Pes Anserine Bursitis

Excerpt

The term "pes anserinus" translates to “goose's foot” in Latin and refers to the conjoined tendons of the sartorius, gracilis, and semitendinosus as they insert on the anteromedial proximal tibia (see Image. Pes Anserinus Tendons). The pes anserine tendons, each innervated by a distinct nerve, create a structure about 5 cm distal to the medial knee joint line. As crucial knee flexors, these muscles also aid in tibial internal rotation and provide resistance against rotational and valgus stresses.

Located underneath the conjoined tendons is the pes anserinus bursa (see Image. Medial View of the Knee). This synovial tissue-lined structure facilitates smooth movement between the conjoined tendons and tibia. The bursa occasionally cushions between the conjoined tendons and medial collateral ligament (MCL). Bursal inflammation and pain can occur following an injury due to increased synovial fluid production by the bursal cells.

Adjacent to the pes anserinus bursa is the musculi sartorii bursa. This fibrous structure is situated between the sartorius tendon and the combined gracilis and semitendinosus tendons. The smaller musculi sartorii bursa may communicate with the pes anserine bursa, and both are commonly referred to collectively as the pes anserine bursa. These bursae do not typically communicate with the knee joint, highlighting their unique anatomical and functional significance in knee movement and pathology.

Pes anserine bursitis involves the inflammation of the bursal sac beneath the pes anserinus. The condition predominantly affects women who are overweight and middle-aged. Pes anserinus bursitis is characterized by pain at the pes anserine insertion, typically triggered by activities such as stair climbing or rising from a seated position.

Pes anserine bursitis is often associated with other knee disorders, especially osteoarthritis. The condition presents as non-traumatic, spontaneous inferomedial knee pain. Pes anserine bursitis is generally self-limiting, usually responding effectively to conservative treatment methods like exercise and stretching programs. The term "pes anserine pain syndrome" encompasses a broader spectrum of medial knee pain, potentially including conditions beyond bursal inflammation. Differentiating between pes anserine bursitis and tendinitis can be challenging, as both the tendons and bursa lie close to each other. However, management for both conditions is the same.

Moschcowitz was the first to describe pes anserine bursitis in 1937 as a condition notable for knee pain, primarily in females, elicited by climbing stairs and rising from a seated position. Difficulty with knee flexion was also observed.