71: Knee Bursitis

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CHAPTER 71

Knee Bursitis

Ed Hanada, MD; Florian S. Keplinger, MD; Navneet Gupta, MD

Synonyms

Prepatellar bursitis (housemaid’s knee)

Infrapatellar bursitis (vicar’s knee)

Anserine bursitis

Medial (tibial) collateral ligament bursitis

Semimembranosus bursitis

ICD-9 Codes

726.60  Enthesopathy of knee, unspecified bursitis of knee

726.61  Pes anserinus tendinitis or bursitis

726.62  Tibial collateral ligament bursitis

726.63  Fibular collateral ligament bursitis

726.65  Prepatellar bursitis

726.69  Other bursitis: infrapatellar; subpatellar

ICD-10 Codes

M76.891  Enthesopathies of right lower limb, excluding foot

M76.892  Enthesopathies of left lower limb, excluding foot

M76.899  Enthesopathies of unspecified lower limb, excluding foot

M71.561  Bursitis, not elsewhere classified, right knee

M71.562  Bursitis, not elsewhere classified, left knee

M71.569  Bursitis, not elsewhere classified, unspecified knee

M76.40  Tibial collateral bursitis, unspecified leg

M76.41  Tibial collateral bursitis, right leg

M76.42  Tibial collateral bursitis, left leg

M70.40  Prepatellar bursitis, unspecified knee

M70.41  Prepatellar bursitis, right knee

M70.42  Prepatellar bursitis, left knee

M70.50  Other bursitis of knee, unspecified knee

M70.51  Other bursitis of knee, right knee

M70.52  Other bursitis of knee, left knee

Definition

Knee bursitis is an inflammation of any bursa in the region of the knee joint and is a common clinical disorder that may lead to functional difficulties. Eleven bursae are found within this region (Fig. 71.1) [1]. Three bursae communicate with the knee joint: quadriceps or suprapatellar, popliteus, and medial gastrocnemius. Four bursae are associated with the patella: superficial and deep prepatellar, and superficial and deep infrapatellar. Two are related to the semimembranosus tendons, and two are related to the collateral ligaments of the knee (one of which is under the pes anserinus, or the conjoined tendons of the sartorius, gracilis, and semitendinosus muscles) [1].

f71-01-9781455775774
FIGURE 71.1 Bursae around knee joint.

In the popliteal fossa, a bursa is located between the medial head of the gastrocnemius and semimembranosus tendon. Swelling in this area is also called Baker cyst and may actually be due to other inflammatory or degenerative conditions (see Chapter 64). For this chapter’s purpose, discussion is limited to knee bursitis arising from inflammation of the previously mentioned bursae.

The most common knee bursitis conditions are the following.

Prepatellar bursitis (housemaid’s knee) is caused by direct trauma, such as falling on a bent knee or frequent kneeling on a hard surface [1]. A case of a massive prepatellar bursitis from chronic crawling as a means of household ambulation in an adult man with cerebral palsy has been reported [2]. In 376 subjects with knee pain and radiographic evidence of knee osteoarthritis, 3.1% had evidence of prepatellar bursitis on magnetic resonance imaging [3].

Infrapatellar bursitis (vicar’s knee) is usually due to repetitive knee flexion in weight bearing, such as deep knee bends, squatting, or jumping; it can be associated with patellar-quadriceps tendinitis [4,5]. In 376 subjects undergoing routine magnetic resonance imaging who had knee pain and radiographic evidence of knee osteoarthritis, 10.6% had evidence of superficial infrapatellar bursitis [3].

Anserine bursitis is commonly seen in overweight older women who also have osteoarthritis of the knees and in individuals who participate in sports that require running, side-to-side movement, and cutting [5,6]. In a study involving persons with a symptomatic knee presenting to an orthopedic clinic with suspected internal knee derangement who had magnetic resonance imaging, only 2.5% of these patients had radiologic evidence of pes anserine bursitis, with no gender preference [7].

Medial collateral ligament bursitis refers to inflammation of a bursa located between the deep and superficial parts of the medial collateral ligament [5]. It has been associated with degenerative disease of the medial joint compartment, with marginal osteophytic spur formation [8]. Furthermore, this bursitis may be seen in equestrian and motorcycle athletes because of the friction applied to the medial side of the knee [8].

Semimembranosus bursitis is usually seen in runners and may be associated with hamstring tendinitis [4]. This was seen in 4.4% of symptomatic subjects undergoing routine magnetic resonance imaging [3].

Symptoms

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