Symptomatic calcification of the medial collateral ligament of the knee joint: a report about five cases

Abstract

Symptomatic calcifications of the rotator cuff tendons is well-known pathologic condition. However, pathologic calcifications may involve other structures of the locomotor system as well. We report about five patients (age 52-66 years) with a painful calcification at the proximal part of the medial collateral ligament of the knee joint. All five patients presented with load-dependent pain pretending meniscus symptoms, but manual valgus stress provoked severe pain at the medial side of the knee. Conventional X-ray examination showed a dense rounded deposit at the proximal part of the medial collateral ligament. Initially all patients were treated conservatively by needling and infiltration with a local anaesthetic. Open resection of the deposit was performed in four patients after unsuccessful conservative treatment. Postoperatively all patients were immediately free of pain. After a mean follow-up of 6 years (patient 1-4) (range=2.5-9.5 years), all patients were still free of pain. Histological evaluation of biopsies obtained during surgery showed nodular deposition of calcium at the collagen fibres, vascular proliferations and inflammative changes. Soft tissue calcifications have to be considered as a rare differential diagnosis in patients presenting with medial knee joint pain. Open resection reduces symptoms immediately. The histological changes seen were comparable to that reported about pathological tendon calcifications of the shoulder. Therefore, both conditions might be of the same aetiology.

Heterotopic mineralization (ossification or calcification) in tendinopathy or following surgical tendon trauma

“…; Hedtmann & Fett ), and pain may be a feature of mineralization within other tendons and ligaments also (Muschol et al . ; Richards et al . ; Tsujii et al .…”

Arthroscopic management of calcific tendonitis of the medial collateral ligament

“…Clinically, it is most commonly seen in the rotator cuff or the supraspinatus tendon, but calcifications involving the MCL of the knee are exceedingly rare, only having been documented thrice till date [4][5][6]. Muschol et al [4] and Wei-Chou et al [5] separately reported five cases and one case of calcific tendinitis of the MCL presented with severe pain at the proximal part of the MCL.…”

“…Muschol et al [4] and Wei-Chou et al [5] separately reported five cases and one case of calcific tendinitis of the MCL presented with severe pain at the proximal part of the MCL. Open resection reduced symptoms immediately and confirmed the diagnosis by performing a biopsy.…”

Physical Examination and Imaging of Medial Collateral Ligament and Posteromedial Corner of the Knee

“…These are commonly seen in asymptomatic patients with remote MCL injuries who have x-rays for nonrelated issues, but can cause pain the subacute setting. 36 In the setting of chronic MCL deficiency, standing, long leg, xrays will allow assessment of limb alignment. Valgus knees with chronic MCL deficiency may need corrective osteotomies to unload MCL reconstructions.…”