Paper
Pay Attention to the Pes Anserine in Knee Osteoarthritis.
Published Feb 1, 2018 · Glenn Sapp, D. Herman
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Abstract
Introduction Pes anserine syndrome is a clinical diagnosis with the predominant finding of tenderness over the proximal anteromedial tibia approximately 2 to 3 inches below the knee. The anatomical source of clinical symptoms has not consistently been identified, but may include either the pes anserine itself (comprised of the sartorius, gracilis, and semitendinosus muscle tendons) and/or the associated pes anserine bursa. There is an association between pes anserine syndrome and knee osteoarthritis, with 20% to 46% of patients with symptomatic knee arthritis also having pes anserine syndrome (1,2). Steroid injections at this site may be more efficacious than oral nonsteroidal anti-inflammatory drugs (NSAIDs) for pain control (1). Pearl Patients who may particularly benefit from a steroid injection are those with findings on ultrasound imaging consistent with pes anserine syndrome (3). However, not all symptomatic patients who may benefit from such an injection will have identifiable tendinopathy or bursitis. When considering the use of intra-articular corticosteroid injection to the knee in patients with both conditions, we stress the importance of also performing a corticosteroid injection at the anserine bursa because pain at this site may limit functional progression just as much as intra-articular pain. Pearl In cases where both conditions are present but only an intra-articular injection was performed, we have noted that patients will often return to clinic stating that "the intra-articular injection did not work" and that they are limited in participation of their physical therapy by their continued pain. However, on examination the patient will typically lack joint line tenderness while continuing to experience pain at the pes anserine. Thus, in our clinical experience, addressing any concomitant pes anserine syndrome with an additional injection at this site greatly assists with our patients' pain and allows them to fully participate in physical therapy without interruption.
Addressing pes anserine syndrome with steroid injections at the anserine bursa greatly aids in pain control and allows patients to fully participate in physical therapy without interruption.
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