Ultrasonographic evaluation of pes anserinus tendino-bursitis in patients with type 2 diabetes mellitus.

OBJECTIVE

To assess musculoskeletal ultrasonographic (US) findings in patients with type 2 diabetes mellitus (DM) with and without pes anserinus (PA) tendinitis or bursitis syndrome; and to determine possible etiologic factors such as systemic diabetic microvascular disease complications in these patients.

METHODS

The knee joints were examined with an ultrasound real-time scanner using a 10 MHz electronic linear transducer in 48 patients with type 2 DM and 25 controls. The presence of systemic diabetic microvascular disease complications was evaluated.

RESULTS

On examination 23 (23.9%) knees of the 14 (29.1%) patients with type 2 DM were found to have PA tendinitis or bursitis syndrome. US revealed that only 4 (8.3%) of the diabetic patients with PA tendinitis or bursitis syndrome had PA tendonitis findings. There were no significant differences in the thickness of PA tendons between the diabetic patients with bilateral knee PA tendinitis or bursitis syndrome (9 patients) and controls, or between the asymptomatic and symptomatic knees in patients with unilateral PA tendinitis or bursitis syndrome (5 patients). The prevalence of morphologic changes of the medial meniscus, effusion and synovitis in the suprapatellar recess, popliteal cyst, and radiographic osteoarthritis (OA) in the diabetic patients with PA tendinitis or bursitis syndrome was found to be increased.

CONCLUSION

The prevalence of PA tendinitis or bursitis syndrome is not uncommon on examination in patients with type 2 DM. However, patients with clinically diagnosed PA tendinitis or bursitis syndrome less frequently have morphologic US changes of the PA tendons. Our results also suggest that structural changes such as meniscus lesions that occur in consequence of OA might have a role in the etiology of medial knee pain in diabetic patients.