From the Research
The treatment of prepatellar bursitis should begin with conservative measures, including rest, ice application, compression, and elevation (RICE protocol), as well as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, with surgical removal of the bursa (bursectomy) considered only for chronic cases that don't respond to conservative treatment or for recurrent infections 1. The goal of treatment is to reduce inflammation in the bursa, which is a fluid-filled sac that normally provides cushioning between the patella and the skin, allowing for smooth movement during knee flexion.
- Patients should avoid kneeling and activities that put pressure on the affected knee.
- Over-the-counter NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (250-500mg twice daily) can help reduce pain and inflammation for 1-2 weeks.
- For more severe cases, aspiration of the bursal fluid may be necessary to relieve pressure and reduce pain, often followed by a corticosteroid injection (such as methylprednisolone 20-40mg) into the bursa to decrease inflammation.
- If infection is suspected (characterized by warmth, redness, fever), oral antibiotics targeting Staphylococcus aureus (such as cephalexin 500mg four times daily for 7-10 days) are prescribed after fluid aspiration for culture 2, 1.
- Patients should wear protective knee pads during activities that involve kneeling to prevent recurrence. Some studies suggest that surgical intervention, such as incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases 1, while others propose outpatient endoscopic surgery under local anesthesia as an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments 3. However, the most recent and highest quality study recommends a conservative treatment regimen, following bursal aspirate-based differentiation between septic and non-septic bursitis 1.