From the Research
Prepatellar bursitis should be initially treated with conservative measures, including rest, ice, compression, and elevation, as well as nonsteroidal anti-inflammatory drugs (NSAIDs) for 1-2 weeks, with aspiration of the bursa fluid and oral antibiotics considered for more severe or septic cases, and surgical intervention reserved for refractory or recurrent cases. The diagnosis of prepatellar bursitis involves clinical presentation, bursal aspirate, and blood sampling analysis, with physical findings such as fever, prebursal temperature difference, and skin lesions suggesting septic bursitis 1.
Diagnosis and Treatment Plan
The treatment plan for prepatellar bursitis includes:
- Conservative measures: rest, ice application for 15-20 minutes several times daily, compression with an elastic bandage, and elevation of the affected limb
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for 1-2 weeks to reduce pain and inflammation
- Aspiration of the bursa fluid may be necessary for more severe cases or if infection is suspected
- Oral antibiotics such as cephalexin (500mg four times daily) or clindamycin (300-450mg four times daily) for 7-10 days if infection is present (septic bursitis)
- Corticosteroid injection into the bursa may be beneficial for recurrent or chronic cases
- Surgical intervention (bursectomy) is rarely needed but may be considered for cases that don't respond to conservative treatment or recur frequently
Prevention Strategies
Prevention strategies for prepatellar bursitis include:
- Wearing knee pads during activities that require kneeling
- Avoiding direct pressure on the kneecap
- Modifying activities to avoid aggravating symptoms
According to a recent study, intrabursal sclerotherapy with polidocanol may be a novel treatment option for recurrent non-septic prepatellar bursitis, with a case report showing significant improvement and no reaccumulation of fluid at 10 months post-procedure 2. However, this treatment option is not widely established and more research is needed to confirm its efficacy. Overall, the treatment plan for prepatellar bursitis should prioritize conservative measures and reserve more invasive treatments for refractory or recurrent cases, with the goal of reducing morbidity, mortality, and improving quality of life.