Case report - calcification of the medial collateral ligament of the knee with simultaneous calcifying tendinitis of the rotator cuff

Abstract

BackgroundCalcification of the medial collateral ligament (MCL) of the knee is a very rare disease. We report on a case of a patient with a calcifying lesion within the MCL and simultaneous calcifying tendinitis of the rotator cuff in both shoulders.Case presentationCalcification of the MCL was diagnosed both via x-ray and magnetic resonance imaging (MRI) and was successfully treated surgically. Calcifying tendinitis of the rotator cuff was successfully treated applying conservative methods.ConclusionThis is the first case report of a patient suffering from both a calcifying lesion within the medial collateral ligament and calcifying tendinitis of the rotator cuff in both shoulders. Clinical symptoms, radio-morphological characteristics and macroscopic features were very similar and therefore it can be postulated that the underlying pathophysiology is the same in both diseases. Our experience suggests that magnetic resonance imaging and x-ray are invaluable tools for the diagnosis of this inflammatory calcifying disease of the ligament, and that surgical repair provides a good outcome if conservative treatment fails. It seems that calcification of the MCL is more likely to require surgery than calcifying tendinitis of the rotator cuff. However, the exact reason for this remains unclear to date.

Medial collateral ligament calcification: a rare knee pain entity with literature review

“…Since the patient in this study did not have any systemic or focal knee ailment, previous knee trauma with subsequent dystrophic calcification in MCL might potentiate the patient’s suffering. According to the literature, it takes about 2–6 weeks to develop post-traumatic calcific deposit ( 12 ); however, in the present study, the patient reported two months after the incident.…”

“…A focal area of tenderness near the knee, just proximal to the joint line, is also included in the fibromyalgia classification criteria ( 10 ). In Pellegrini Stieda syndrome ( 9 , 12 ), patients usually complain of distal medial thigh pain. Knee joint pain, due to avulsion fracture of medial femoral condyle at the insertion of proximal portion of medial collateral ligament, is another differential diagnosis of medial knee pain.…”

“…After the shoulder, the hip is the second frequent location for tendinitis followed by the elbow, wrist, hand, and ankle/foot. In the knee, calcification is frequent near osseous attachments of the ligaments or the popliteal tendon ( 12 ). Since the patient in this study did not have any systemic or focal knee ailment, previous knee trauma with subsequent dystrophic calcification in MCL might potentiate the patient’s suffering.…”

“…Kamawal et al. documented MCL calcification using both conventional X-ray and MRI of knee ( 12 ). Chang et al.…”

“…Considering its wide margin of safety in terms of radiation exposure, recently diagnostic utility of ultrasonography in various musculoskeletal conditions including soft tissue rheumatisms has increased. Although MRI is a valuable tool in delineating meniscal tears, ligamentous injury, and soft tissue calcification, it may provide clinically irrelevant information, though not related to the patients' symptoms at all, increasing healthcare cost further ( 12 , 16 ). MRI exposure also contraindicates in patients with metal implants, such as cardiac pacemakers ( 17 ).…”