Anterior Knee Pain (Pes Anserinus Bursitis)

Overview

What is pes anserinus bursitis?

Pes anserine bursitis occurs when the bursa — or fluid-filled sac — inside your knee joint becomes irritated and produces too much fluid. The bursa then swells, causing knee pain and tenderness. This condition is sometimes called pes anserinus pain syndrome (PAPS).

How common is pes anserinus bursitis?

Pes anserinus bursitis is most common among athletes. The condition is also prevalent in adults with osteoarthritis and those who are overweight. Statistically, anterior knee pain, or knee pain in the front of the knee, is most common in women over 50 with obesity.

What does pes anserinus bursitis feel like?

Your pain level can vary depending on how advanced your condition is. In general, people with pes anserinus bursitis experience more discomfort when kneeling, standing up from a chair or walking up and down stairs. Typically, pain improves with sufficient rest.

Do I have pes anserinus bursitis or a stress fracture?

Pes anserinus bursitis symptoms may be similar to that of a stress fracture. However, stress fractures in this particular area are uncommon. If you experience knee pain, schedule a consultation with your healthcare provider for proper diagnosis and treatment.

What’s the difference between anterior knee pain and knee bursitis?

Your knee contains up to 11 bursae, including the suprapatellar, prepatellar, infrapatellar and pes anserinus bursae. Knee bursitis is a generalized term that refers to inflammation of any of these bursae. Anterior knee pain – or pes anserinus bursitis – refers specifically to inflammation of the pes anserinus bursa.

Symptoms and Causes

What causes anterior knee pain?

Bursitis most often occurs due to overuse or stress on the bursa. Some of the most common pes anserinus bursitis causes include:

  • Playing sports that require repetitive knee movements, like soccer or tennis.
  • Tight hamstrings.
  • Abnormal knee alignment (valgus).
  • Being overweight.
  • Overuse of the knee.
  • Improper training techniques, such as failing to stretch before a workout.
  • An existing injury to the MCL (medial collateral ligament).
  • Knee arthritis.

What are the symptoms of anterior knee pain?

People with pes anserinus bursitis usually develop one or more warning signs. Pes anserinus symptoms may include:

  • Pain in the knee joint that develops gradually and feels better with rest.
  • Knee pain that worsens during exercise or climbing stairs.
  • Pain on the inside of your knee, two to three inches below the joint.

Diagnosis and Tests

How is pes anserinus bursitis diagnosed?

Your healthcare provider will examine your knee and discuss your symptoms with you. Because pes anserinus 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.

Management and Treatment

How do you treat pes anserinus bursitis?

There are several ways to reduce discomfort and begin your road to recovery. Pes anserinus bursitis treatments include:

  • Medication. Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling.
  • Rest. Discontinue activities that lead to bursitis flare-ups. Ask your healthcare provider when you can return to your normal routines.
  • Cold packs. Applying ice to the affected area three to four times daily can help reduce inflammation.
  • Wedge insoles. If your anterior knee pain is due to abnormal knee alignment, wedge insoles can help place your leg in a more favorable position.
  • Kinesiology tape. You can use kinesiology tape to ease your anterior knee pain symptoms. Be sure to talk to your healthcare provider about proper techniques.
  • Physical therapy. Your healthcare provider may recommend ultrasound treatments or stretching exercises to help you regain strength and range of motion.
  • Bursa injections. Your provider may inject steroid medications into the bursa to alleviate your symptoms.
  • PRP injections. Platelet-rich plasma (PRP) is taken from a sample of your blood. It’s used to promote healing and tissue regeneration.
  • Surgery. Though rare, surgery may be warranted in severe cases. During this procedure, your bursa is surgically removed. People who undergo this procedure can usually resume normal activities in about three to four weeks.

Are there possible complications regarding pes anserinus bursitis?

Though rare, people can develop complications due to lack of proper care. When pes anserinus bursitis is left untreated, you may experience an increase of inflammation and discomfort. Additionally, the muscles and tendons around your knee joint may weaken over time.

How can I manage pes anserinus bursitis?

The best way to manage pes anserinus bursitis pain is to closely follow your healthcare provider’s recommendations. In addition to getting rest, taking medications and applying ice to the area, you can also try sleeping with a pillow between your thighs. This helps reduce pressure on the bursa and can ease your symptoms.

How long does pes anserinus bursitis last?

Most people with pes anserine bursitis heal in about six to eight weeks. It could take longer for more severe cases. You’re likely to recover faster if you rest and seek proper treatment.

Prevention

How can I reduce my risk for pes anserinus bursitis?

To reduce your risk for pes anserinus bursitis, ask your healthcare provider to recommend exercises you can do at home. These exercises can help stretch and strengthen the muscles in your knees, thighs and abdomen — and in many cases, they can prevent a recurrence.

If you’re overweight, losing a few pounds can help take pressure off of the pes anserine bursa. Talk to your healthcare provider before making any changes to your diet.

Outlook / Prognosis

When can I go back to work after pes anserinus bursitis treatment?

Most people can return to work immediately following pes anserinus bursitis treatment, especially if you have a sedentary office job. However, if your job is physically demanding, you may need to take a few weeks off. Ask your healthcare provider when it’s safe for you to return to work or school.

Living With

When should I call my healthcare provider?

Any time you develop persistent knee pain, you should schedule a visit with your healthcare provider. Pes anserinus bursitis can be successfully managed with prompt and proper care.

Frequently Asked Questions

Is pes anserinus bursitis permanent?

No. Pes anserinus bursitis can heal within six to eight weeks, as long as proper measures are taken. Some people may be more prone to developing the condition, especially athletes or those with osteoarthritis. However, with timely care, you can greatly reduce your risk for pes anserinus bursitis or prevent it altogether.

What’s the difference between pes anserinus bursitis and tendinitis?

Pes anserinus bursitis refers to inflammation of the fluid-filled sac in the knee joint. Tendinitis is a condition characterized by inflammation of the tendons.

A note from Cleveland Clinic

Knee pain can be debilitating and interfere with your quality of life. Fortunately, pes anserinus bursitis can be effectively treated, especially when diagnosed in the early stages. Your healthcare provider can determine a personalized treatment plan to ease your painful symptoms and help you return to normal life.

Last reviewed by a Cleveland Clinic medical professional on 07/19/2021.

References

  • American Academy of Orthopaedic Surgeons. Pes Anserine (Knee Tendon) Bursitis. (https://orthoinfo.aaos.org/en/diseases--conditions/pes-anserine-knee-tendon-bursitis) Accessed 7/6/21.
  • Kiel J, Kaiser K. Stress Reaction and Fractures. 2020 Aug 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29939612. Accessed 7/7/21.
  • U.S. National Library of Medicine. Bursitis. (https://medlineplus.gov/ency/article/000419.htm) Accessed 7/7/21.

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