Disclosures: Vanessa Roos, MD: No financial relationships or conflicts of interest
Case Description: A 39 year-old man presented to musculoskeletal clinic with a 2-3 month history of left medial knee pain. Pain was aggravated supine and associated with intermittent medial knee edema. He had failed conservative, non-directive treatment including icing, nonsteroidal anti-inflammatory drugs and physical therapy. Patient had a remote history of cross-country running and medial meniscus excision surgery but no recent trauma or change in activity. Clinical assessment revealed left knee effusion with tenderness to palpation over medial joint line without mechanical symptoms. X-rays showed mild degenerative changes. Magnetic Resonance Imaging (MRI) revealed large tibial collateral ligament bursitis which was further confirmed by ultrasound (US). Ultrasound-guided aspiration of the bursa followed by corticosteroid injection was performed providing 100% pain relief measured by the the visual analog scale.
Setting: Musculoskeletal Clinic
Patient: 39 year-old man with left medial knee pain Assessment/
Results: At 3-month follow-up post injection, patient continued to have 100% pain relief.
Discussion: Tibial collateral ligament bursitis is a rare cause of medial knee pain with few cases described in runners, patients with osteoarthritis, and patients with recent trauma to the knee. The tibial collateral ligament bursa is located between the ligament’s superficial and deep portions. Generally, it can be visualized under US and MRI only when distended with fluid in the setting of inflammation. To our knowledge, this is the first case of tibial collateral ligament bursitis in a patient without predisposing factors. US has been shown to be a reliable modality for guidance of corticosteroid injections into the tibial collateral ligament bursa.
Conclusion: Collateral ligament bursitis should be considered as a differential diagnosis in any patient presenting with medial knee pain. The importance for accurate and precise diagnosis is highlighted in this case by the patient’s failure to respond to prior non-directed treatment plans as well his rapid and definitive response to directed treatment.
Level of Evidence: Level V
To cite this abstract in AMA style:
Roos V, Worthing R, Sawaki L. The Importance of Identifying a Rare Cause of Medial Knee Pain: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-importance-of-identifying-a-rare-cause-of-medial-knee-pain-a-case-report/. Accessed May 3, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-importance-of-identifying-a-rare-cause-of-medial-knee-pain-a-case-report/