Slideshow
-
Figure. Anteroposterior radiograph of the left knee.
A 66-year-old woman presents with left knee pain that has been present for the last few months. The patient does not recall having a known injury or precipitating event. She notes that the pain is located just over the medial femoral condyle. On physical examination, she has pain to palpation medially over the medial femoral condyle and no laxity to the medial collateral ligament (MCL). Pain is made worse with hyperflexion of the knee. Radiograph (Figure) shows ossification of the soft tissues just medial to the medial femoral condyle.
Submit your diagnosis to see full explanation.
Pellegrini-Stieda lesions result from ossification within the medial soft tissues adjacent to the medial femoral condyle. Most cases are asymptomatic and found incidentally on imaging but those that are symptomatic are referred to as Pellegrini-Stieda syndrome.1,2 The ossification is thought to be caused by either an MCL avulsion injury, avulsion of the gastrocnemius muscle, or ossification of the adductor magnus tendon.1,2 Injury to this area is thought to cause an inflammatory cascade that leads to delayed ossification of the surrounding soft tissues.1
Symptoms of Pellegrini-Stieda syndrome include pain to palpation over the medial femoral condyle and worsening pain with full knee extension and flexion. The lesion can vary in shape and size, with larger lesions generally becoming more symptomatic.1 Conservative treatment with ice, oral nonsteroidal anti-inflammatory drugs (NSAIDs), and rest is typically effective.1 Refractory cases can be considered for a local corticosteroid injection or surgical excision. Results of surgical excision vary with some studies showing a high recurrence rate.1
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
References
1. Weaver M, Sherman AI. Pellegrini Stieda disease. In: StatPearls [Internet], StatPearls Publishing. Updated August 9, 2022. Accessed January 23, 2023. https://www.ncbi.nlm.nih.gov/books/NBK535347/
2. Wiegerinck JI, Somford MP. Review of Stieda’s article (1908) on the Pellegrini-Stieda lesion. J ISAKOS. 2016;1(4):214-218. doi:10.1136/jisakos-2016-000054
QUESTION
