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 of MCL, also known as Pellegrini Stieda syndrome. What is a Pellegrini-Stieda lesion, and how do we treat it?
What is Pellegrini Stieda lesion?
A calcium deposit on the top part of the medial collateral ligament is known as a Pellegrini Stieda 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
A Pellegrini-Stieda lesion usually forms after an acute injury to the medial collateral ligament. Tearing of the ligament leads to bleeding and swelling of the ligament fibres. 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-Stieda 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 Stieda syndrome Imaging
A calcium deposit on the top part of the medial collateral ligament is known as a Pellegrini stieda 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-stieda lesion forms after an acute injury to the medial collateral ligament. Tearing of the ligament leads to bleeding and swelling of the ligament fibres. 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-Stieda 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 Stieda syndrome Imaging
An X-ray will often confirm the diagnosis of calcification of the MCL at the top part of the ligament. Calcium deposits are seen after about three weeks. Calcium can also be seen on ultrasound, but less on MRI scans.
Treatment of Pellegrini-Stieda lesion
Most cases of Pellegrini-Stieda 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, stubborn cases 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. We also call this procedure a calcium barbotage. A cortisone injection around the calcification will assist in recovery. Generally, you need to see a doctor experienced in ultrasound-guided interventions.
Surgery for Pellegrini-Stieda 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 of the normal ligament.
Overall, surgical excision results 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 stieda lesion
Pellegrini-Stieda syndrome is due to calcification of the MCL 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.
I have been diagnosed with PSS while on holiday in Cyprus.
Following a course of anti inflammatory meds and a cortisone injection I was let out of hospital, but the pain has returned.
I ca barely bend my knee and I am treating with ice and rest?
I am due to fly next week – should I try?
Thank you.
Anti-inflammatory treatment should help. I’d continue with oral inflammatories and regular ice.