Infrapatellar Bursitis

Other Names

• Superficial infrapatellar bursitis
• Clergyman's knee
• Vicar's knee

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Background

• This page refers to bursitis of the superficial bursa anterior to the distal patellar tendon

Epidemiology

• Unknown
• Generally limited to case reports

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Pathophysiology

• See: Bursopathies (Main)
• General
  • Overall, poorly characterized in the literature
  • Generally considered an inflammatory condition with fluid accumulation as a result of chronic stress
• Etiology
  • Infection
  • Crystal disease including Gout
  • Trauma

Associated Conditions

• Patellar Tendonitis

Pathoanatomy

• 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

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Risk Factors

• Occupations/ Activities
  • Kneeling
  • Crawling

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Differential Diagnosis

• Fractures
  • Distal Femur Fracture
  • Patellar Fracture
  • Tibial Plateau Fracture
  • Proximal Fibula Fracture
• Dislocations & Subluxations
  • Patellar Dislocation (and subluxation)
  • Knee Dislocation
  • Proximal Tibiofibular Joint Dislocation
• Muscle and Tendon Injuries
  • Quadriceps Contusion
  • Iliotibial Band Syndrome
  • Quadriceps Tendonitis
  • Patellar Tendonitis
  • Popliteus Tendinopathy
  • Extensor Mechanism Injury
    • Patellar Tendon Rupture
    • Quadriceps Tendon Rupture
    • Patellar Fracture
• Ligament Pathology
  • ACL Injury
  • PCL Injury
  • MCL Injury
  • LCL Injury
  • Meniscal Pathology
  • Posterolateral Corner Injury
  • Multiligament Injury
• Arthropathies
  • Knee Osteoarthritis
  • Septic Arthritis
  • Gout
  • Synovial Osteochondromatosis
• Bursopathies
  • Prepatellar Bursitis
  • Pes Anserine Bursitis
  • MCL Bursitis
  • Infrapatellar Bursitis
• Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
  • Chondromalacia Patellae
  • Patellofemoral Osteoarthritis
  • Osteochondral Defect Knee
  • Plica Syndrome
  • Infrapatellar Fat Pad Impingement
  • Patellar Instability
• Neuropathies
  • Saphenous Nerve Entrapment
• Other
  • Bakers Cyst (Popliteal Cyst)
  • Patellar Contusion
• Pediatric Considerations
  • Patellar Apophysitis (Sinding-Larsen-Johnansson Disease)
  • Patellar Pole Avulsion Fracture
  • Tibial Tubercle Avulsion Fracture
  • Tibial Tuberosity Apophysitis (Osgood Schalatters Disease)
  • Proximal Tibial Metaphyseal Fracture
  • Proximal Tibial Physeal Injury

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

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Clinical Features

• History
  • Patient will endorse anterior knee pain
  • Often with a history of repetitive microtrauma from kneeling
• Physical Exam
  • Palpable swelling inferior to the patella
• Special Tests

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Evaluation

Short axis view of intrapatellar bursa with well defined fluid collection

Radiology

• Standard Radiographs Knee
  • Often normal
• Findings
  • May show calcification of bursa in chronic cases

Ultrasound

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

MRI

Sagittal view of knee MRI showing well defined fluid collection anterior to patella tendon

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

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Classification

• Not applicable

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Management

Nonoperative

• Relative rest
• NSAIDS
• Physical Therapy
• Compression Sleeve or Ace Wrap
• Aspiration / Injection
  • Persistently swollen or painful bursa may require aspiration
  • If considered non-infectious, consider Corticosteroid Injection

Operative

• Generally not indicated (case reports?)

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Rehab and Return to Play

Rehabilitation

• Needs to be updated

Return to Play

• Needs to be updated

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Complications And Prognosis

Prognosis

• Most patients can expect to make a full recovery

Complications

• Chronic pain

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See Also

• Internal
  • Physical Exam Knee
  • Knee Pain (Main)
  • Knee Anatomy (Main)
• External
  • Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/

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