The knee bursitis is classified according to location, cause, and course:

1. **Prepatellar bursitis:** Inflammation of the bursa in front of the kneecap (common in kneeling activities).

2. **Infrapatellar bursitis:** Inflammation of the bursa below the kneecap, often due to overuse of the patellar tendon.

3. **Pes anserinus bursitis:** Inflammation of the bursa on the inner side of the knee joint, usually due to improper loading or osteoarthritis.

4. **Aseptic bursitis:** Non-infectious inflammation due to overuse or mechanical irritation.

5. **Septic bursitis:** Infectious inflammation caused by bacterial pathogens, accompanied by fever and severe pain.

6. **Traumatic bursitis:** Triggered by bruises, impacts, or chronic pressure on the knee.

The causes of bursitis in the knee are varied and include mechanical, inflammatory, and infectious factors:

• Mechanical irritation:
  • Repeated movements or constant kneeling, as in manual work (“housemaid's knee”).
  • Overloading of the knee joint through sports such as running or soccer.
• Traumatic injuries:
  • Falls or direct bruises to the knee.
• Inflammatory diseases:
  • Accompanying symptoms of rheumatism, gout, or osteoarthritis.
• Infections:
  • Penetration of bacteria through open wounds or injections into the bursa.
• Risk factors:
  • Overweight, which increases the load on the knee joint.
  • Misalignments such as bow legs or knock knees.

The symptoms vary depending on the location and cause of the bursitis, but typically include:

• Swelling: Visible and palpable swelling over the affected bursa.
• Pain: Local pain that is intensified by movement or pressure.
• Redness and warmth: Signs of acute inflammation, especially in septic bursitis.
• Movement limitations: Difficulty bending or straightening the knee.
• General symptoms: Fever and general malaise in infectious bursitis.

The diagnosis is made through medical history, clinical examination, and supportive procedures:

• Medical history:
  • Collection of the duration of the illness, possible triggers such as overuse or injuries, and pre-existing conditions.
• Physical examination:
  • Palpation of the knee joint to assess swelling, tenderness, and redness.
• Imaging:
  • Ultrasound: Visualization of fluid accumulations and bursitis.
  • MRI: Detailed assessment in chronic or complicated cases.
  • X-ray: To rule out bone injuries or osteoarthritis.
• Laboratory tests:
  • Blood tests to determine inflammation levels or infections.
  • Aspiration of the bursa to analyze the fluid if septic bursitis is suspected.

Conservative Therapy

Most bursitis in the knee can be treated without surgical intervention:

• Immobilization and Relief:
  • Avoiding stress and using knee pads or braces.
• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Antibiotics for septic bursitis.
• Physiotherapy:
  • Exercises to strengthen muscles and improve mobility.
  • Manual therapy to relieve the bursa.
• Local Applications:
  • Cold therapy for acute inflammation.
  • Heat applications for chronic complaints.
• Aspiration: Draining excess fluid from the bursa.

Surgical Therapy

In case of persistent complaints or complications, surgery may be necessary:

• Bursectomy: Surgical removal of the inflamed bursa in recurrent inflammations.
• Debridement: Cleaning of infected or necrotic tissue.
• Corrective Surgery: For underlying misalignments or osteoarthritis.

To prevent and alleviate symptoms of knee bursitis, the following measures are recommended:

1. Pressure relief: Use of pads or knee pads during kneeling activities.
2. Ergonomic load: Avoidance of unilateral or excessive strain on the knee.
3. Regular exercise: Promotion of flexibility and stability of the knee joint through targeted training.
4. Healthy lifestyle: Weight reduction to relieve the joints and treatment of underlying inflammatory conditions.
5. Early treatment: At the first signs of swelling or pain, a doctor should be consulted in a timely manner.