PELLIGRINI-STIEDA LESION

Definition:   An inflammed calcification within a tear of the proximal MCL ligament.   The Medial Collateral ligament most commonly tears or is injured proximally at it’s femoral origin. A calcified lesion in this location is called a Pelligrini Stieda Lesion.1,2,3

Mechanism of Injury:   Valgus stress force to the lateral aspect of the knee forcing stretching of the MCL.1,2,3

Differential Diagnoses:
Distal adductor magnus tendon calcification 2, MCL sprain/tear, medial meniscal tear, medial knee osteoarthritis.

Examination:
There may be warmth along with tenderness over the proximal MCL origin. There may be pain with valgus stress of the knee without gapping. Ensure there are no other ligamentous injuries assessing for ACL, PCL and LCL injuries. Ensure there is no evidence of an associated meniscal injury. An isolated pelligrini-stieda lesion will not be associated with a joint effusion.

Investigations:

Xray – Will likely demonstrate the lesion on AP, tunnel, and Weight bearing images.
Figure 1 AP Xray of Knees

Figure 2 Tunnel View of Knees

Figure 3 Hilighted area of Interest

Ultrasound (US) – Will assess the MCL for partial tear, thickening, edema and should also identify the boney avulsion within the torn ligament.
Figure 4 – US of proximal MCL insertion – with affected area of edema

Management:

Initial treatment options for a Pelligrini-Stieda Lesion may include NSAIDs and icing.  However, it is likely that an US-guided cortisone injection is required.   If the cortisone injection is unsuccessful then excision of the avulsed fragment can be considered.

Dr. Neil Dilworth (Jan 4, 2014)

References:

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

2) 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.

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