Rizky Dio Asgira, Lee Kevin, Sulaeman Wendell Sebastian, Butarbutar John Christian Parsaoran, Suginawan Earlene Tasya
Department of Orthopaedic and Traumatology, Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospital Lippo Village, Tangerang, Indonesia.
J Orthop Case Rep. 2023 Jul;13(7):27-32. doi: 10.13107/jocr.2023.v13.i07.3742.
Pellegrini-Stieda syndrome is described as pain and restriction at the range of motioncaused by calcification in the medial collateral ligament (MCL) around the knee with the recognized radiographic findings of the lesion in the affected site. The pathomechanism of Pellegrini-Stieda is suspected to be similar as calcification of the rotator cuff that is thought to be reactive calcification followed by resorption and tendon remodeling involving four phases (pre-calcific, formative, resorptive, and healing) without any trauma history. Since the calcium deposit in the rotator cuff has been well managed by percutaneous lavage, in this case report, we assumed that the pathomechanism of Pellegrini-Stieda Syndrome is similar to calcification of the rotator cuff, thus can be treated with the same principle using ultrasound-guided percutaneous lavage (UGPL).
The aim of the study was to discuss UGPL as management for Pellegrini-Stieda with suspected similar pathomechanism to rotator cuff calcification.
A 52-year-old woman came to the outpatient clinic with a week of severe pain in her right knee. The patient had difficulty walking due to stiffness and pain that is aggravated by moving her knee. Radiographic examination confirmed calcified lesions located within the MCL on the right knee. In consideration of the acute pain, we opted to perform UGPL procedure. Follow-ups were done 1 week and 1 month after the procedure. The patient reported no pain when walking and bending her knee during the follow-up examination and there was no complication noted. Overall, she was very satisfied with the result. We also interviewed her for the lower extremity functional scale Score which the patient gave 64 points and 72 points out of 80 for week 1 and 1 month, respectively, indicating favorable results.
Based on our case, UGPL can be an option for treating Pellegrini-Stieda Syndrome because it produces the same result as UGPL on rotator cuff calcification. Surgery should be the last resort if this procedure fails. Future high-quality randomized controlled trials were required to determine the reliability of this method.
佩莱格里尼 - 施蒂达综合征被描述为膝关节内侧副韧带（MCL）钙化导致的活动范围疼痛和受限，且在受影响部位有公认的病变影像学表现。佩莱格里尼 - 施蒂达综合征的发病机制被怀疑与肩袖钙化相似，后者被认为是反应性钙化，随后是吸收和肌腱重塑，涉及四个阶段（钙化前期、形成期、吸收期和愈合期），且无任何创伤史。由于经皮灌洗已很好地处理了肩袖中的钙沉积，在本病例报告中，我们假设佩莱格里尼 - 施蒂达综合征的发病机制与肩袖钙化相似，因此可以使用相同的原则，即超声引导下经皮灌洗（UGPL）进行治疗。
本研究的目的是探讨UGPL作为治疗佩莱格里尼 - 施蒂达综合征的方法，该综合征疑似与肩袖钙化有相似的发病机制。
一名52岁女性因右膝疼痛一周前来门诊。患者因膝关节僵硬和疼痛而行走困难，活动膝关节会加重疼痛。影像学检查证实右膝MCL内有钙化病变。考虑到急性疼痛，我们选择进行UGPL手术。术后1周和1个月进行了随访。患者在随访检查中报告行走和屈膝时无疼痛，且未发现并发症。总体而言，她对结果非常满意。我们还询问了她下肢功能量表评分，患者在第1周和第1个月分别给出了64分和72分（满分80分），表明结果良好。
基于我们的病例，UGPL可以作为治疗佩莱格里尼 - 施蒂达综合征的一种选择，因为它在肩袖钙化治疗中产生了相同的效果。如果该手术失败，手术应作为最后的手段。未来需要高质量的随机对照试验来确定该方法的可靠性。
