Prepatellar (Kneecap) Bursitis
Prepatellar bursitis also known as kneecap bursitis involves inflammation of a small fluid filled sac at the front of the knee known as a bursa. There are bursae near joints throughout the body to help with smooth movement between bones and soft tissue. These can be irritated by anything from injury to overuse, causing them to fill with excess liquid. The additional pressure placed on the structure of the joint or soft tissue due to the inflamed bursa can cause pain, discomfort and limited range of motion.
Prepatellar bursitis is often caused by repeated and significant pressure on the kneecap. We see this most often in people who have jobs that require kneeling, such as plumbers. Athletes often experience prepatellar bursitis as well, especially if they land on their knee often. This is most commonly seen in football players, wrestlers, soccer players and others playing contact sports.
Patients with rheumatoid arthritis have an additional risk of developing prepatellar bursitis. Rheumatoid arthritis is an autoimmune disorder that causes degenerative inflammation within the knee joint. Patients with gout may also experience prepatellar bursitis more than others. In rare cases, but much more urgently, prepatellar bursitis may be caused by a bacterial infection. This usually occurs when there is a laceration on the front of the knee, allowing bacteria to penetrate the skin.
The Signs and Symptoms of Prepatellar Bursitis
It will often be clear when a patient experiences prepatellar bursitis. There is not much tissue between the skin and the kneecap, so when the bursa fills with fluid, it may be obvious – in the form of swelling or a lump at the front of the knee. Because of its location, it will likely reduce range of motion of the knee and cause some discomfort, especially the more active a patient gets. The pain usually subsides as activity levels do. If the bursa is infected due to bacteria, the area may be warm to the touch and patient may experience significant pain. While many patients are concerned about the look of the knee, there is little cause for alarm, however it should be evaluated by a qualified orthopedic surgeon, urgently if accompanied by a laceration.
The Diagnostic Process
As with all orthopedic concerns, a medical history and physical examination are the first steps in making the diagnosis. A physical examination is usually sufficient to diagnose prepatellar bursitis. However, additional imaging may be ordered if there are signs of concurrent injuries to the knee.
Treatment for Prepatellar Bursitis
The first course of treatment for inflammation due to prepatellar bursitis is RICE – Rest, Ice, light Compression and Elevation. Patients will also benefit from anti-inflammatory medication, specifically NSAIDs such as ibuprofen – Advil or Motrin – and naproxen – Aleve. Do not take these medications if you have heart or kidney problems, or a history of stomach ulcers or irritation. It is best to consult with a physician prior to starting any medication. If the bursitis is bacterial in nature, antibiotics will be necessary, and patients may require drainage of the bursa should antibiotics alone not resolve the infection.
The next step and treatment of prepatellar bursitis, if anti-inflammatory and/or antibiotic treatment doesn’t work, is removing the fluid from the bursa. This is known as fine needle aspiration and requires just a few minutes in the office. We typically do not recommend to drain the bursa or inject it with a corticosteroid as this greatly increases the risk of infection.
If none of the above treatments work, the entire bursa will be removed surgically. This is known as a bursectomy. We limit this procedure only to patients who have not seen significant improvement with any of the options mentioned above. This is a definitive and permanent solution.
We encourage you to schedule a consultation with our office at the earliest stage of prepatellar bursitis. One of our highly experienced orthopedic surgeons will offer treatment options and what may be best for your situation.