A bursa is a small sac that reduces friction between soft tissues and bone. Around the knee, bursitis can affect several areas, including the prepatellar bursa in front of the kneecap, the pes anserine bursa along the inner upper tibia, and the bursa beneath the iliotibial band along the outer knee.
Inflammation of these tissues may result from direct trauma, repetitive activity, overuse, or increased friction.
What Is Bursitis?
Prepatellar bursitis is inflammation of the bursa between the patella (kneecap) and overlying skin. This bursa allows the skin to glide over the kneecap with less friction.
Pes anserine bursitis affects the bursa where the tendons of three thigh muscles attach to the upper tibia on the inner side of the leg, just below the knee. The tendon, bursa, or both may become inflamed and painful.
Iliotibial band syndrome involves excessive friction of the iliotibial band and underlying bursa along the outer knee. Repetitive bending and straightening of the knee, most often with running or cycling, can cause inflammation of the bursa, tendon, or both.
Causes and Risk Factors
Common causes include repetitive activity, overuse, sudden increases in activity, and direct trauma.
Risk factors vary by location and may include:
- Repetitive kneeling or landing on the knees
- Running, cycling, jumping, or other repetitive knee-bending activities
- Endurance sports
- Sports involving pivoting, cutting, or direct contact
- Sudden increases in training amount, frequency, or intensity
- Inadequate rest between workouts
- Poor physical conditioning or flexibility
- Improper training technique or inadequate warm-up
- Running on hills, inclines, or banked surfaces
- Knee arthritis
- Leg alignment differences, including knock knees with pes anserine bursitis or bow legs with iliotibial band syndrome
Symptoms
Symptoms depend on the area involved.
Prepatellar bursitis may cause:
- Pain, tenderness, swelling, warmth, or redness over the front of the kneecap
- Limited knee movement
- Occasionally, severe pain with movement
- Crackling when the bursa is moved or touched
- Occasionally, painless swelling
- Fever if the bursa is infected
Pes anserine bursitis may cause:
- Pain, tenderness, swelling, warmth, or redness along the inner leg two to three inches below the knee
- Pain that worsens as activity continues
- Pain with running or bending the knee against resistance
- Crackling when the tendon or bursa is moved or touched
Iliotibial band syndrome may cause:
- Pain, tenderness, and swelling along the outer knee that may travel up or down the thigh or leg
- Pain that worsens as activity continues
- Pain when running downhill, using stairs, or running on banked surfaces
- Crackling when the tendon or bursa is moved or touched
Treatment
Initial treatment commonly includes medications and ice to relieve pain and inflammation, stretching and strengthening exercises, and modification of the activity that caused or aggravates symptoms.
Physical therapy or evaluation by an athletic trainer may be helpful. Depending on the location and symptoms, treatment may also include:
- Knee pads for prepatellar bursitis
- An elastic bandage, knee sleeve, or brace
- Arch supports or orthotics
- Changes in running or cycling technique
- Cortisone injection into the bursa when recommended
Surgery is generally reserved for symptoms that persist despite conservative treatment, recur frequently, or involve significant chronic inflammation. Depending on the condition, surgery may involve removal of the inflamed bursa or affected scarred tissue.
Antibiotics may be prescribed when a prepatellar bursa is infected.
Recovery and Outcomes
These conditions usually respond well to conservative treatment when the affected area is rested and aggravating activities are modified.
Prepatellar bursitis may resolve within about two weeks with appropriate conservative treatment. Pes anserine bursitis is usually curable within about six weeks. Iliotibial band syndrome may resolve within approximately six to 12 weeks with appropriate conservative treatment and rest from aggravating activities.
Potential complications include:
- Persistent or recurrent pain and inflammation
- Chronic inflammation or scarring
- Delayed healing if activity is resumed too soon
- Reduced ability to train or compete
- Joint stiffness with prepatellar bursitis
- Infection of the prepatellar bursa
- Risks associated with surgery
When to See Dr. Chudik
If you have persistent pain, swelling, or tenderness around the knee, symptoms that continue despite activity modification, or worsening symptoms, schedule an evaluation with Dr. Chudik.
Call 630-324-0402, request an appointment online, or email contactus@chudikmd.com.