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, can be seen in those whose occupations require a kneeling posture , such as carpet layers and housemaids .
acute trauma , such as a fall directly onto the patella , may cause patellar bursitis .
the other causes of prepatellar bursitis include infection or low - grade inflammatory conditions , such as gout , syphilis , tuberculosis , or rheumatoid arthritis .
treatment for prepatellar bursitis is determined primarily by the cause of bursitis and secondarily by the pathological change in the bursa .
surgery is not required in most instances ; but , if needed , the surgical procedures involved are ( 1 ) aspiration and irrigation with an appropriate drug , ( 2 ) incision and drainage in cases of acute suppurative bursitis [ 11 , 12 ] , and ( 3 ) excision of chronically infected and thickened bursa [ 3 , 79 , 1116 ] . for the last category of patients , we usually make a transverse incision at the anterior knee region under regional or general anaesthesia , which entails admission to hospital and leaves poor cosmetic results .
, we propose an out - patient arthroscopic method under local anaesthesia aiming at a better cosmetic appearance and cost savings for the treatment of chronic prepatellar bursitis .
we presume that the results of the endoscopic approach would be better than those obtained with the conventional technique .
from september 1996 to february 2001 , 60 patients ( 31 male and 29 female ) with prepatellar bursitis who had failed to respond to non - operative treatments were included in this prospective study .
patients who presented with acute suppurative infection , systemic diseases ( such as rheumatoid arthritis , gout , tuberculosis , diabetic mellitus , bleeding tendencies , etc . ) , alcoholism , or steroid therapy were excluded from our series . only those who had repeated minor injuries or an apparent trauma of the ipsilateral knee were included .
the average age was 33.5    11.1  years ( range 2155 ) .
twenty - seven patients ( 45% ) had a history of repeated minor knee injuries without apparent underlying cause .
there were housewives , farmers , construction workers , fishermen , electronic technicians , athletes , engineers , and teachers .
the repeated minor injuries were due to occupations or lifestyles in which they were frequently required to kneel .
the mechanisms were motorcycle accidents and histories of falling down while running in the office , during matches , or while jogging , and after a contusion caused by contact with a hard object .
all these patients had histories of undergoing aspiration of fluid or injection of steroid into prepatellar bursa cavities at our hospital or the other clinics .
radiographic examination included plain films of an anteroposterior and a lateral view of the knee .
mri ( magnetic resonance image ) or ct ( computerised tomography ) was not used routinely .
if the culture was positive for bacterial growth , the patients were excluded from the study .
the skin was prepared in an aseptic manner over the whole lower extremity . a 1% xylocaine with a 1:100,000 epinephrine solution
two or three 2  mm portals were made ( fig .  1 ) .
an anterior medial portal and an anterior lateral portal were routinely used ; and , if necessary , a superior lateral portal was also made . a no .
the bursa cavity and synovial thickening were directly visualised by endoscopy . the motorised shaver was inserted through the other portal , and total synovectomy ( including the bursa ) was performed until all the pathological lesions were removed ( fig .  2 ) .
after all the procedures were completed , the portals were closed with adhesive tape without any suture .
the anterior knee area was dressed with loosely unfolded gauze and padding and bandage applied . 

2adhesive tape is usually enough to close the wounds the wounds were minimal as compared to a no .
15 scalpel adhesive tape is usually enough to close the wounds no hospitalisation was needed .
nonsteroidal anti - inflammatory drugs ( nsaid ) were given and ice packing was applied for the first 48 hours .
we evaluated the patients by recording swelling , pain , activities , and range of motion of their knee every month .
radiographic and sonographic examinations were made at the first and third months and every three  months after operation .
the skin was prepared in an aseptic manner over the whole lower extremity . a 1% xylocaine with a 1:100,000 epinephrine solution
two or three 2  mm portals were made ( fig .  1 ) .
an anterior medial portal and an anterior lateral portal were routinely used ; and , if necessary , a superior lateral portal was also made .
the bursa cavity and synovial thickening were directly visualised by endoscopy . the motorised shaver was inserted through the other portal , and total synovectomy ( including the bursa ) was performed until all the pathological lesions were removed ( fig .  2 ) .
after all the procedures were completed , the portals were closed with adhesive tape without any suture .
the anterior knee area was dressed with loosely unfolded gauze and padding and bandage applied . 

2adhesive tape is usually enough to close the wounds the wounds were minimal as compared to a no .
nonsteroidal anti - inflammatory drugs ( nsaid ) were given and ice packing was applied for the first 48 hours .
we evaluated the patients by recording swelling , pain , activities , and range of motion of their knee every month .
radiographic and sonographic examinations were made at the first and third months and every three  months after operation .
the average time for follow - up was 45.3    14.9  months ( range 2987 ) .
preoperatively , our patients received a local steroid injection an average of 3.2    2.3 times ( range 18 ) and underwent aspiration an average of 4.1    2.9 times ( range 112 ) .
two portals were made for only 24 ( 40% ) patients and three portals for the other 36 ( 60% ) .
all cases had endoscopic findings of synovial thickening and local inflammatory vascular patches throughout the cavity ( both anterior and posterior wall ) ( fig .  3 ) .
after arthroscopic surgery , mild pain was present in 12 ( 20% ) , cases but could be controlled easily with oral analgesics . in our follow - up , 80% of the patients were completely pain - free .
no limitation of their activities was noted . no tenderness or hypoethesia of the surgical scar was noted .
only three patients needed repeated aspiration on the fifth to tenth days after operation due to vigorous ambulation and activities against our advice .
no more recurrent swelling was found . in the final radiographic examination , no heterotopic bone formation or patella infera
the sonographic examination showed no recurrence of accumulated fluid in any of the 60 cases .
the procedures were precise and the risk of skin damage can be minimised the hypervascularised synovium can be identified and removed under endoscopic monitoring .
prepatellar bursitis may be induced by many things , e.g. infections , tophi , rheumatoid arthritis , tuberculosis , trauma , minor injuries , or even in polio cases [ 19 , 17 ] .
this includes initial aspiration , applying compressive dressings , such as an ace bandage , and administering nonsteroidal anti - inflammatory agents for ten to 14  days .
due to the fact that repeated bursal aspiration is generally of little value , surgical excision is indicated for stubborn cases .
the literature reveals that the most common complication of surgical treatment is wound problems [ 3 , 1115 , 19 , 20 ] .
poor healing of the incision , local tenderness , or decreased sensation of scar are not rare [ 2 , 17 ] .
quayle and robinson   described excision of only the posterior half of the prepatellar bursa , which is supposed to help in preventing damage to the overlying skin .
endoscopic examination of extra - articular cavities , clefts , and recesses is routinely performed today [ 3 , 1116 , 1923 ] .
witonski   suggested an arthroscopic resection of prepatellar bursitis of traumatic origin with good cosmetic results and economic advantages ( reduced costs , time - saving and shortened hospital stays ) .
kerr et al .   reported that arthroscopic bursectomy could prevent wound problems [ 1116 ] ; however , their patients needed hospitalisation and general anaesthesia . in our series , we treated patients on an outpatient basis .
if tension is present after operation , a simple suture can be applied without difficulty .
the operation time is short ( average time 18 minutes ) . in terms of reducing medical costs ,
our results showed these endoscopic procedures caused no infection , no limitation of range of motion , no need for lifestyle change and no skin problems .
however , we did not include infectious bursitis and systemic diseases accompanied by bursitis in our series .
gomez - rodriguez et al .   stated that 95% of septic bursitis could be treated well without open surgical drainage .
pien et al .   described 47 episodes of septic bursitis in a private community medical practice , and the majority of patients were able to be treated as outpatients with oral antibiotics .
on the contrary , knight et al .   suggested treatment of septic olecranon and prepatellar bursitis with percutaneous placement of a suction - irrigation system with subsequent antibiotic treatment for 19  days .
the role of endoscopic surgery in treatment for septic prepatellar bursitis is still unclear , and further investigation is required .
for the treatment of stubborn post - traumatic prepatellar bursitis , outpatient endoscopic bursectomy under local anaesthesia is a time - saving and cost - effective procedure .
operative treatment of prepatellar bursitis is indicated in intractable bursitis . 
 the most common complication of surgical treatment for prepatellar bursitis is skin problems . for traumatic prepatellar bursitis 
 , we propose a protocol of outpatient endoscopic surgery under local anaesthesia . from september 1996 to february 2001 , 
 60 cases of failed nonoperative treatment for prepatellar bursitis were included . 
 the average age was 33.5    11.1  years ( range 2155 ) . 
 the average operation duration was 18 minutes . 
 two to three mini - arthroscopic portals were used in our series . 
 no sutures or a simple suture was needed for the portals after operation . 
 after follow - up for an average of 36.3  months , all patients are were symptom - free and had regained knee function . 
 none of the population had local tenderness or hypo - aesthesia around their wound . 
 their radiographic and sonographic examinations showed no recurrence of bursitis . 
 outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post - traumatic prepatellar bursitis after failed conservative treatments . 
 both the cosmetic results and functional results were satisfactory .