Pes Anserine Bursitis

Knee tendon, or pes anserine bursitis as it is known, is considered a self-limiting condition. The length of time it takes to resolve the condition varies. Six to eight weeks of stretching and strengthening for most patients can help reduce symptoms. It is important to treat knee tendon bursitis in the early stages to reduce the symptoms and prevent long-term damage and chronic conditions from setting in. When knee tendon bursitis is left untreated, you may experience an increase in inflammation and discomfort. Additionally, the muscles and tendons around your knee joint may weaken over time. So pain in the knee should not be ignored. A good place to determine where the pain is coming from and what to do about it is Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado.

OVERVIEW

The pes anserine bursa is a thin, fluid-filled sac located on the inside of the knee joint. It cushions the joint and prevents the bones from rubbing against each other. Pes anserine (knee tendon) bursitis is a condition characterized by inflammation of this bursa. This painful condition occurs most commonly in young people involved in sports, middle-aged women who are obese, and people aged 50-80 who have osteoarthritis of the knee. The condition is also commonly associated with type 2 diabetes; 24% to 34% of patients with type 2 diabetes who report knee pain are found to have knee tendon bursitis. Sometimes, however, no direct cause can be identified. What is important to realize is that the knee is very complex. From person to person, the size and location of a pes anserinus bursa can vary, so everyone’s situation is always unique.

ABOUT THE KNEE

The knee joint is the largest in the body. It is a sophisticated hinge joint that helps with standing, moving, and keeping balance. Three important bones come together at the knee joint: the tibia (shin bone), the femur (thigh bone), and the patella (kneecap). Besides bones, knee anatomy is composed of many ligaments, cartilage, muscles, nerves, and tendons. Bursae are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, heels, and knees. They contain a small amount of fluid and are positioned between bones and soft tissues, acting as cushions to help reduce friction. The pes anserine bursa is one of 13 bursa that surround the knee.

WHAT IS KNEE TENDON BURSITIS?

Knee tendon bursitis is the inflammation of the pes anserine bursa present between the tendons of the hamstring muscle and the tibia or shinbone on the inner side of the knee. The condition occurs when the pes anserine bursa becomes inflamed and produces excess fluid causing the bursa to swell which places pressure on the adjacent sections of the knee. Pain and tenderness on the inner aspect of the knee are the most common symptoms of knee tendon or pes anserine bursitis. This condition is sometimes called pes anserinus pain syndrome (PAPS).

CAUSES

Knee tendon bursitis mainly results from overuse or constant stress and friction on the bursa. The condition is commonly noted in athletes, especially runners. Some of the other factors that can contribute to the occurrence of knee tendon bursitis include:

Tight hamstring muscles
Improper training techniques
Osteoarthritis of the knee
Medial meniscus rupture
Obesity
Participating in long-distance running, basketball, soccer, racket sports, and other sports that involve side-to-side movement
Lacking appropriate training for running, such as not stretching, suddenly increasing distance, or running excessively on hills or uneven ground
Being duckfooted, flat-footed, or having knock knees
Being unable to perform knee extension
Abnormal knee alignment (valgus)
Having diabetes mellitus
Having a patellar (kneecap) malalignment
Injuring the knee’s medial collateral ligament (MCL)

SYMPTOMS

People with knee tendon bursitis usually develop one or more warning signs. Knee tendon bursitis symptoms may include:

Pain that gradually develops in an area about 2-3 inches below the knee joint, occurring on the inside of the knee and/or in the center of the shinbone
Limited range of motion and weakness
Pain that increases with exercise or climbing up and down stairs
Pain that increases when rising from a seated position or sitting with legs crossed
Difficulties sleeping
Swelling
Warmth and visible redness on the skin in the area as inflammation in the bursa along the tendons becomes more severe
Pain that develops gradually and feels better with rest

NON-SURGICAL TREATMENTS

Treatment of knee tendon bursitis is almost entirely non-operative. Conservative treatments include:

Apply ice at regular intervals three or four times a day for 20 minutes at a time
Rest, including cutting back or eliminating activities that trigger symptoms
Cushioning—use of pillows between legs while sleeping
NSAIDs or nonsteroidal anti-inflammatory drugs such as naproxen and ibuprofen to relieve inflammation, swelling and pain
Cortisone injections
Compression such as wrapping the knee with an elastic bandage, kinesiology tape, or compression stocking
Wedge insoles if the pain is due to abnormal knee alignment
Maintaining a healthy weight, or a weight-loss program in obese individuals
Treating and managing diabetes very closely
Physical therapy that includes a consistent flexibility and strength exercise program, especially for the hamstrings and quadriceps muscles
Avoiding sudden increases in running mileage or uphill running
Always warming up before starting a sport or heavy physical activity

WHEN IS SURGERY INDICATED?

Surgical intervention is usually not considered unless conservative treatment has failed over a long period. Procedures that involve bursa drainage and removal may be required. In the first procedure, the surgeon makes an incision in the skin over the affected area and drains the excess fluid from the bursa. If the bursa is severely damaged, the surgeon may remove the entire inflamed sac. Surgical incision of a bursa called a bursectomy, is a fairly simple and minimally invasive procedure. It can be performed with open surgery or arthroscopic surgery, involving an arthroscope guided by a camera and small instruments making it easy to remove or repair the damaged bursa.

GETTING A GOOD DIAGNOSIS. GETTING A GOOD DOCTOR.

Knee tendon bursitis is diagnosed by reviewing your medical history and performing a thorough physical examination. Fluid from your bursa may be removed for lab analysis. Because knee tendon bursitis can exhibit the same symptoms as a stress fracture, an X-ray may be required to rule out a broken bone. Ultrasound or magnetic resonance imaging (MRI) may also be necessary to determine the extent of your injury. However, although the cause of the pain may be clear in cases of severe osteoarthritis with knee swelling and limited range of motion, studies have shown that in cases of mild to moderate arthritis, there is a poor correlation between radiographic findings and severity of knee pain. Magnetic resonance imaging (MRI) is unreliable in establishing a diagnosis, as studies in older adults found a high rate of false-positive results and incidental MRI changes in the contralateral, asymptomatic knee. Thus, imaging findings may have little correlation with the actual cause of the knee pain. An increasing number of overweight middle-aged and older individuals are presenting to healthcare professionals with knee pain. This problem has proven difficult to treat, which places into question the pathogenesis of knee pain in this population. Getting an accurate diagnosis for knee tendon bursitis can be difficult and takes exceptional and highly successful orthopedic surgeons to pinpoint the exact problem and know how to create individualized treatment options. You won’t find surgeons with more exacting skill than those at Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. Known for their excellent outcomes, the surgeons at CCOE are there to answer all your questions to help you make knowledgeable decisions. A qualified and compassionate orthopedic surgeon can be your trusted partner in the journey to a healthier, pain-free, and more active life.