Last Updated on Wednesday, 03 February 2016 16:48
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I hit my right knee hard into the boards when I was checked. Over the past week, I have developed swelling, like a baseball, over the front of one of my knees. I’ve been told that it is a bursitis -what should I do about it? Should I get an MRI?
Answer: The symptoms that you are experiencing and the mechanism of your injury do fit the diagnosis of prepatellar bursitis – an inflammation of the large prepatellar bursa in the front of the knee.
A bursa is a sac that is filled with synovial fluid (similar to the fluid in your joints) that allows frictionless gliding of soft tissues over bones. The prepatellar bursa is over your kneecap (the patella) and it normally allows the skin to glide over your kneecap when your knee in bent or straightened. Bursitis is an inflammation of the sac that can cause pain and marked swelling due to increased production of fluid. Bursitis can be caused by inflammatory conditions, but is most often due to either a chronic or an acute insult to the sac lining. In your case, it sounds like the hit to the front of your knee acutely injured the prepatellar bursa to cause the inflammation and swelling you are experiencing.
Traumatic prepatellar bursitis is fairly common in ice hockey players. It is usually caused by dropping down to one’s knee and taking a slapshot to a relatively unprotected knee or falling on the front part of a bent (flexed) knee. The prominent swelling that can develop on the front of the knee is not actually inside the knee, so an MRI would not be indicated.
The main treatment for a prepatellar bursitis is a well fitted compression wrap or sleeve over the kneecap to place constant pressure over the bursa. This pressure may be painful when first applied, but should quickly become tolerable. I have commonly supplemented this wrap with a piece of foam to further apply pressure over the bursa. The main goal of this wrap is to decrease the size of the bursal sack and decrease a re-accumulation of fluid. Other concurrent treatments for prepatellar bursitis include ice and over- the-counter anti-inflammatory medications. In rare occasions, a knee immobilizer may be used for a limited time to prevent further swelling of the bursa. Once an athlete has normal strength and knee motion, return to play is allowed. The athlete should keep a protective pad and compression bandage over the knee to prevent further blows and repeated swelling.
If there are any small lacerations or abrasions around the front of the knee, any redness or warmth of the skin in this area, or if you develop a fever, your knee should be evaluated by a physician to verify an infection is not present. In general, we do not drain a prepatellar bursa that is swollen because fluid will often continue to leak out of the needle drainage site after the aspiration has been completed and increase the risk for infection.
To summarize, the most effective treatment for prepatellar bursitis is a well fitted compression wrap, ice, and anti-inflammatory medications if needed. Once an athlete has full motion and strength of their knee, a return to play is allowed with a compression wrap and protective pad over the knee. If this treatment does not prove effective, further medical evaluation should be sought.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
