Summary Prepatellar bursitis is the swelling and inflammation of the anterior knee bursa associated with pain with kneeling. Diagnosis is made clinically with mild swelling and tenderness over the anterior knee overlying the patella. Treatment is nonoperative with compressive wraps and NSAIDs. Occasionally, in the setting of septic bursitis, antibiotics may be indicated. Epidemiology Incidence most common bursitis of the knee Anatomic location bursa anterior to patella Risk factors excessive kneeling common in wrestlers concern for septic bursitis in wrestlers Etiology Pathophysiology may be septic or aseptic 20% are septic Anatomy Prepatellar bursa the prepatellar bursa is a potential space function to enhance gliding of tissue over patella Presentation History often patients have a history of kneeling Symptoms pain swelling Physical exam can be warm to touch, especially if septic Studies Aspiration with gram stain and culture rarely indicated can be used to distinguish between septic versus aseptic if necessary on physical exam a septic presentation is difficult to distinguish from an aseptic presentation the collection is extra-articular so the patient does not have the pain one has with septic arthritis S. aureus is the most commonly cultures organism in both septic olecranon and prepatellar bursitis Treatment Nonoperative compressive wrap, NSAIDs, +/-aspiration and immobilization for 1 week indications most cases technique corticosteroid use is controversial Operative bursal resection indications rare open or arthroscopic arthroscopic bursal resection