Constant friction on the front of the knee irritates a small lubricating sac (bursa) located just in front of the kneecap (patella). The bursa enables the kneecap to move smoothly under the skin. If the bursa becomes inflamed, it fills with fluid and causes swelling at the top of the knee. This condition is called prepatellar bursitis.
Who is at risk:
Symptoms of kneecap bursitis include:
Your doctor may first recommend an x-ray to rule out the possibility of a fracture. Conservative treatment is usually effective as long as the bursa is simply inflamed and not infected.
If the swelling is significant, your doctor may decide to drain (aspirate) the bursa with a needle. Chronic swelling may also be treated by draining the bursa. If the swelling continues, your doctor may recommend surgical removal of the bursa. This operation is an outpatient procedure. It takes a few days for the knee to regain its flexibility and some weeks before normal activities can be resumed.
You can help prevent bursitis by following these simple recommendations:
The simplest way to avoid another episode of bursitis is to avoid the activity that caused it. Of course, this may be impossible for the serious athlete. For these people, quality kneepads should be used during activity, and frequent breaks from the causative activity should become routine. It's also wise to reduce or stop the activity at first sign of pain and to ice the knee following each training session or game.
The key to improving sports performance after a diagnosis of bursitis of the kneecap is proper a rehabilitation program, and adhering to some of those same principles after the injury is gone.
Continue to perform the exercises in the rehabilitation section to strengthen the leg muscles around the knee, and also refer to the prevention section for important information on how to keep you in the game and perform to your fullest potential.
Remember that the single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.
Benefits derived from stretching include:
Although rest, nonsteroidal anti-inflammatory drugs, and avoiding the activity that caused the injury are the main steps for rehabilitating your bursitis, the following exercises, which place no extreme mechanical or weight-bearing stress on the knee, patellar tendon, or kneecap and use full range of knee motion, can be very effective during rehabilitation:
During rehabilitation from prepatellar bursitis, you'll need to maintain strength of the thigh muscles. Here's an exercise that does not put undue stress upon the knee:
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your bursitis recovers, not by how many days or weeks it has been since your injury occurred.
Generally, full use of the affected knee should be delayed until all symptoms subside. In the interim, activities that place no pressure on the knees, such as swimming or cycling, can maintain cardiovascular fitness. Unfortunately, prepatellar bursitis caused by infection may result in prolonged absence from activity, although sometimes, when the most effective antibiotic is applied against bacterial infection, exactly the opposite could occur.,/
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:
Symptoms may disappear within 10 days or persist for more than two weeks and recur from time to time. The most rapid recovery is expected when the condition is due to a single blow to the area that is localized to the front of the knee.
Prepatellar bursitis caused by overuse often resolves after two weeks if you refrain from the activity that caused the problem. If the bursitis is caused by an infection, recovery may take several weeks, depending on the effectiveness of the drug treatment.