What is it?

A bursa is a fluid-filled sac that helps reduce friction between different surfaces and tissues. The pre-patellar bursa is located between the skin and the knee cap (patella), and allows for better movement of the skin over the patella. This is just one of many bursae located around the knee.

Irritation and inflammation of the pre-patellar bursa often occur with overuse of the knee. Specifically, it occurs in people who spend long periods of time kneeling and has the nickname “housemaid’s knee.” Not only can it occur through repeated kneeling, but it can also happen with a traumatic injury when someone falls onto the patella. This type of injury leaves the person at risk for an infection. Small tears at the surface of the skin allow bacteria to pass into the bursa, leading to septic bursitis. Pre-patellar bursitis affects all age groups, but it affects more men than women.

 

Symptoms

Symptoms of pre-patellar bursitis include:

• Swelling around the kneecap

• Pain

• Redness

• Difficulty kneeling

• Decreased knee range of motion

• Warm to the touch

• Fever, chills, or increased fatigue (signs of infectious bursitis)

 

Sports Medicine Evaluation & Treatment

The physician will push on the area of tenderness and assess the motion of the knee joint. He or she will check for signs of infection. Your physician may drain the area with a needle to relieve any swelling and determine whether or not the bursa is infected. Imaging studies are usually not required, but an ultrasound may be used to assess the bursa. Depending on the severity, your physician may inject a steroid into the affected area to help with inflammation, so long as the bursa is not infected.

 

Treatment options

• Rest, ice, compression, and elevation

• Anti-inflammatory medications

• Antibiotic therapy for bursa that appears infected

• Physical therapy to improve range of motion and strengthen surrounding muscle groups

• Corticosteroid injection for persistent swelling in non-infected bursitis

• Surgical removal of bursa for bursitis not responding to more conservative treatment (very rare)

 

Injury Prevention

Since this is an injury that typically occurs in individuals who work on their knees, proper knee padding can prevent inflammation to the pre-patellar bursa. Avoiding prolonged and repetitive kneeling may help with prevention too. Kneepads also help decrease the risk of traumatic pre-patellar bursitis in people prone to landing on their knees like volleyball players, football players, and wrestlers.

 

Return to Play

Once swelling, pain and range of motion have improved, you may return to play. If the affected bursa is being treated with antibiotics, you should wait until you have been re-assessed and released by your physician before returning to athletic activity.

AMSSM Member Authors
Andrew Nowakowski, DO and Jacklyn Kiefer, DO

References
Cardone DA, Tallia AF. Diagnostic and Therapeutic Injection of the Hip and Knee. Am Fam Physician. 2003 May;67(10):2147-52.
Wilson-MacDonald J. Management and outcome of infective pre-patellar bursitis. Postgrad Med J. 1987 Oct;63(744)851-53.
Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011 June;29(6):359-67.