The deep infrapatellar bursa lies between the posterior patellar ligament surface and the anterior tibial cortex, protected from the surface by the Hoffa fat pad. It is distinct from the superficial infrapatellar bursa (clergyman's knee) which lies between the ligament and the overlying skin. Deep infrapatellar bursitis produces infrapatellar pain that can be confused with patellar tendinopathy and is diagnosed on MRI or ultrasound.
| Location | Between the patellar ligament and the anterior tibial cortex, above the tibial tuberosity |
|---|---|
| Nearby |
|
Reduces friction between the patellar ligament and the anterior tibial surface during knee flexion and extension
The deep infrapatellar bursa can become inflamed from repetitive kneeling with the knee in a more extended position than the superficial bursa requires, producing infrapatellar pain and fullness reproduced by resisted knee extension and by direct deep palpation beside the distal patellar ligament. It is visualised on sagittal knee MRI as a fluid-filled space deep to the distal patellar tendon. It must be distinguished from patellar tendinopathy and Hoffa fat pad impingement. Ultrasound-guided injection targets the bursa specifically, and chronic cases may need endoscopic bursectomy.
Inflammation between the patellar ligament and tibial cortex producing deep infrapatellar pain managed with relative rest and targeted ultrasound-guided injection.
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