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Prepatellar Bursitis
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Contents
Other Names
- Housemaid's knee
- Carpenter's knee
- Prepatellar Bursitis (PPB)
- Infectious Prepatellar Bursitis
- Noninfectious Prepatellar Bursitis
- Aseptic Prepatellar Bursitis
- Coal miner’s knee
- Carpet layer’s knee[1]
- Hemorrhagic bursitis
Background
- This page refers to bursitis of the pretallar bursa, most commonly referred to as prepatellar bursitis (PPB)
History
- Described as early as 1961 among coal miners[2]
Epidemiology
- Overall underreported in literature with a paucity of studies[3]
- Males > Females (need citation)
- Majority of cases between 40 and 60 years of age
- Pediatrics
- More likely to be septic, in immunocompromised kids (need citation)
Pathophysiology
- See: Bursopathies (Main)
- General
- Poorly described in the literature thus much of discussion, management is extrapolated from other bursopathies
- Occurs due to friction between the dermal layers and patella, or compressive forces from direct trauma
- Noninfectious/ Aseptic
- Represents the majority of cases
- Common etiologies include trauma, crystal deposition or systemic inflammatory diseases
- Infectious
- Between 20-30% are septic
- Typically from skin lesions
- Less commonly, can also arise spread primary cellulitis and in rare cases, from hematogenous
- Common bacteria: Staphylococcus aureus (#1), Brucella sp.[4]
- Uncommon pathogens: fungi, tuberculosis[5]
- Up to 50% of all SB cases occur in immunocompromised patients (need citation)
- #2 location for septic bursitis behind the olecranon, which is 4x more common[6]
- Hemorrhagic
- Can occur due to trauma or in patients on anticoagulation
Etiology
- Trauma
- Most commonly due to chronic, repetitive microtrauma
- Can be due to acute trauma
- Typically aseptic unless violation of soft tissue
- Crystal deposition
- Including gout, psuedogout causing aseptic, inflammatory
- Systemic inflammatory diseases
- Includes rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, or uremia[7]
Pathoanatomy
- Prepatellar Bursa
- Located between the Patella and overlying subcutaneous tissue
Risk Factors
- Sports
- Wrestling[8]
- Volleyball
- Baseball and Softball catchers
- Occupations
- Common in occupations requiring kneeling
- Housekeeping
- Plumbing
- Carpet installers
- Gardening
- Roofing
- Autoimmune and Inflammatory
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
Clinical Features
- History
- Typically some sort of repetitive microtrauma
- May be an acute trauma
- Patients will endorse knee pain, anterior swelling
- Trouble ambulating
- Physical Exam
- Obvious swelling of prepatellar bursa
- Overlying erythema, warmth are often present
- The prepatellar space will be tender with fluctuance, edema, crepitus
- Range of motion is often restricted
- Notably absent is a joint effusion
- Septic vs aseptic can be difficult to distinguish clinically
- Special Tests
Evaluation
Radiographs
- Standard Radiographs Knee
- Typically Normal
- Used to exclude other pathology
- Potential findings
- Prepatellar soft tissue swelling
- Calcifications in the prepatellar soft tissues in more chronic cases[9]
Ultrasound
- Findings
- Hypoechoic fluid collection anterior to patella[10]
- May have heterogenous debris
- Also useful to guide aspiration or injection if indicated
MRI
- Not typically indicated
- Potential Findings
- Low T1, bright T2/STIR signal intensity
- Wall of bursa may be thickened, irregular
Laboratory
- Labs are not typically indicated
- However, if septic bursitis is a consideration, then labs are indicated
- Aspiration: Fluid analysis, gram stain, culture, glucose, protein, lactate
- Serum: CBC, ESR, CRP
Characteristic | Appearance | WBC (per µL) | Differential count | Bursal fluid–to–serum glucose ratio | Gram stain | Culture |
Septic bursitis (SB) | Purulent | 1500-300,000; mean 75,000 | Polymorphonuclear (PMN) cells | < 50% | Positive in 70% | Positive |
Nonseptic bursitis (NSB) | Serosanguineous, straw colored, or bloody | 50-10,000; usually < 3000 | Predominantly mononuclear cells | >50% | Negative | Negative |
Classification
- Not applicable
Management
Prognosis
- Most cases will completely resolve with prompt, appropriate treatment
- No large scale studies evaluating prognosis of PPB
Nonoperative
- Indications
- Inflammatory and non-infectious
- Compression
- Analgesics
- Aspiration
- Not typically recommended as first line therapy
- Indicated if septic bursitis is a consideration
- Corticosteroid Injection
- Can be considered in refractory cases
- No clear guidelines or evidence
- Consider
- Physical Therapy if recovery is slow or delayed
- Occupational Therapy directed at activity modification
- Knee Pads for occupations where repetitive microtrauma occurs due to kneeling
- Septic Bursitis
- Antibiotics with gram positive coverage
- Orthopedic surgery consultation
Operative
- Indications
- Failure of conservative treatment
- Septic bursitis
- Technique
- Open vs arthroscopic Bursectomy
- Irrigation and debridement
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- No clear guidelines
- Can return to sport or occupation when symptoms and swelling have resolved
- Should wear knee protection to prevent recurrence
Complications
- Inability to return to sport
- Septic Bursitis
- Need for inpatient management
- Need for surgery
See Also
- Internal
- External
- Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/
References
- ↑ Myllymäki, T., et al. "Carpet-layer's knee: An ultrasonographic study." Acta Radiologica 34.5 (1993): 496-499.
- ↑ Sharrard, W. J. W. "Haemobursa in kneeling miners." (1961): 1103-1104.
- ↑ Baumbach SF , Lobo CM, Badyine I, Mutschler W, Kanz KG: Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg2014; 134(3): 359–70.
- ↑ Almajid, F. M. "A rare form of Brucella bursitis with negative serology: a case report and literature review." Case reports in infectious diseases 2017 (2017).
- ↑ MacLean, S., and S. Kulkarni. "Tuberculosis of the patella masquerading as prepatellar bursitis." The Annals of The Royal College of Surgeons of England 95.1 (2013): e17-e19.
- ↑ Ho G, Tice AD, Kaplan SR (1978) Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases. Ann Intern Med 89(1):21–27
- ↑ Diering, Nina, et al. "Calcific prepatellar bursitis in a patient with limited cutaneous systemic sclerosis." JDDG: Journal der Deutschen Dermatologischen Gesellschaft 15.12 (2017): 1248-1250.
- ↑ Mysnyk MC , Wroble RR, Foster DT, et al. : Prepatellar bursitis in wrestlers. Am J Sports Med1986; 14(1): 46–54.M.
- ↑ Stahnke M, Mangham DC, Davies AM. Calcific haemorrhagic bursitis anterior to the knee mimicking a soft tissue sarcoma: report of two cases. Skeletal Radiol. 2004 Jun;33(6):363-6. Epub 2004 May 1
- ↑ 2. Draghi F, Corti R, Urciuoli L, Alessandrino F, Rotondo A. Knee bursitis: a sonographic evaluation. (2015) Journal of ultrasound. 18 (3): 251-7. doi:10.1007/s40477-015-0168-z - Pubmed
Created by:
John Kiel on 10 June 2019 17:08:23
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Last edited:
4 October 2022 15:52:41
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