Prepatellar bursitis (nonseptic)

Background

Sagittal section of right knee-joint, showing frontal bursae.

• Generally occurs via repetitive kneeling on hard surfaces
• One of the more common sites for septic bursitis (especially in children)

Clinical Features

• Mild pain
• Swelling over lower pole of patella that may result in restricted ROM
  • May be so severe that must differentiate from a joint effusion

Differential Diagnosis

Knee diagnoses

Acute knee injury

• Knee dislocation
• Knee fractures
  • Patella fracture
  • Segond fracture
  • Tibial plateau fracture
• Meniscus and ligament knee injuries
• Patella dislocation
• Patellar tendonitis
• Patellar tendon rupture
• Quadriceps tendon rupture

Nontraumatic/Subacute

• Arthritis
• Gout and Pseudogout
• Osgood-Schlatter disease
• Patellofemoral syndrome (Runner's Knee)
• Patellar tendonitis (Jumper's knee)
• Pes anserine bursitis
• Popliteal cyst (Bakers cyst)
• Prepatellar bursitis (nonseptic)
• Septic bursitis
• Septic joint
• DVT

Evaluation

• Clinical diagnosis, based on history and physical exam
• There is currently no consensus on the optimal diagnosis strategy for prepatellar bursitis. The majority of patients studied did receive an aspiration of fluid (82%), but those patients had a significantly higher rate of complications (persistent infection, secondary infection in initially aseptic bursae) than patients treated with antibiotics alone.

Management

• Supportive
  • NSAIDs
  • Rest
  • Warm compresses
• IV antibiotics if infected bursa (Septic bursitis) is suspected

Disposition

• Outpatient

See Also

• Knee (Minor)
• Bursitis