Images in Clinical Medicine
Infrapatellar Bursitis
N Engl J Med 2008; 359:2366November 27, 2008
- Article
A 69-year-old patient presented with chronic bilateral knee pain. No recent trauma or underlying medical condition was reported. A radiograph revealed multiple bilateral calcifications ventral to the tibial plateau, projecting from the infrapatellar bursa. The presence of such calcifications in radiographic studies is a typical end-stage feature of chronic prepatellar bursitis, also known as housemaid's knee. The characteristic calcifications of the infrapatellar bursa (Panel A, anteroposterior view; Panel B, lateral view) are the result of a chronic bursitis. This disease affects people with continual mechanical strain and monotone movements of the patella. In this case, the patient had worked as a tiler for many years. Repeated, long-lasting stress leads to inflammation, with consecutive thickening of the bursal wall, eventually causing calcification. Prevention and treatment consist of avoiding unnecessary kneeling and, when kneeling cannot be avoided, using padding to cushion the knees. This patient received physiotherapy and analgesic medications as needed for pain. In follow-up at 1 year, he reported that the pain was much diminished.
Lars Kamper, M.D.
Patrick Haage, M.D.
Helios Clinic Wuppertal, D-42283 Wuppertal, Germany
