The pes anserinus ('goose foot') is the conjoined insertion of the sartorius, gracilis, and semitendinosus tendons onto the anteromedial tibia 5-6 cm below the medial joint line. Sartorius is most anterior and superior, gracilis lies central, and semitendinosus is most posterior and inferior. The pes anserinus bursa lies between the tendons and the medial collateral ligament superficially.
Pes anserinus bursitis and tendinopathy produce medial knee pain 5 cm below the joint line, reproduced by resisted knee flexion and internal tibial rotation with the knee at 90 degrees. It is common in obese patients, those with knee osteoarthritis, and swimmers (breaststroke kick). Ultrasound distinguishes bursitis (fluid-filled bursa between tendons and MCL) from tendinopathy (intratendinous change). Harvesting gracilis and semitendinosus for ACL reconstruction is performed within this complex.
Bursal inflammation between the pes tendons and the MCL producing medial tibial pain with stairs and turning, common in osteoarthritic knees, treated with ultrasound-guided steroid injection.
Rare avulsion of the conjoined pes anserinus from the tibial insertion in high-energy valgus or rotational injuries, producing medial knee instability requiring surgical reattachment.
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