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Infrapatellar Bursitis

From WikiSM

Other Names

  • Superficial infrapatellar bursitis
  • Clergyman's knee
  • Vicar's knee
  • Deep Infrapatellar Bursitis

Background

  • This page refers to bursitis of the either the superficial or deep infrapatellar bursa of the knee

History

  • First mentioned by Klein in 1996[1]

Epidemiology

  • Not well described in the literature, mostly limited to case reports
  • Knee bursitis in the workforce was estimated to have a prevalence of 1.4% to 2.3%[2]

Description

The superficial and deep infrapatellar bursa are illustrated[3]
Line diagram showing the superficial and deep infrapatellar bursae. (1) Superficial infrapatellar bursa, (2) deep infrapatellar, femur (F), Hoffa's fat pad (HF), patella (P), patellar tendon (PT) and tibia (T)[4]

General

  • Overall, poorly characterized in the literature
  • Generally considered an inflammatory condition with fluid accumulation as a result of chronic stress

Etiology

  • Infection[5]
  • Crystal disease including Gout
  • Trauma

Associated Conditions

Anatomy of the Superficial Infrapatellar Bursa

  • Lies between the subcutaneous tissues and the superficial aspect of the Patellar Tendon
  • Can exist as a single sac, or less commonly, multisegmented series of loculated sacs

Anatomy of the Deep Infrapatellar Bursa

  • Lies above the tibial tubercle, immediately superior to the distal patellar tendon and posterior to the lower 3rd of the tendon
  • Reduces friction of the patellar tendon over the tibia

Risk Factors

  • Occupations/ Activities
    • Kneeling
    • Crawling

Differential Diagnosis

Differential Diagnosis Knee Pain

Clinical Features

Radiograph demonstrating significant pre- and infra-patellar soft tissue edema

History

  • Patient will endorse anterior knee pain
  • Often with a history of repetitive microtrauma from kneeling

Physical Exam: Physical Exam Knee

  • Palpable swelling inferior to the patella (if superficial)

Evaluation

Short axis view of intrapatellar bursa with well defined fluid collection
Sagittal view of knee MRI showing well defined fluid collection anterior to patella tendon

Radiology

Ultrasound

  • Can be used to help diagnose injury
  • Findings
    • Discrete, well defined fluid collection anterior the patella tendon

MRI

  • Findings
    • Fluid collection that projects exophytically, anterior to the patellar tendon
    • Localized with well defined fluid collection

Classification

  • Not applicable

Management

Knee Compression Sleeve

Nonoperative

Operative

  • Generally not indicated (case reports?)

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Needs to be updated

Complications And Prognosis

Prognosis

  • Most patients can expect to make a full recovery

Complications

  • Chronic pain
  • Inability to return to work/ sport

See Also

Internal

External

References

  1. ↑ Klein, Wilhelm. "Endoscopy of the deep infrapatellar bursa." Arthroscopy: The Journal of Arthroscopic & Related Surgery 12.1 (1996): 127-131.
  2. ↑ Le Manac’h, A. P., et al. "Prevalence of knee bursitis in the workforce." Occupational medicine 62.8 (2012): 658-660.
  3. ↑ Malanga, Gerard A., and Kenneth R. Mautner. "Atlas of ultrasound-guided musculoskeletal injections." (No Title) (2014).
  4. ↑ Hirji, Zameer, Jaspal S. Hunjun, and Hema N. Choudur. "Imaging of the bursae." Journal of Clinical Imaging Science 1 (2011).
  5. ↑ Van den Bossche, Dorien, et al. "Case report: infrapatellar bursitis caused by Prototheca wickerhamii." Medical mycology case reports 1.1 (2012): 13-16.
Created by:
John Kiel on 10 June 2019 17:08:43
Authors:
Last edited:
3 February 2025 15:23:57
Categories:
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