From the Research
Pes anserine bursitis is best managed with a combination of conservative measures, including rest, ice, compression, and elevation (RICE protocol) for acute pain, and local injections, with oxygen-ozone injection being a viable option for long-term relief, as shown in the most recent study 1. The initial treatment should focus on NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 7-10 days to reduce inflammation and pain.
- Physical therapy is essential and should include:
- Stretching exercises for the hamstring muscles
- Strengthening of the quadriceps
- Correction of biomechanical issues that may contribute to the condition Local corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine 1%) or oxygen-ozone injections can be administered directly into the bursa for patients with persistent symptoms despite conservative management, with oxygen-ozone injections showing longer-lasting effects 1. Weight loss is recommended for overweight patients as excess weight increases stress on the medial knee. Addressing underlying conditions like diabetes, osteoarthritis, or pes planus (flat feet) is important as these can exacerbate symptoms. Most cases resolve within 2-3 weeks with appropriate management. Surgery is rarely needed but may be considered for recalcitrant cases. This condition occurs when the bursa between the pes anserinus tendon (formed by the sartorius, gracilis, and semitendinosus tendons) and the medial tibial plateau becomes inflamed, typically due to overuse, direct trauma, or biomechanical issues affecting the medial knee, and has been studied in various contexts, including its treatment with polydeoxyribonucleotide injection 2, mesotherapy 3, and comparison of physical therapy and corticosteroid injection 4.