Introduction
Pes anserine bursitis or breaststroke knee is an inflammatory condition of medial knee at pes anserine bursa.
Aetiology
- More common in overweight middle-age females.
- Common in swimmers
Pathoanatomy
Pes anserinus “goose-foot”:
Conjoined tendons of three muscles that insert onto the anteromedial (front and inside) surface of the proximal tibia.
- Pes-anserine tendons: Tendons of Sartorius, Gracilis & semitendinosus
- Innervation:
- Sartorius: Femoral n.
- Gracilis: Obturator n.
- Semitendinosus: Tibial branch of Sciatic n.
Anserine bursa (tibial intertendinous bursa):
Submuscular bursa located deep to the pes anserinus on the anteromedial proximal tibia.
Clinical features
Pain:
Particular with rising from a seated position, going upstairs, or sitting with their legs crossed (semitendinosus, gracilis, and sartorius function in unison in the act of crossing one leg over the other; thus, this motion typically will elicit the pain seen in pes anserine bursitis)
Tenderness & localized swelling below joint line at the medial aspect of knee
Diagnosis
Differential diagnosis
Knee bursitis:
- Subpatellar
- Prepatellar (M/C)
- Infrapatellar
- Pes Anserine
Management
- Physiotherapy
- Pain management
- Local injection