Marc Darrow, MD, JD.
As with any bursitis or conditions that are thought to be caused by run away inflammation, pes anserine bursitis treatment typically follows the rest and anti-inflammatory remedies including ice, NSAIDs use. Avoidance of activities like stair climbing, that can worsen the condition are also generally recommended. Physical therapy is often prescribed to strengthen the muscles around the knee to help resume these activities.
While many times these remedies will help people, many times these treatments fail. As this problems tends to be found in women who are considered overweight and middle-aged, the problems in this group is usually seen in conjunction with knee osteoarthritis. For others, such as athletes or people with a physically demanding line of work, Pes anserine bursitis or tendinopathy can come on from overuse.
The MRI’s wrong diagnosis
A November 2022 case history (1) tells of a 57-year-old woman who was initially misdiagnosed for her knee pain because her GP did not perform a physical examination and instead sent her to an MRI. The MRI showed mild knee osteoarthritic changes which may have contributed to her ongoing symptoms; however, there was no obvious finding for the woman’s extreme knee pain. Eight weeks after her GP visist, the woman went to an emergency room for her knee pain. On examination she was diagnosed clinically with pes anserinus bursitis and prescribed physical therapy.
In this case the authors focused on the overreliance of MRI and imaging: “Pes anserinus bursitis is frequently misdiagnosed and often not considered a differential diagnosis for a painful knee. This case has highlighted the importance of performing a thorough history and clinical examination when considering the challenge of diagnosing musculoskeletal knee pain, particularly in primary care. This case has also demonstrated the dangers of overreliance on imaging modalities. In particular, referring patients for imaging too early may lead to a loss of patient confidence and worse patient outcomes, as some musculoskeletal problems do not improve with time alone. ”
Corticosteroids, oxygen-ozone (O2-O3), and dextrose Prolotherapy
There are many different types of treatments offered for the more stubborn bursitis. A September 2023 study (2) evaluated the effectiveness of local injection-based therapies of corticosteroids, oxygen-ozone (O2-O3), and dextrose Prolotherapy 20% solution for Pes anserine bursitis. Using standard pain and disability patient-reported questionnaires, patients were followed one and eight weeks after treatment. Each of the three groups had 24 patients.
The researchers found “All three treatment options are effective for patients with Pes anserine bursitis. This study showed that the effects of O2-O3 injection and prolotherapy last longer than those of corticosteroid injection.”
Platelet-rich plasma injections
A June 2021 study (3) demonstrated good success with ultrasound guided leukocyte-rich platelet-rich plasma injections in sixty patients with pes anserinus tendinobursitis. In this paper, the 60 patients were split into two groups, one group receiving one leukocyte-rich platelet-rich plasma injection, the other group receiving two leukocyte-rich platelet-rich plasma injections a week apart.
When all patients were evaluated with Likert scale (patient outcome survey) twelve weeks after treatments, the patients reported:
- complete healing in 22 (36.7 %) patients,
- significant relief in 25 (41.7 %) patients,
- mild relief in 4 (6.7 %) patients,
- 5 (8.3 %) same as before treatment patients,
- and worsened pain in 4 (6.7 %) patients were seen.
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References
1 Allen MF, Allen DE. Pes Anserinus Bursitis: A Case Report. Cureus. 2022 Nov 11;14(11).
2 Babaei-Ghazani A, Eftekharsadat B, Soleymanzadeh H, ZoghAli M. Ultrasound Guided Pes Anserine Bursitis Injection Choices; Prolotherapy or Oxygen-Ozone or Corticosteroid: A Randomized Multicenter Clinical Trial. American Journal of Physical Medicine & Rehabilitation. 2023 Sep 27:10-97.
3 Karabaş Ç, Çaliş HT, Topaloğlu US, Karakükçü Ç. Effects of ultrasound guided leukocyte-rich platelet-rich plasma (LR-PRP) injection in patients with pes anserinus tendinobursitis. Transfusion and Apheresis Science. 2021 Jun 1;60(3):103048.