A 26-year-old male football player presents with well localised pain about the medial knee. The pain is related to activity and is associated with quite marked localised tenderness. He reported having sustained a medial collateral ligament injury to his knee five months previously. While he was able to return to football after this injury, he does not feel that the problem has ever completely resolved – and is now getting worse. The main finding on clinical examination was localised tenderness about the medial femoral condyle.
An AP x-ray image of the knee shows a small curvilinear ossification adjacent to the medial femoral condyle. This was not present on an x-ray taken at the time of his initial injury. No other abnormality is seen.
This player was diagnosed with Pellegrini-Stieda syndrome. After a discussion about the treatment options he elected to have a steroid injection. This was administered about the area of calcification at the medial femoral condyle. He responded well to this and remains symptom-free six months later.
Pellegrini-Stieda syndrome should be suspected when patients continue to have pain following an otherwise uncomplicated medial collateral ligament injury. It can generally be diagnosed on x-ray however MRI may have a role. MR imaging can show the ossicle or enthesophyte at the medial femoral condyle and would generally show increased signal and thickening of the medial collateral ligament. I can also demonstrate other possible causes of medial knee pain.
In many cases the calcification is not associated with any symptoms. When it is symptomatic however there are a number of treatment options. Local treatments (like ice, topical ant-inflammatories and massage) can be effective. Steroid injections can help improve pain while some patients need to have surgical exploration, excision of the abnormal tissue and/or repair of the medial collateral ligament. In general the prognosis is good.
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.