orthopedic surgery app

ORTHOFIXAR | Orthopedic Surgery Learning App

orthopedic surgery app android orthopedic surgery app ios
Infrapatellar Bursa Injection Easy Explain | OrthoFixar 2024

Hello Surgeon

X

How can we help you today?

Procedure

Infrapatellar Bursa Injection

Content List

Infrapatellar bursa injection is used in case of acute or chronic bursitis as a second line of treatment if conservative treatments have failed.

Acute or chronic bursitis is caused by overuse, prolonged running or kneeling; trauma or a direct blow to the infrapatellar bursa. It’s characterized by Anterior knee pain distal to the lower pole of the patella; painful resisted extension of knee, full passive flexion of knee, tenderness mid-tendon.

Equipment Neede

  1. Syringe: 2 ml
  2. Needle: Blue, 23 gauge / 1.25 inches (30 mm)
  3. Kenalog 40: 20 mg
  4. Lidocaine: 1.5 ml, 2%
  5. Total volume: 2 ml

Related Anatomy

There exist two infrapatellar bursae, with one situated superficially and the other deeply to the tendon. According to a limited study, it was discovered that the deep bursa consistently positioned itself at the posterior aspect of the tendon’s distal third and was slightly broader. A fat pad apron is present, which extends from the retropatellar fat pad, segregating the bursa partially. The technique delineated is for the deep bursa, which is more frequently affected.

See Also: Knee Ligaments Anatomy
Infrapatellar Bursa Injection

Infrapatellar Bursa Injection Technique

To begin, the patient should sit with their leg extended and knee supported. Next, locate the tender area at the midpoint of the tendon and mark it. Then, insert the needle horizontally at the lateral edge of the tendon, just above the tibial tubercle. It’s important to ensure that the needle enters deep to the posterior surface of the tendon and that there is no resistance to fluid flow. Finally, deposit the solution as a bolus.

Infrapatellar Bursa Injection Technique
Infrapatellar Bursa Injection Technique

To prevent further discomfort, it is recommended to limit the use of the knee until the pain subsides. In some cases, corrective measures such as adjusting footwear, modifying running style, and performing exercises to strengthen the quadriceps and hamstring muscles may be required. For individuals in occupations such as carpet laying that may contribute to the issue, a pad with a hole to relieve pressure on the affected bursa may be employed.

Infrapatellar Bursa Injection can be done using Ultrasonographic.

Ultrasound guided infrapatellar injection
Ultrasound guided infrapatellar injection (Ultrasonographic finding (long axis image) deep infrapatellar bursa injection)
See Also: ITB Friction Syndrome

Notes

It is tempting to believe that pain found at the midpoint of the patellar tendon is caused by tendinitis, but in our experience, this is extremely rare at this site. Infrapatellar tendinitis is found consistently at the proximal teno-osseous junction on the patella or, rarely, at insertion into the tibial tubercle. Pain here in an active adolescent should be considered to be Osgood-Schlatter’s disease and should not be injected because of its proximity to the growing end plate; taping and rest may relieve the symptoms.

For the superficial infrapatellar bursa and the prepatellar bursa, palpate for the center of the tender area and, using the same equipment, inject just deep to the skin and superior to the bone. Free flow of the fluid confirms the correct placement within the structure. Consider using hydrocortisone for thin, dark-skinned individuals to avoid skin depigmentation or fat atrophy.

References & More

  1. Injection Techniques in Musculoskeletal Medicine. A Practical Manual for Clinicians In Primary And Secondary Care. Fifth Edition
  2. Reichmister J. Injection of the deep infrapatellar bursa for Osgood-Schlatter’s disease. Clin Proc Child Hosp Dist Columbia. 1969 Jan;25(1):21-4. PMID: 5271370.
  3. Rishor-Olney CR, Pozun A. Prepatellar Bursitis. [Updated 2022 Sep 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557508/
  4. Nakase, Junsuke & Oshima, Takeshi & Takata, Yasushi & Shimozaki, Kengo & Asai, Kazuki & Tsuchiya, Hiroyuki. (2020). No superiority of dextrose injections over placebo injections for Osgood–Schlatter disease: a prospective randomized double-blind study. Archives of Orthopaedic and Trauma Surgery. 140. 10.1007/s00402-019-03297-2.
Angle Meter App for Android & iOS
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Orthopedic FRCS VIVAs Quiz
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
Top 12 Best Free Orthopedic Apps
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase
All-in-one Orthopedic App
  • Lifetime product updates
  • Install on one device
  • Lifetime product support
One-Click Purchase