What is the management of prepatellar bursitis (inflammation of the prepatellar bursa)?

From the Guidelines

Management of prepatellar bursitis involves both conservative and interventional approaches, with the primary goal of reducing pain and inflammation, and the most effective initial treatment being the RICE protocol (rest, ice, compression, elevation) 1. The RICE protocol is recommended initially, with patients advised to avoid kneeling and activities that pressure the affected knee.

• Oral NSAIDs such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) for 1-2 weeks can help reduce pain and inflammation, as they are recommended for short-term pain relief, although they have no effect on long-term outcomes 1.
• For more severe cases, aspiration of the bursa may be necessary to relieve pressure and pain, followed by compression bandaging.
• If infection is suspected (indicated by warmth, redness, fever), antibiotic therapy should be initiated; common choices include cephalexin (500mg four times daily) or clindamycin (300-450mg four times daily) for 7-10 days.
• Corticosteroid injections (such as methylprednisolone 40mg with lidocaine) may be considered for non-infectious cases that don't respond to initial treatment, though these carry a small risk of infection, and locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes 1.
• Physical therapy focusing on quadriceps strengthening and knee flexibility can aid recovery and prevent recurrence, as eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1.
• Surgical intervention (bursectomy) is rarely needed but may be considered for chronic cases resistant to conservative management or cases with recurrent infections, as surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1. Most cases resolve within 2-3 weeks with appropriate treatment, though patients should be counseled that complete resolution may take longer in chronic cases.

From the Research

Management of Prepatellar Bursitis

The management of prepatellar bursitis can be divided into conservative and surgical treatments.

• Conservative treatment includes:
  • Aspiration of fluid from the bursa 2
  • Rest, ice, immobilization, and injection of a corticosteroid and analgesic combination 2
  • Compression, immobilization, antiphlogistic medication, and instillation of corticosteroids for non-septic bursitis 3
  • Antibiotics, immobilization, and antiphlogistic medications for selected cases of septic bursitis 3
• Surgical treatment is indicated in cases of intractable bursitis or when conservative treatment fails, and includes:
  • Surgical drainage of the bursa 4
  • Bursotomy with incision and drainage, or bursectomy for purulent aspirate 3
  • Endoscopic treatment under local anesthesia for traumatic prepatellar bursitis 5
  • A 2-stage technique using negative pressure dressings for large chronic prepatellar bursitis 6

Treatment Outcomes

The outcomes of treatment for prepatellar bursitis vary, with some patients experiencing recurrence or ongoing symptoms, particularly those with preexisting chronic bursitis or those who kneel at work 4. However, surgical treatment can be effective in resolving symptoms and improving function, with satisfactory cosmetic and functional results 5.