Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Pellegrini Stieda Syndrome

From WikiSM
(Redirected from Pellegrini Stieda Disease)

Other Names

  • Pellegrini Stieda Syndrome
  • Pellegrini-Stieda Syndrome (PSS)
  • Pellegrini-Stieda Disease
  • Pellegrini-Stieda's Disease
  • Köhler–Pellegrini–Stieda disease

Background

  • This page refers to so-called Pellegrini Stieda syndrome (PSS)

History

  • Pellegrini in 1905 was the first to describe the sign of Pellegrini–Stieda[1]
  • Stieda later published a series of 5 cases[2]

Epidemiology

  • Not well described in the literature
  • Incidence is unknown

Introduction

Anatomy of left knee joint and attachments of deep medial collateral ligament (MCL) above and below medial meniscus. (ACL, anterior cruciate ligament; LCL, lateral collateral ligament; PCL, posterior cruciate ligament.)[3]
Relationship of the MPFL (medial patellofemoral ligament), VMO (vastus medialis obliquus muscle), SM (semimembranosus), MGT (medial gastrocnemius tendon), POL (posterior oblique ligament) and sMCL (superficial medial collateral ligament).[4]

General

  • Diagnostic criteria
    • Classic radiographic findings of pellegrini-stieda sign
    • Combination of clinical symptomatology of pain and restriction in the range of motion

Pellegrini–Stieda Sign

  • Also called Pellegrini-Stieda lesion,
  • Calcification of the medial collateral ligament of the knee
  • This is seen months/ years after trauma, either direct or indirect

Pathophysiology

  • Thought to initially occur with an insult to the medial collateral ligament
    • Involves some form of valgus stress with disruption of MCL fibers
    • Acute, direct trauma
    • Repetitive trauma
    • Overstretching injury
  • Causing acute inflammation that initiates a process of delayed ossification
    • Hematoma, ecchymosis, swelling may or may not be noted
    • Can occur as early as 2 weeks or as late as 6[5]
  • Other implicated causes include
    • Micro-repetitive trauma from therapeutic manipulation of a restricted knee joint
    • Post-surgical rehabilitation
  • Origin of the calcification has been debated[6]
  • Stieda Fracture
    • Avulsion fracture of medial femoral condyle from the MCL

Associated Conditions

Risk Factors

  • Male[7]
  • Age 25-40

Differential Diagnosis

Differential Diagnosis Medial Knee Pain

Differential Diagnosis Knee Pain

Clinical Features

History

  • History of knee injury, sometimes vague
    • May involve specific knee-knee collision during sport
    • Can be as proximal as a 3 weeks or years later
  • Pain typically localizes to medial knee
  • Range of motion is often decreased/ painful
  • Can get worse over time

Physical Exam: Physical Exam Knee

  • Knee is stiff, restricted range of motion
  • Full knee extension is often painful
  • Tenderness to the medial femoral condyle area/ proximal MCL
  • Lump may or may not be palpated

Special Tests

Evaluation

Large calcification (pelligrini-stieda lesion) of the medial knee[8]
T1 and T2 hypointense mass adjacent to the MCL origin from the medial femoral condyle typical of an ossified Pellegrini-Steida lesion.[9]
Pelligrini-Stieda lesion seen on ultrasound. Note the hyperechoic calcification with posterior acoustic shadowing[10]

Radiographs

  • Standard Radiographs Knee
    • Sufficient to make diagnosis when combined with clinical exam
  • Pellegrini Stieda Sign
    • Longitudinally linear opacity
    • Calcification in the soft tissue located medial to the medial femoral condyle
  • Note
    • Do not confuse with medial femoral condyle avulsion fracture
    • Do not Medial femoral condyle enthesophyte

MRI

  • Findings
    • Ossicle or enthesophyte showing bone marrow signal at the medial femoral condyle
    • Medial collateral ligament is usually thickened

Ultrasound

  • Findings
    • Hyperechoic calcification with posterior acoustic shadowing
    • The MCL may be thickened

Classification

Proposed Classification Based on Location[11]

  • I: beak-shaped with inferior orientation and union to the femur: the ossification arises from the femur and extends inferiorly in the TCL
  • II: drop-shaped with inferior orientation and parallel to the femur: located in the TCL, without attachment to the femur.
  • III: elongated with superior orientation: ossification lying in the distal adductor magnus tendon
  • IV: beak-like with superior orientation and inferior attached to the femur: ossification attached to the femur, extending into both the TCL and the adductor magnus tendon

Management

Nonoperative

Operative

  • Indications
    • Severe, refractory cases
  • Technique
    • Surgical excision of calcifications

Rehab and Return to Play

Rehabilitation

  • General approach
    • Stretching and range of motion exercises
  • Initial
    • Emphasis on avoiding overload, microtrauma
    • Ice therapy
    • Mobilization
  • Knee bending exercises/ stretching
    • Examples include heel slide, seated knee bending, chair slides

Return to Play/ Work

  • Return to play can be considered when the following criteria is met[12]
    • Full range of motion is restored
    • Athlete is relatively pain free
  • Range of motion should be symmetric
  • Quadriceps and hamstring strength should be normal and symmetric

Prognosis and Complications

Prognosis

  • Most cases resolve in 5-6 months
  • Surgical outcomes
    • High variance in patient outcomes overall
    • High recurrence rate
  • Surgical excision may require reconstruction of the MCL

Complications

  • Restricted range of motion
    • Subsequently, patients can develop joint contracture
  • Gait abnormalities
  • Decreased activities of daily living
  • Chronic Pain

See Also

Internal

External

References

  1. ↑ Pellegrini, A. "Traumatic calcification of the collateral tibial ligament of the left knee joint." Clin Mod 11 (1905): 433-439.
  2. ↑ Stieda, Alfred. "Uber eine typische verletzung am unteren femurende." Archiv klin Chir 85 (1908): 815-826.
  3. ↑ Jacob, George, et al. "Percutaneous arthroscopic assisted knee medial collateral ligament repair." Arthroscopy Techniques 9.10 (2020): e1511-e1517.
  4. ↑ Memarzadeh, Arman, and Joel TK Melton. "Medial collateral ligament of the knee: Anatomy, management and surgical techniques for reconstruction." Orthopaedics and Trauma 33.2 (2019): 91-99.
  5. ↑ Theivendran K, Lever CJ, Hart WJ. Good result after surgical treatment of Pellegrini-Stieda syndrome. Knee Surg Sports Traumatol Arthrosc. 2009 Oct;17(10):1231-3.
  6. ↑ Somford, M. P., Lorusso, L., Porro, A., Van Loon, C., & Eygendaal, D. The Pellegrini–Stieda Lesion Dissected Historically. The journal of knee surgery.2018; 31(06): 562-567.
  7. ↑ Scheib, J. S., and R. J. Quinet. "Pellegrini-Stieda syndrome mimicking acute septic arthritis." Southern medical journal 82.1 (1989): 90-91.
  8. ↑ Altschuler, Eric L., and Thomas N. Bryce. "Pellegrini–stieda syndrome." New England Journal of Medicine 354.1 (2006): e1.
  9. ↑ Case courtesy of Chris O'Donnell, Radiopaedia.org, rID: 37592
  10. ↑ Image courtesy of sonotool.net, “Pellegrini-Stieda Lesions”
  11. ↑ Mendes, Luiz FA, et al. "Pellegrini–Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of the tibial collateral ligament—anatomic and imaging investigation." Skeletal radiology 35 (2006): 916-922.
  12. ↑ Shanker, V. S., Gadikoppula, S., & Loeffler, M. D. Post traumatic osteoma of tibial insertion of medial collateral ligament of knee joint. British journal of sports medicine.1998; 32(1): 73-74. Level of evidence: 5
Created by:
John Kiel on 24 April 2024 14:00:07
Authors:
Last edited:
1 May 2025 20:53:23
Categories:
Retrieved from "https://wikism.org/w/index.php?title=Pellegrini_Stieda_Syndrome&oldid=32467"