What is the pathophysiology of pes anserine bursitis?

Updated: May 08, 2018
  • Author: P Mark Glencross, MD, MPH, FACOEM, FAAPMR; Chief Editor: Milton J Klein, DO, MBA  more...
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Pes anserine bursitis was initially described in the 1930s as an inflammation of the pes anserinus bursa underlying the conjoined tendons of the gracilis and semitendinosus muscles and separating them from the head of the tibia. [4] It was defined on the basis of observations of this type of bursitis in older adults with arthritis.

The sartorius, gracilis, and semitendinosus muscles are primary flexors of the knee. These 3 muscles also influence internal rotation of the tibia and protect the knee against rotary and valgus stress. Theoretically, bursitis results from stress to this area (such as may result when an obese individual with anatomic deformity from arthritis ascends or descends stairs).

Pathologic studies do not indicate whether symptoms are attributable predominantly to true bursitis, to tendinitis, or to fasciitis at this site. [5] Panniculitis at this location has been described in obese individuals. However, controversy remains regarding the true pathophysiology of the clinical syndrome of pes anserine bursitis/tendinitis, because in many cases where the disorder’s presence is clearly suggested, imaging studies (ultrasonography) fail to demonstrate pathologic findings in the pes anserinus bursa or tendon.

One case of gouty bursitis in the pes anserinus bursa has been described in a patient with known gout, elevated uric acid levels, periarticular MRI findings of pes anserine bursitis, and negative birefringent crystals on ultrasound-guided aspiration of the bursa. However, no contrast study was performed to fully exclude a communication with the articular space. [6]

One case of snapping pes anserine tendons was described associated with bursitis. [7]

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