(Fig 4-D.01) Superficial Prepatellar Bursitis in Gout

https://youtu.be/d71gPr4f5Uc

 

https://youtu.be/YiEAI7pISIU

 

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📌  Anterior Knee Bursa/Recess

✅ Suprapatellar Recess

• Extends cranially from the knee joint, posterior to the quadriceps fat pad, and anterior to the prefemoral fat pad .
• Extends medially and laterally over the femoral condyles, communicating with the medial and lateral recesses beneath each retinaculum .

 

✅ Prepatellar Bursitis

• Caused by acute or repetitive injury, leading to fluid accumulation, synovitis, and bursal wall thickening. Commonly due to repetitive kneeling .
• Associated with infection, gout, sarcoid, CREST syndrome, and immunocompromise.
• MRI shows a circumscribed fluid collection anterior to the patella. May appear heterogeneous with hemorrhage or infection.
• Chronic cases result in significant bursal enlargement, wall thickening, and internal debris.
• Septic bursitis is often related to penetrating injury, indicated by a draining sinus tract or intrabursal gas.
• Intrabursal hemorrhage leads to complex fluid collections with variable signal intensity.

 

✅ Superficial Infrapatellar Bursa

• Located anterior and slightly superior to the tibial tuberosity.
• Uncommon site for bursitis, but can result from trauma or overuse, such as "clergyman’s knee" .
• Chronic inflammation may lead to communication with prepatellar or pretibial bursae.

 

✅ Deep Infrapatellar Bursa

• Wedge-shaped, synovium-lined structure in the anteroinferior knee, not communicating with the knee joint cavity .
• Bursitis characteristic of Osgood-Schlatter disease but can be caused by gout, sepsis, hemorrhage, and fat pad contracture .

 

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📌 Prepatellar Bursae

✅ Detailed Anatomy

• Prepatellar subcutaneous bursa: Between skin and superficial fascia.
• Prepatellar subfascial bursa: Between superficial fascia and intermediate aponeurotic fascial layer.
• Prepatellar subaponeurotic bursa: Between aponeurotic layer and deep fibrous layer.
• Prepatellar quadriceps continuation: Thickest layer, vertically oriented fibers from rectus femoris tendon adherent to patella.

 

✅ Imaging Findings

• Superficial bursal fluid: Focal, unilocular fluid arc over patella, patellar tendon, or tibial tubercle.
• Communication between bursae: Unilaminar, bilaminar, or trilaminar appearance when distended.
• Septa within fluid collection: Representing various prepatellar fibrous layers.

 

References

1. Magn Reson Imaging Clin N Am. 2014 Nov;22(4):601-20.
2. RadioGraphics 2018; 38:2069–2101.
3. Insights Imaging (2013) 4:257–272.
4. Clin Sports Med. 2014 Jul;33(3):413-36.
5. AJR 2009; 192:W111–W116 
6. AJR 2007; 188:W355–W358

 

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