Infrapatellar bursitis causes pain and swelling at the front of the knee, just below the kneecap.
Also known as Clergyman’s Knee, infrapatellar bursitis develops when there is irritation and inflammation of one of the small fluid-filled sacs in the knee.
This may be from overuse, spending lots of time on your knees, an injury or underlying knee condition.
With proper treatment, most cases of infrapatellar bursitis will settle within a few weeks. Clergyman's knee is the most common cause of swelling below the knee.
Here we look at the common causes, symptoms, diagnosis and treatment of infrapatellar bursitis as well as how long it takes to recover.
Bursa are small fluid-filled pockets or sacs filled that sit between bones, muscles and tendons. They provide cushioning and lubrication allowing the soft tissues to slide smoothly over each other or over bone without any friction.
There are a number of different bursa around the knee. The infrapatellar bursa is found just below the kneecap and sits around the patellar tendon, the large tendon that connects the quadriceps muscles to the lower leg.
The infrapatellar bursa is actually made up of two sacs:
Superficial Infrapatellar Bursa – sits in front of the patellar tendon, between the tendon and the overlying skin
Deep Infrapatellar Bursa – Sits underneath the patellar tendon, between the tendon and the shin bone (tibia)
For all intents and purposes, the superficial and deep infrapatellar bursae are treated as one.
The infrapatellar bursa protects the patellar tendon as you bend and straighten the knee, allowing it to glide smoothly and freely over the tibia as you move.
Irritation, pressure or friction on the bursa cause it to produce excess fluid as a protective mechanism to prevent damage, resulting in bursitis. The bursa gradually swells and if left untreated, may thicken and harden. In extreme situations, calcifications may appear in the bursa.
Common causes of infrapatellar bursitis include:
Infrapatellar bursitis symptoms usually come on gradually over a few weeks or months and consist of:
To diagnose infrapatellar bursitis your doctor will start by asking you about your symptoms, such as how the pain started and what aggravates it. They will then examine your knee and perform various tests to look at the integrity of the different knee structures.
They may send you for an x-ray to rule out an underlying bone spur or bony injury. If they suspect soft tissue damage then they will send you for an MRI scan.
If they suspect septic bursitis, your doctor will remove some fluid from the bursa with a needle and have it tested for infection.
There are a number of treatment options for infrapatellar bursitis:
One of the big aims with infrapatellar bursitis is to reduce the fluid in the bursa which can leak out into the knee. There are lots of different options when it comes to knee swelling treatment that can help.
Infrapatellar bursitis can last for anything from a couple of weeks to a few months. If you follow the recommended treatment above, particularly resting from aggravating activities, then symptoms of clergyman’s knee should settle within a few weeks. Generally, the sooner you start treatment, the quicker you will recover.
If infrapatellar bursitis has developed secondary to other knee problems, such as patellar tendon inflammation (Jumpers Knee) or Osgood Schlatters Disease, then it may take 3-6 months for things to fully settle down.
There are a number of other conditions that cause front knee pain and pain below the knee with similar symptoms to infrapatellar bursitis. If there is no swelling at the front of the knee, it might be something else is going on such as:
Page Last Updated: 03/06/23
Next Review Due: 03/06/25
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2. Study.com - Deep & Superficial Infrapatellar Bursitis: Symptoms & Treatment. By Dr A. Monroe
3. BMJ Best Practice - Bursitis. By Dr N. Maffulli, Dr U. Longo, Dr V Denaro et al. August 2019