II. Epidemiology

  1. Incidence: Rare
  2. Most common in males, ages 25 to 40 years

III. Pathophysiology

  1. Medial collateral ligament (MCL) ossification (calcification)
  2. Results from valgus stress induced MCL injury
  3. Inflammatory response to injury leads to a delayed calcification at 2 to 6 weeks after injury

IV. Causes

  1. Acute MCL injury
  2. Repetitive MCL injury and overuse
  3. Overstretching

V. Symptoms

  1. Medial Knee Pain following injury

VI. Signs

  1. Medial knee tenderness
    1. Medial femoral condyle
    2. Proximal medial collateral ligament (MCL)
  2. Palpable firm localized swelling may be present
  3. Absent Knee Effusion
  4. Provocative
    1. Range of motion is painful (active and passive)
    2. Valgus stress test painful

VII. Imaging

  1. XRay Knee (preferred)
    1. Linear calcification at the medial aspect of the medial femoral condyle (Pellegrini-Stieda Sign)
    2. Distinguish from avulsion Fracture
  2. MRI Knee
    1. Not typically needed in Pellegrini-Stieda Lesion, unless unclear diagnosis with persistent symptoms
    2. MRI demonstrates MCL thickened

VIII. Differential Diagnosis

IX. Management

  1. Conservative management (preferred and effective)
    1. NSAIDs
    2. Physical therapy (esp. range of motion Exercises)
    3. Expect gradual healing over a 6 month course
  2. Surgical Excision of Calcifications
    1. Rarely indicated
    2. Surgery increases the risk of calcification recurrence as well as need for MCL reconstruction

X. Complications

  1. Restricted range of motion
  2. Joint Contractures
  3. Altered Gait

XI. Resources

XII. References

  1. Kiel (2024) Crit Dec Emerg Med 38(5): 16-7

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