Infrapatellar Bursitis

Other Names

Superficial infrapatellar bursitis
Clergyman's knee
Vicar's knee

Background

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

History

Epidemiology

Unknown
Generally limited to case reports

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^[1]
- 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

Risk Factors

Occupations/ Activities
- Kneeling
- Crawling

Differential Diagnosis

Fractures
Dislocations & Subluxations
- Patellar Dislocation (and subluxation)
- Knee Dislocation
- Proximal Tibiofibular Joint Dislocation
Muscle and Tendon Injuries
Ligament Pathology
Arthropathies
Bursopathies
Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
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

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

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

Classification

Not applicable

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?)

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

References

↑ 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:

John Kiel

Last edited:

4 October 2022 15:53:12

Categories:

Knee | Lower Extremity | Bursopathies | Overuse

[1] Van den Bossche, Dorien, et al. "Case report: infrapatellar bursitis caused by Prototheca wickerhamii." Medical mycology case reports 1.1 (2012): 13-16.

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