Medial collateral ligament tears cause pain and swelling inside the knee. Generally, MCL injuries settle with a period of bracing and rehab. However, in some cases, the healing of an MCL tear is complicated by calcification, also known as Pellegrini-Steida syndrome. What is a Pellegrini-Steida lesion, and how do we treat it?

What is Pellegrini-Steida lesion? 

X-ray showing calcification in medial ligament

A calcium deposit on the top part of the medial collateral ligament is known as a Pellegrini-Steida lesion. Calcification leads to pain and stiffness of movement. Generally, these lesions are more common in men between 25-40, forming weeks after a knee injury.

Causes

In most cases, a Pellegrini-Steida lesion forms after an acute injury to the medial collateral ligament. Tearing of the ligament leads to bleeding and swelling of the ligament fibers. Rather than healing, the body responds by depositing calcium in the torn ligaments. Calcium deposits form within 2-4 weeks of an injury and may take up to 6 months to disappear. In rare cases, this condition can occur spontaneously without an injury history.

Symptoms of Pellegrini-Steida syndrome

Generally, people with this condition describe a history of injury to the inside of the knee. Ususally, symptoms improve initially, only to worsen after 2-4 weeks with increasing medial knee pain and restriction in movement. Some people find they can’t straighten their affected knee fully. In addition, touching the top part of the MCL is painful.

Other causes of inside knee pain need to be excluded, including knee arthritis, an avulsion fracture of the medial femoral epicondyle, semimembranosus tendonitis, or myositis ossificans.

Pellegrini-Steida syndrome Imaging

X-ray showing calcification medial collateral ligament known as Pellegrini-steida syndrome

An X-ray will often confirm the diagnosis of calcification at the top part of the medial collateral ligament. Calcium deposits are seen after about three weeks. Calium can also be seen on ultrasound or MRI.

Treatment of Pellegrini-Stieda lesion 

Most cases of Pellegrini-Steida syndrome settle with conservative management.

Simple treatment 

Generally, we use oral anti-inflammatories to reduce pain and swelling. In addition, rest from sports, range of motion exercises, and rehab will accelerate recovery. Some examples of knee range of motion exercises include heel slides, seated knee bending, and seated chair slides.

Nonetheless, cases that prove stubborn need an ultrasound-guided injection. We direct a needle under ultrasound to break up the calcification into smaller pieces to help the body resorb the calcium deposits. An injection of cortisone around the calcification will also assist in recovery. Generally, it is important for you to see a doctor experienced in ultrasound-guided interventions.

Surgery for Pellegrini-Steida lesion 

Ususally, we only reserve surgery in cases that fail conservative management. In complex issues, we excise the calcification, careful not to remove too much normal ligament.

Overall, results from surgical excision are, at best, unpredictable. Recent studies show a high recurrence rate or laxity from excessive removal of the medial ligament.

Final word from Sportdoctorlondon regarding the Pellegrini-Steida lesion

Pellegrini-Steida syndrome is due to calcification of the medial collateral ligament after trauma leading to pain and restriction in the movement of the knee. Most cases settle with simple treatments such as ice and anti-inflammatory medication.

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Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.