Endoscopic versus Open Bursectomy for Prepatellar and Olecranon Bursitis

Abstract

Objectives Bursitis of the olecranon and the patella are not rare disorders, and conservative management is successful in most cases. However, when patients do not respond to conservative treatment, open excisional surgery or, recently, endoscopic bursectomy, can be used. The aim of this study was to evaluate the results of open and endoscopic treatments of olecranon and prepatellar bursitis. Patients and methods Forty-nine patients (37 male and 12 female), who were treated with endoscopic bursectomy (25 patients) or open bursectomy (24 patients) were included in this study. Thirty patients had olecranon bursitis, while 19 patients had prepatellar bursitis. The patients' average age was 61.1 ± 12.3 (range 33-81) years. All of the patients' hospitalization and surgery times were recorded. The satisfaction of the patients was evaluated with a satisfaction scoring system, as well as by evaluating residual pain, the range of joint movement, and the cosmetic results of the procedure. Results The average follow-up time was 16 ± 9 months (range 12-27). The median operation time was 23.2 ± 3.5 minutes for the endoscopic bursectomy group and 26.4 ± 6.8 minutes for the open bursectomy group. The median hospitalization time was 0.56 ± 0.5 days (range 0-1 day) for the endoscopic group and 1 ± 0 days for the open bursectomy group (P<0.01). According to the patient satisfaction questionnaire, the endoscopic bursectomy group's score was 8.5 ± 1.3 (range 5-10), and the open bursectomy group's score was 5.29 ± 1.8 (range 1-9) (P<0.01). Conclusion Endoscopic bursectomy is a time-saving and efficient surgical treatment option for patients with prepatellar and olecranon bursitis.

Keywords: bursitis; elbow arthroscopy; endoscopic; endoscopic bursectomy; knee arthroscopy; minimally invasive surgery; olecranon bursitis; open bursectomy; prepatellar bursitis.

Figure 1. a) Clinical view of a right prepatellar bursitis; b) open excised prepatellar bursa

Figure 2. a) Clinical view of the patient with left olecranon bursitis and zones that need attention (ME: medial epicondyle, LE: lateral epicondyle, NU: nerveus ulnaris); b) minimal prepatellar portals opened with no. 11 scalpel (yellow drawing: infrapatellar branch of saphenous nerve; X marks: the portal for endoscopy)

Figure 3. a) Intraoperative view of endoscopic bursectomy in left knee with prepatellar bursitis; anteromedial portal was opened a little bit laterally to avoid any damage to infrapatellar nerve; b) endoscopic view of the prepatellar bursitis

Figure 4. a) Endoscopic view of the hypervascularised synovium; b) bursal wall was debrided with shaver