Bursitis, Pes Anserine (Pes Anserine Syndrome)

Bursitis, Pes Anserine (Pes Anserine Syndrome) is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • The pes anserinus (“goosefoot”) is the combined insertion of the sartorius, gracilis, and semitendinosus tendons on the anteromedial tibia.
  • The pes anserine muscles help flex the knee and resist valgus stress.
  • The pes anserine bursa lies between the semitendinosus tendons and the tibial attachment of the medial collateral ligament.
  • Pes anserine syndrome is due to irritation of the bursa and/or tendons in this area.

Epidemiology

Incidence
Inflammation of the pes anserine bursa is detected in up to 2.5% of magnetic resonance imaging (MRI) studies of patients with knee pain. The overall incidence is likely higher.

Etiology and Pathophysiology

Pes anserine bursitis occurs due to:

  • Overuse injury
  • Excessive valgus and rotary stresses
  • Mechanical forces and degenerative changes
  • Direct trauma

Risk Factors

  • Obesity, age, female gender (common in middle age, overweight females)
  • Osteoarthritis, medial meniscal tears
  • Pes planus; genu valgum
  • Long distance running, hill running
  • Swimming (“breaststroker’s knee”); cycling
  • Sports with side-to-side/cutting activity (soccer, basketball, racquet sports)

Commonly Associated Conditions

  • Osteoarthritis (OA)
    • Increased incidence of pes bursitis in patients with severe OA (>90% association with OA in one study)
    • Higher grades of OA associated with a thicker pes anserine bursa and larger area of bursitis (1)[C]
  • Valgus knee deformity
  • Obesity, female gender
  • Diabetes mellitus (questionable association)

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Basics

Description

  • The pes anserinus (“goosefoot”) is the combined insertion of the sartorius, gracilis, and semitendinosus tendons on the anteromedial tibia.
  • The pes anserine muscles help flex the knee and resist valgus stress.
  • The pes anserine bursa lies between the semitendinosus tendons and the tibial attachment of the medial collateral ligament.
  • Pes anserine syndrome is due to irritation of the bursa and/or tendons in this area.

Epidemiology

Incidence
Inflammation of the pes anserine bursa is detected in up to 2.5% of magnetic resonance imaging (MRI) studies of patients with knee pain. The overall incidence is likely higher.

Etiology and Pathophysiology

Pes anserine bursitis occurs due to:

  • Overuse injury
  • Excessive valgus and rotary stresses
  • Mechanical forces and degenerative changes
  • Direct trauma

Risk Factors

  • Obesity, age, female gender (common in middle age, overweight females)
  • Osteoarthritis, medial meniscal tears
  • Pes planus; genu valgum
  • Long distance running, hill running
  • Swimming (“breaststroker’s knee”); cycling
  • Sports with side-to-side/cutting activity (soccer, basketball, racquet sports)

Commonly Associated Conditions

  • Osteoarthritis (OA)
    • Increased incidence of pes bursitis in patients with severe OA (>90% association with OA in one study)
    • Higher grades of OA associated with a thicker pes anserine bursa and larger area of bursitis (1)[C]
  • Valgus knee deformity
  • Obesity, female gender
  • Diabetes mellitus (questionable association)

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