Why does it occur?
Bursa are fluid-filled sacs that serve as a lubricant layer to allow tissues to slide past each other without much friction. The prepatellar bursa can become inflamed in patients who participate in excessive kneeling activities (wrestler’s, plumbers, housekeepers, gardeners, etc.). The bursa is also commonly inflamed in patients with inflammatory disorders such as Gout or Rheumatoid Arthritis.
Symptoms most commonly include pain and swelling overlying the kneecap and are typically worsened by activities that place pressure on the front of the knee. Sometimes the swelling can get large enough to be compared to a golf or even tennis ball. It is very important to realize that a serious infection called septic bursitis can occur in addition to just getting swelling in the area. If this were to happen, the knee would also tend to be red, hot, potentially associated with a fever.
An x-ray may be recommended to assess the bones of the knee for underlying pathology. An ultrasound may be used to visualize the bursa, especially if considering an aspiration or cortisone injection. MRI is often not needed for diagnostic purposes, but may be obtained if another diagnosis is being ruled out.
Nonoperative management is typically the first line treatment for prepatellar bursitis. Activity modification, especially avoiding direct pressure on the kneecap, wearing a compression bandage (i.e. ACE Wrap) or kneepad is usually recommended. NSAIDs such as Advil or Aleve (if not contraindicated for the patient) may also be recommended to decrease pain and swelling. Ultrasound-guided aspiration may be recommended for large fluids collections. This fluid can then be sent out to a lab for analysis to rule out infection and an underlying condition such as Gout. Patients with suspected septic bursitis will be additionally placed on antibiotics and taken to the operating room for a surgical drainage procedure if not responding to antibiotics.
Surgery for Prepatellar Bursitis (that which is not septic) is usually only considered in cases where the patient continues to have recurrent fluid collections and pain despite nonoperative management. The goal of surgery is to remove the bursa and close the space that continues to fill with fluid. It is a short (actual surgical time is typically less than 20 minutes) outpatient procedure, meaning the patient can go home the same day as surgery.
Patients will be instructed to remain in a knee brace locked in extension for up to two weeks following surgery. Physical Therapy will begin approximately 2 weeks after surgery and last anywhere from 2-6 weeks depending on the patient. Patients usually return back to normal activity 4-6 weeks after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.