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Author: Garry Ho, MD, FAMSSM, FAC Affiliation: OrthoVirginia Co Author(s): None Senior Editor: Carlton Covey, MD, MEd
Clinical Vignette: 48 year-old previously-sedentary male presents with 3 weeks of right anteromedial knee pain with running. On examination of his right knee, there is full ROM, normal ligamentous exam, no joint line tenderness, but positive tenderness to palpation over pes anserine.
Image Interpretation: A small anechoic fluid collection was seen deep to the sartorius tendon and superficial to the MCL, consistent with pes anserine bursitis.
Teaching Pearl: The sartorius, gracilis and semitendinosus tendons insert roughly 5 cm distal to the medial knee joint line forming the pes anserine. These are primary knee flexors and play a secondary role in tibial internal rotation with a resultant protective effect against rotation and valgus stress. Pes anserine pain syndrome is frequently associated with knee osteoarthritis, obesity, and angular deformity of the knee (varus or valgus alignment). Tendinopathy or bursopathy can also occur with activities involving repetitive knee flexion however true bursitis is relatively uncommon. Sports ultrasound provides valuable information to distinguish pes anserine bursitis from other causes of medial knee pain, and allows for precise needle placement for interventional procedures.
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