Pellegrini-Stieda Lesion

Pellegrini-Stieda Lesion (also known as Pellegrini-Stieda Syndrome and Disease)

Description:  Pelligrini-Stieda lesions are believed to be calcifications of prior medial collateral ligament (MCL) injuries.  They typically occur in the proximal segment of the ligament.  They can be quite painful, associated with swelling and heat, and aggravated with valgus stress of the knee.  The pathology is believed to involve caclification within the hematoma that occurs at the site of the MCL injury. (1-6)

Figure 1 – Anatomy of MCL

Differential Diagnosis:  MCL sprain/tear, medial meniscal tear, osteochondroma, medial knee osteoarthritis, semimembranosis/semitendinosis tendinitis, myositis ossificans.

Examination:

Inspection: Swelling may be evident over medial femoral condyle.
Palpation:  Palpation of the medial femoral condyle over the lesions are typically warm/hot to touch as well as painful.
Not typically associated with other injuries, except when associated with a Grade III MCL injury, thus an effusion would not be expected with this injury.

Investigations:

Xray – the calcification can often be seen on an AP, weight-bearing or tunnel view radiograph of the knee.
Figure 2 -Weightbearing Radiograph

Figure 3 – Tunnel View Radiograph of same patient

Figure 4- Pelligrini-Stieda Lesion hilighted on Tunnel view radiograph

Ultrasound – An ultrasound can confirm the presence of the lesion as well as associated edema.
Figure 2 – Pelligrini-Stieda Lesion on Ultrasound

Management:

Conservative:  Most often these are treated conservatively.   NSAIDs can be used initially either systemically or topically to reduce inflammation and pain.  If this has no further benefit a local cortisone injection can be quite effective.   A bihinged brace may be added to the above prior to surgical considerations.Very rarely do these lesions need to be treated surgically.

Surgical:  Excision of the lesion often precludes disruption of the medial collateral ligament.  A technique is described where after the calcification is excised, the adductor magnus tendon is dissected and moved distally to reconstruct the MCL.(3)

Dr. Neil Dilworth (Jan 4, 2014 , updated Sept 30, 2017)

References:
1. Houston AN, Roy WA, Faust RA, Ewin DM. Pellegrini-Stieda syndrome: report of fourteen cases followed from original injury.South Med J. 1960 Mar;53:266-72. No abstract available.
2. Majjhoo, H. Sagar Pellegrini-Stieda disease JCR: J Clin Rheumatol, 17 (8) (2011), p. 456, 10.1097/rhu.0b013e31820568db

3. Theivendran K1, Lever CJ, Hart WJ.  Good result after surgical treatment of Pellegrini-Stieda syndrome.  Knee Surg Sports Traumatol Arthrosc. 2009 Oct;17(10):1231-3. doi: 10.1007/s00167-009-0725-0. Epub 2009 Feb 17.

4. Miller, M Review of orthopaedics. 5th ed. ed. Philadelphia: Saunders / Elsevier; 2008.

5.  Mendes LF1, Pretterklieber ML, Cho JH, Garcia GM, Resnick DL, Chung CB. Pellegrini-Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of the tibial collateral ligament-anatomic and imaging investigation. Skeletal Radiol. 2006 Dec;35(12):916-22. Epub 2006 Sep 19.

6.  Daniel’s knee injuries : ligament and cartilage structure, function, injury and repair. 2nd ed. ed. Philadelphia: Lippincott Williams & Wilkins; 2003.