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Pes Anserine Bursitis
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Contents
Other Names
- Pes Anserine Pain Syndrome (PAPS)
- Anserine bursitis
- Pes Anserine Pain
- Pes Anserinus Tendinitis or Bursitis (PATB)
Background
- This page refers to inflammation of the pes anserine bursa, commonly referred to as pes anserine tendinitis or bursitis (PATB)
History
Epidemiology
- In a large Mexican population, the incidence was 0.34% among 13,000 surveyed individuals[1]
- Another study found a prevalence of 0.54% in males and 0.7% in females[2]
Pathophysiology
- Inflammation
- Historically, thought to cause local inflammation to surrounding tendinous structures
- Includes Medial Meniscus, Medial Collateral Ligament which may irritate pes anserine bursa
- Studies rarely show inflammation of the bursa[3]
- Overuse leading to tendinopathy
- Thought to be due to repetitive flexion, adduction
- Some authors suggest semitendinosus is the most common culprit
- Other implicated etiologies
- Direct trauma
- Obesity
Pathoanatomy
- Pes Anserine
- "Pes Anserine" comes from the Latin referring to “goose’s foot”
- Conjoined tendinous attachment of Semitendinosus, Gracilis, and Sartorius
- Bursa between proximal medial Tibia and the insertion point of the 3 tendons[4]
Associated Conditions
- Knee Osteoarthritis
- Specifically, the medial joint space
- Up to 90% of cases[5]
Pediatric Considerations
- Rare in skeletally immature pediatric patients
- Consider physical fracture in the setting of medial tibial pain
Risk Factors
- Sports[6]
- Running
- Basketball
- Basketball
- Racquet Sports
- Racquet sports
- Other
- Obesity
- Diabetes Mellitus
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
- 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

Palpation of pes bursa and associated pes anserine tendons. Note knee is flexed to 90°[7]
Clinical Features
- History
- Medial knee pain
- Worse with standing, stairs, crossing leg
- Subjective weakness, diminished range of motion
- Physical Exam
- Swelling may or may not be present
- Tenderness over the pes anserine at the medial, proximal tibia, with knee at 90°
- In extension, tenderness may be over medial joint line
- Pain with resisted internal rotation and flexion of the knee
- Location: 3-4 cm medial to tibial tubercle, 3 cm below anteromedial tibial platea
- Special Tests
- No tests specific to Pes Anserine

Pes Anserine bursitis with fluid in the bursa seen in long axis (arrow)[8]
Evaluation
Radiographs
- Standard Knee Radiographs
- Findings
- Underlying osteoarthritis is common
Ultrasound
- Findings
- Swelling
- Bursal fluid
- Thickened pes anserine, especially in patients with knee OA[9]
MRI
- Not typically indicated
- Findings[10]
- Increased bursal fluid
- Thickened bursal wall
- Surrounding tissue edema
- Abnormal wall / surrounding tissue enhancement
Classification
- Not applicable
Management
Nonoperative
- Indication
- Vast majority of cases
- When appropriate, treatment should be directed at underlying etiology
- For example, osteoarthritis
- Relative rest
- Activity modification
- NSAIDS
- Weight Loss
- Physical Therapy
- Emphasis on strengthening quadriceps muscles
- Also if indicated, core, gluteal, short hip rotator strengthening
- Corticosteroid Injection
- One small study showed potential benefit[11]
- Consider an intra-articular injection for knee OA + intra-bursa injection for pes anserine pain
Operative
- Indications
- Rarely, failure of conservative treatment
- Technique
- Bursal incision and drainage
- Bursectomy
Rehab and Return to Play
Rehabilitation
- Emphasis on
- Closed kinetic chain exercises
Return to Play
- No clear return to play guidelines
Complications & Prognosis
Prognosis
- Needs to be updated
Complications
- Chronic pain
- Inability to return to sport
See Also
External
- Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/
References
- ↑ Alvarez-Nemegyei, Jose, et al. "Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria." The Journal of Rheumatology Supplement 86 (2011): 15-20.
- ↑ Alvarez-Nemegyei, José, et al. "Prevalence of rheumatic regional pain syndromes in Latin-American indigenous groups: a census study based on COPCORD methodology and syndrome-specific diagnostic criteria." Clinical rheumatology 35 (2016): 63-70.
- ↑ Uson, J., et al. "Pes anserinus tendino-bursitis: what are we talking about?." Scandinavian journal of rheumatology 29.3 (2000): 184-186.
- ↑ Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF. Common Soft Tissue Musculoskeletal Pain Disorders. Prim Care. 2018 Jun;45(2):289-303.
- ↑ Alvarez-Nemegyei J, Peláez-Ballestas I, Goñi M, et al. Prevalence of rheumatic regional pain syndromes in Latin-American indigenous groups: a census study based on COPCORD methodology and syndrome-specific diagnostic criteria. Clin Rheumatol. 2016 Jul;35 Suppl 1:63-70.
- ↑ Sapp GH, Herman DC. Pay Attention to the Pes Anserine in Knee Osteoarthritis. Curr Sports Med Rep. 2018 Feb;17(2):41.
- ↑ Cowles, Larry M., and Anthony I. Beutler. "Pes Anserine Pain Syndrome." Common Pediatric Knee Injuries: Best Practices in Evaluation and Management (2021): 207-216.
- ↑ Image courtesy of ultrasoundcases.info, "Pes anserinus tendons"
- ↑ Toktas, Hasan, et al. "Ultrasonographic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis." Modern rheumatology 25.1 (2015): 128-133.
- ↑ Forbes JR, Helms CA, Janzen DL. Acute pes anserine bursitis: MR imaging. Radiology. 194 (2): 525-7.
- ↑ Yoon HS, Kim SE, Suh YR, Seo YI, Kim HA. Correlation between ultrasonographic findings and the response to corticosteroid injection in pes anserinus tendinobursitis syndrome in knee osteoarthritis patients. J Korean Med Sci. 2005 Feb;20(1):109-12.
Created by:
John Kiel on 10 June 2019 17:09:49
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Last edited:
13 March 2023 01:18:04
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