Anserine

Pes Anserine Bursitis

Bursitis is the general term used to describe inflammation of any bursa. The bursae are cavitary structures lined with synovial tissue that cushions and assists during the motion of joints and muscles. Bursitis is usually accompanied by tenderness; however, swelling and redness may also be present.

Pes anserine bursitis is a clinical entity associated with pain at the medial knee and the proximal medial tibial region. A more generic term, pes anserine pain syndrome, has been applied to refer to medial knee pain, which may or may not include inflammation of the bursal sac. This article focuses on the clinical entity of pes anserine bursitis, unless otherwise specifically stated.

Sartorius, gracilis, and semitendinous tendons insert roughly 5 cm distal to the medial knee joint line forming a structure that mimics the natatory membrane of the goose and hence is called "goosefoot" or pes anserinus in Latin. The 3 muscles are primary knee flexors and play a secondary role in tibial internal rotation with a resultant protective effect against rotation and valgus stress. There are thirteen bursae around the knee, one of them is the pes anserinus bursa. The pes anserinus bursa is situated immediately beneath the pes anserinus separating it from the upper medial tibia. Usually, there is no communication between the pes anserinus bursa and the knee joint.

In 1937, Moschcowitz was the first to describe pes anserinus bursitis changes when he reported the complaint of knee pain almost exclusively in females with pain complaint with ascending or descending stairs or rising from a seated position or difficulty with knee flexion. It is challenging to differentiate between pes anserine bursitis and tendinitis as both the tendons and bursa are anatomically close to each other. However, management is the same.

Anserine syndrome

Knee pain is a common complaint in clinical practice, and pes anserinus tendino-bursitis syndrome (PATB) has been frequently diagnosed based only on clinical features that may cause equivocal interpretations. Patients complain of characteristic spontaneous medial knee pain with tenderness in the inferomedial aspect of the joint. Studies with different imaging modalities have been undertaken during the last years to identify whether these patients suffer from bursitis, tendinitis, or both. Nevertheless, little is known regarding the structural defect responsible for this disturbance. Due to these problems and some controversies, we suggest the term "anserine syndrome" for this condition. Diabetes Mellitus is a known predisposing factor for this syndrome. Overweight and osteoarthritis seem to represent additional risk factors; however, their role in the pathophysiology of the disease is not yet understood. Treatment includes non-steroidal anti-inflammatory drugs, physiotherapy, and injections of corticosteroid, with highly variable responses, from 10 days to 36 months to achieve recovery. The lack of knowledge about its epidemiological, etiological, and pathophysiological aspects requires future studies for this common and intriguing disorder.

Important roles of dietary taurine, creatine, carnosine, anserine and 4-hydroxyproline in human nutrition and health

Taurine (a sulfur-containing β-amino acid), creatine (a metabolite of arginine, glycine and methionine), carnosine (a dipeptide; β-alanyl-L-histidine), and 4-hydroxyproline (an imino acid; also often referred to as an amino acid) were discovered in cattle, and the discovery of anserine (a methylated product of carnosine; β-alanyl-1-methyl-L-histidine) also originated with cattle. These five nutrients are highly abundant in beef, and have important physiological roles in anti-oxidative and anti-inflammatory reactions, as well as neurological, muscular, retinal, immunological and cardiovascular function. Of particular note, taurine, carnosine, anserine, and creatine are absent from plants, and hydroxyproline is negligible in many plant-source foods. Consumption of 30 g dry beef can fully meet daily physiological needs of the healthy 70-kg adult human for taurine and carnosine, and can also provide large amounts of creatine, anserine and 4-hydroxyproline to improve human nutrition and health, including metabolic, retinal, immunological, muscular, cartilage, neurological, and cardiovascular health. The present review provides the public with the much-needed knowledge of nutritionally and physiologically significant amino acids, dipeptides and creatine in animal-source foods (including beef). Dietary taurine, creatine, carnosine, anserine and 4-hydroxyproline are beneficial for preventing and treating obesity, cardiovascular dysfunction, and ageing-related disorders, as well as inhibiting tumorigenesis, improving skin and bone health, ameliorating neurological abnormalities, and promoting well being in infants, children and adults. Furthermore, these nutrients may promote the immunological defense of humans against infections by bacteria, fungi, parasites, and viruses (including coronavirus) through enhancing the metabolism and functions of monocytes, macrophages, and other cells of the immune system. Red meat (including beef) is a functional food for optimizing human growth, development and health.

Traumatic Anserine Folliculosis

Clinical anatomy of the knee

The clinical anatomy of several pain syndromes of the knee is herein discussed. These include the iliotibial tract syndrome, the anserine syndrome, bursitis of the medial collateral ligament, Baker's cyst, popliteus tendon tenosynovitis and bursitis of the deep infrapatellar bursa. These syndromes are reviewed in terms of the structures involved and their role in knee physiology. All of the discussed structures can be identified in their normal state and more so when they are affected by disease. The wealth of information gained by cross examination of the medial, lateral, posterior and anterior aspects of the knee brings to life knowledge acquired at the dissection table, from anatomical drawings and from virtual images.