The Pellegrini–Stieda Lesion Dissected Historically

Abstract

The Pellegrini-Stieda lesion is a common finding on conventional X-rays. Whether it originates in the medial collateral ligament (MCL) of the knee or the medial head of the gastrocnemius muscle or another structure remains under debate. We discuss the difference in the articles by Pellegrini and Stieda and follow the vision on the origin of the lesion through time. A systematic research in PubMed/MEDLINE was conducted, identifying all articles on the Pellegrini-Stieda lesion and analyzing them for proposed origin of the lesion. The articles with their conclusion based on either finding during surgery or magnetic resonance imaging (MRI)/computed tomography were analyzed in more detail. Our PubMed/Medline search identified 4,997 articles. After exclusion of articles that were not on the Pellegrini-Stieda lesion and of doubles, 27 articles remained. By checking the references manually, 10 more articles were identified. Proposed origins were MCL, medial gastrocnemius, adductor magnus, vastus medialis, deep MCL, and superficial MCL. Although the MCL was most often coined as origin of the lesion (54% overall, 25% on MRI, and 57% during surgery), many cases remained undecided (50% on MRI) or no specific structure was found to be the origin (29% during surgery). There are diverse proposed origins of a calcification on the medial side of the knee. The eponymous term Pellegrini-Stieda lesion seems fitting, as it comprises two different thoughts on the origin of the lesion. MRI seems to be a noninvasive and quite accurate method for future research.

Isolated Femoral LCL Avulsion Fracture in the Adult Knee: Two Patient Cases and Literature Review

“…The second patient case displayed mild femoral LCL attachment calcification on follow-up CT-scan ( Figure 4 ). This observation appears similar to that observed by Pellegrini-Stieda at the medial knee [ 33 ].…”

“…As described by Pellegrini and Stieda [ 33 ], MCL femoral avulsion fracture and proximal tears are known to promote adjacent soft tissue calcification. The second patient case displayed mild femoral LCL attachment calcification on follow-up CT-scan ( Figure 4 ).…”

Heterotopic Mineralization of the Medial Collateral Ligament: Our Experience Treating Two Cases of Calcific Versus Ossific Lesions With Ultrasonic Vacuum Debridement

“…Historically, mineralization of the MCL on radiographs has been described as Pellegrini-Stieda lesions, named after early twentieth century Italian and German surgeons that described ‘ossifications’ of the MCL at or near its proximal insertion of the medial femoral condyle [ 13 ], and are characterized based on location and shape (Table 2 ) [ 14 ]. PS lesions have also been described in the tendon of the adductor magnus muscle, medial gastrocnemius muscle or medial patellofemoral ligament [ 15 ], and are often associated with trauma [ 16 ]. Refractory cases of PS lesions may require surgical debridement of the lesion.…”

Back to the roots of rheumatology – Imaging of regional pain syndromes

“…Posttraumatic ossification affecting the proximal MCL, the so-called Pellegrini-Stieda lesion, can be nicely demonstrated with US. Most patients are asymptomatic with only a small percentage of them presenting with medial knee pain [87]. When the MCL rupture occurs distally, its anterior fibers are displaced over the pes anserinus tendons and, in some patients, these tendons can become incarcerated between the distal ligament stump and the tibia causing the equivalent of a Stener lesion, the so-called "Stener-like lesion" of the MCL by analogy to the pathology of the UCL of the MCP joint of the thumb.…”