Prepatellar bursitis is inflammation of the fluid-filled sac (bursa) that sits between your skin and kneecap. It presents as a visible squishy swelling on the front of the knee, sometimes with pain, warmth, or redness.
Common causes
- Prolonged kneeling — flooring installers, plumbers, gardeners, and religious devotion have all been described causes
- Direct trauma to the front of the knee (fall, sports impact)
- Repetitive minor trauma
- Infection (septic bursitis) — a serious concern needing prompt care
- Rheumatologic conditions (gout, rheumatoid arthritis)
Two important types
Aseptic (non-infected)
Most cases. Painless or mildly painful swelling, no warmth or systemic symptoms. Responds to conservative care.
Septic (infected)
Painful, warm, red, sometimes with fever or malaise. Needs prompt medical attention — antibiotics and sometimes drainage. Don't attempt to manage this yourself.
Red flags — see a physician urgently
- Marked warmth or redness
- Severe pain
- Fever, chills, or feeling unwell
- Recent break in the skin over the knee
- Rapid enlargement
Conservative treatment for aseptic bursitis
Activity modification — eliminate kneeling, use knee pads when needed.
Compression — a snug knee sleeve or wrap.
Ice during acute flares.
Manual therapy — soft tissue work around the knee, joint mobilization for surrounding structures.
Ergonomic changes — for occupations that involve kneeling, using proper knee protection is essential.
What NOT to do
Attempting to drain a bursa yourself. Injecting anything without proper sterile technique. Continuing to kneel through it — the tissue won't heal while it's being re-traumatized.
When to consider referral
Persistent large bursa unresponsive to conservative care, or any suspicion of infection, needs physician management. Chronic bursitis may occasionally need aspiration or, rarely, surgical excision.
Most simple prepatellar bursitis resolves within 4-8 weeks with modification and conservative care. Come in for an assessment if you're unsure whether yours needs medical attention.