritis (OA) are higher, as there appears to be an association between PAPS and knee OA. As an example, in a small observational study including 37 patients with PAPS, 93 percent also had knee OA, the majority of whom were obese women [8]. In another observational study of 50 patients with 90 symptomatic osteoarthritic knees, PAPS was present in 73 knees (83 percent) [9].

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2017.
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