Ultrasound-guided percutaneous lavage of calcific bursitis of the medial collateral ligament of the knee: a case report and review of the literature

Calcifications of the Knee's Medial Compartment: A Case Report and Literature Review on the Adductor Magnus Tendon as an Uncommon Location and the Role of Ultrasound-Guided Lavage

Background: This paper examines the diverse etiologies of medial knee pain, emphasizing the prevalence of calcification-related pathologies, such as Pellegrini-Stieda Syndrome (PSS), particularly in the medial collateral ligament (MCL) and adjacent structures. Furthermore, we present a case of calcification of the distal adductor magnus tendon (DAMT) insertion into the femoral condyle of the knee and describe its treatment using ultrasound-guided percutaneous lavage (UGPL). A narrative review was conducted based on a single case; it underscores the importance of accurate diagnosis using magnetic resonance imaging (MRI) to differentiate between various calcific conditions, guiding appropriate treatment strategies. Case Presentation: A 70-year-old patient presenting with severe medial knee pain, with a duration of 4 days, and functional impotence underwent X-ray, ultrasound, and magnetic resonance imaging (MRI) examinations, revealing calcification in the DAMT. Treatment consisted of UGPL. The patient's pain level was assessed using the visual analog scale (VAS) initially and after 30 days of treatment. Upon initial assessment, the patient reported a VAS score of 9 out of 10. After 30 days of completing the treatment, the symptoms ceased. Follow-up imaging (X-ray, ultrasound, and MRI) showed only very tiny fragments of calcification remaining. Conclusions: UGPL is an effective technique for treating calcific tendinopathy of the DAMT insertion into the medial femoral condyle of the knee, offering significant pain relief and functional improvement. This case highlights the importance of considering this rare condition in the differential diagnosis of medial knee pain.

Case Report: Surgical management of medial collateral ligament calcification

Calcification is a self-limiting disease, characterized by the deposition of calcium, causing severe pain, swelling, and movement disorder. It is mainly found in the shoulder joint but has also been reported in other joints such as the wrist, hip, knee, foot, and ankle. However, calcification of the medial collateral ligament (MCL) has been rarely reported. The patient was a 47-year-old female without any trauma, whose chief complaint was pain and impaired flexion-extension of the affected knee joint. The diagnosis was calcification of the MCL, subsequently demonstrated by imaging examination. Conservative treatment was initially attempted, followed by arthroscopic surgery, and the postoperative pathological results confirmed the calcified tendon. The patient had a favorable prognosis 1 month after the procedure. This study demonstrates that arthroscopic surgery can result in effective and swift recovery of clinical outcomes for patients with calcification of the MCL.

Calcific bursitis of the Gruberi bursa: a case report

BACKGROUND

Bursitis is the inflammation of a synovial bursa, a small synovial fluid-filled sac that acts as a cushion between muscles, tendons, and bones. Further, calcific bursitis results from calcium deposits on the synovial joint that exacerbates pain and swelling. The Gruberi bursa is located dorsolaterally in the ankle, between the extensor digitorium longus and the talus. Despite limited literature on its pathophysiology, the aim of this case is to discuss the bursa's association with calcific bursitis and its management via a case presented to our clinic.

CASE PRESENTATION

A 47-year-old Caucasian female with no past medical or family history presents with acute right ankle pain following a minor injury 3 months prior with no improvement on analgesic or steroid therapy. Imaging demonstrated incidental calcium deposits. The day prior to presentation, the patient stated she used 1-pound ankle weights that resulted in mild swelling and gradual pain to the right dorsoanterior ankle. Physical exam findings displayed a significant reduction in the range of motion limited by pain. Imaging confirmed calcification within the capsule of the talonavicular joint, consistent with Gruberi bursitis. Initial management with prednisone yielded minimal improvement, requiring an interventional approach with ultrasound-guided barbotage that elicited immediate improvement.

CONCLUSION

The presented case report highlights a rare and unique instance of acute ankle pain and swelling caused by calcific Gruberi bursitis in a young female. Although the Gruberi bursa is a relatively new discovery, it contains inflammatory components that may predispose it to calcification and should be considered in the differential of ankle swelling. Therefore, utilizing a systematic approach to a clinical presentation and considering all differential diagnoses is essential.

Ultrasound-guided treatment of medial collateral ligament calcification of the knee with TenJet™: a case report

Calcification of the medial collateral ligament is a rare cause of medial knee pain along with functional impairment. Most cases are asymptomatic but those that are symptomatic typically respond to conservative management. However, in those instances with persistent symptoms that desire further intervention but want to minimize the risks associated with surgery, we present a novel approach for calcium removal with an ultrasound-guided percutaneous needle tenotomy with TenJet™ as a reasonable treatment modality.

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

Chronic injury to the medial collateral ligament (MCL) is common following an acute knee injury. This case report presents two patients that failed to respond to conservative treatment with clinical evidence of an MCL injury and radiographic finding of a benign-appearing soft tissue lesion in the MCL. Calcified or ossified lesions have been described with chronic MCL injuries. Ossification and calcification of the MCL have been observed as potential causes of chronic MCL pain. Here, we detail the distinction between these two distinct intra-ligamentous heterotopic deposits and describe a novel treatment approach using ultrasonic percutaneous debridement, a technique that is typically reserved for tendinopathies. In both cases, pain improved, and they were able to return to their prior level of function.

Ultrasound-guided percutaneous treatment of a calcific acromioclavicular joint: A case report

RATIONALE

Calcific tendinopathy is one of the most frequent causes of nontraumatic shoulder pain. However, intra-articular calcifications appear to be an infrequent condition. We herein report a rare case study of an intra-articular calcification of the acromioclavicular joint.

PATIENT CONCERNS

A 46-year-old man presented with an acute pain in the anterior superior region of the left shoulder which also radiated to the left cervical region. The man during the physical evaluation also presented severe functional limitation of the shoulder movements in all planes of motion.

DIAGNOSES

The diagnosis was carried out through a radiographic and an echotomographic examination, highlighting the intra-articular calcific formation associated to a reactive inflammatory reaction.

INTERVENTIONS

An ultrasound-guided percutaneous treatment following the guidelines for calcific tendinopathy of the shoulder was carried out.

OUTCOMES

The posttreatment was satisfactory with the disappearance of the pain and the recovery of the shoulder movements in all planes of motion.

LESSONS

We can affirm that the ultrasound-guided percutaneous treatment in patients with calcification of the acromion-clavicular joint represents a valid and nonpainful therapeutic treatment.

Calcium hydroxyapatite deposition disease: Imaging features and presentations mimicking other pathologies

OBJECTIVE

Calcium hydroxyapatite depositional disease (HADD) is usually asymptomatic and self-limiting; however, when there is an associated inflammatory process or HADD occurs in an unusual location, it may mimic trauma, infection, or neoplasm. The purpose of this article is to review the imaging features of HADD and how to distinguish it from more worrisome entities that can have similar appearances.

CONCLUSION

An understanding of the presentations of HADD is important to allow early and confident diagnosis. In particular, familiarity with presentations that resemble more ominous pathologies is essential to avoid costly and time-consuming workup or intervention.

Treatment of a calcific bursitis of the medial collateral ligament: a rare cause of painful knee

Medial knee pain is common in clinical practice and can be caused by various conditions. In rare cases, it can even be by calcific bursitis of the medial collateral ligament (MCL). Treatment of calcific bursitis and/or calcification of the MCL classically includes observation, local injections, shockwave therapy and surgical resection. We report a case of nontraumatic medial knee pain poorly responsive to conservative treatments. Ultrasound (US) imaging revealed a massive lobed hyperechoic formation with partial acoustic shadow in the MCL context compatible with calcific bursitis, and magnetic resonance imaging (MRI) confirmed the presence of the bursa's calcific deposit surrounded by hyperintense signal compatible with pericalcific edema. We performed a double-needle ultrasound-guided percutaneous lavage (UGPL), which is today a fairly common treatment for many musculoskeletal disorders, such as rotator cuff calcific tendinopathy and elbow extensor tendons pathology, but regarding the knee, it is not part of ordinary care. This report shows the clinical and imaging presentation of calcific bursitis of the MCL and describes in detail the technique to perform the UGPL with a system of two needles, two syringes and a double connection to ensure a correct lavage of the calcium deposit without significant intrabursal pressure increase and consequently without pain during the procedure.