MR imaging of calcification of the lateral collateral ligament of the knee: a rare abnormality and a cause of lateral knee pain

Acute calcific periarthritis-a commonly misdiagnosed pathology

Acute calcific periarthritis (ACP) is a self-limiting, monoarticular, peri-articular process of dystrophic mineral deposition and adjacent inflammation. Patients present with a sudden onset of pain, localised swelling, erythema, tenderness and restricted range of motion. Symptoms reduce in severity within 4-7 days and self resolve in 3-4 weeks. ACP is commonly misdiagnosed, in particular, as infective or inflammatory pathologies such as septic arthritis and gout. This condition has specific imaging findings which allows differentiation from other disorders when combined with the clinical presentation. Prompt diagnosis results in appropriate management and reduces the likelihood of unnecessary diagnostic and therapeutic procedures.

Symptomatic calcification of the lateral collateral ligament: a case report

Symptomatic calcification is an entity in which hydroxyapatite calcific deposits cause inflammation, then burst and dissolve into the surrounding structures. Although a well-known pathologic condition in the rotator cuff tendons, it can also occur in other structures of the locomotor system. Radiographs are usually taken at the initial examination but can also be useful for follow-up evaluation of the course of the calcified matter. Here, we present a case of symptomatic calcification of the lateral collateral ligament of the knee, in which movement of the calcified matter could be observed both by radiography and magnetic resonance imaging as correlated with the clinical symptoms.

Calcific tendinitis of biceps femoris: an unusual site and cause for lateral knee pain

A 37-year-old man presented to the acute knee and sports medicine clinic with atraumatic lateral knee pain. He had point tenderness over the lateral aspect of his knee which had not settled with anti-inflammatory medications. Imaging revealed a large opaque lesion lateral to the knee and although there was no clear mechanism, injury to the posterolateral corner was considered. An MRI subsequently revealed a rare case of calcific tendinitis to the biceps femoris tendon insertion. This condition was self-limiting and did not require interventions such as steroid injections. This is the first reported case of calcific tendinitis of biceps femoris as a cause of acute knee pain.

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

BACKGROUND

Calcification 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 PRESENTATION

Calcification 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.

CONCLUSION

This 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.

Acute calcific periarthiritis of the knee presenting with calcification within the lateral collateral ligament

A 71-year-old woman was admitted with acute swelling of the right knee, pain on the lateral aspect and restricted movement. There was no instability or locking. She had no history of trauma and was generally in good health. Plain radiographs demonstrated a calcific opacity adjacent to the lateral femoral condyle. This was shown to be within the lateral collateral ligament (LCL) at ultrasound and MRI. A diagnosis of acute calcific periarthritis (ACP) was made. The patient's symptoms resolved within a few weeks with simple analgaesia. ACP presenting with calcification within the LCL is rare. It is important to recognise the clinical and imaging findings of this condition as it may mimic other more serious pathologies such as infection and gout. This may result in unnecessary investigations, misdiagnoses and incorrect treatments.

Calcium deposits in the hand and wrist

Calcium, or calcific, deposition disease in the form of acute calcific periarthritis of the hand and wrist is an uncommon entity that may be confused with more common crystalline or inflammatory arthropathies as well as infection. It is important for the clinician to be aware of this disease process and to include it in the differential diagnosis of patients presenting with acutely painful, focal inflammation of the hand or wrist. Nonsurgical management is often sufficient; however, considering the self-limited nature of the disease, accurate diagnosis is essential to avoid unnecessary antibiotic or surgical treatment.

Arthroscopic management of calcific tendonitis of the medial collateral ligament

Calcific tendinitis most commonly occurs to the shoulder, but may also involve other structures of the locomotor system. It is a rare cause of knee pain. We report a 46-year-old woman with severe medial knee pain and limitation of movement in her right knee. There was a marked tenderness site at the proximal insertion of the medial collateral ligament (MCL). Flexion was able to provoke the painful symptoms in the medial knee. The involvement of differentiated diagnoses were excluded by history, laboratory and radiograph examinations, while X-ray, CT and MRI suggested calcific tendonitis of the MCL. Due to the failure of conservative treatments, we offered her arthroscopic excision of calcific deposit which was sent for biopsy. Histopathological evaluation confirmed the diagnosis of calcific tendinitis. This patient recovered shortly afterwards with immediate resolution of symptoms following excision. Thus far, calcifications involving the MCL have been documented thrice. Calcific tendonitis of the MCL diagnosed and treated by arthroscopy has not previously been reported, which can be challenging to diagnose and treat because of its rarity. Although conservative treatment appears to be frequently satisfactory, arthroscopic excision may be a better option for the refractory or severe cases.

Symptomatic calcification of the anterior cruciate ligament: A case report

We report a rare case of symptomatic calcification of the ACL. A 31-year-old man complained of severe knee pain with restriction of knee motion from 30° to 130° for a week. Plain radiographs and multi-planar CT revealed calcification within the intercondylar notch with no osteoarthritic changes. MRI revealed a low signal intensity mass near the intact ACL. The ACL appeared bulged by arthroscopy and white and creamy fluid exuded from the partially excised synovial membrane. Pain subsided immediately postoperatively. Histologically, the calcific deposit near the ACL showed negligible degenerative changes and resembled calcifying tendinitis of the rotator cuff. Although calcific deposits rarely affect the knee joint, calcification of the ACL should be included in differential diagnoses for acute knee pain and restricted range of motion such as mechanical locking. This case illustrates that arthroscopic removal of the deposits can be effective.

Acute calcific periarthritis of the hand and wrist: a series and review of the literature

This article presents three patients with acute calcific periarthritis (ACP) of the hand and wrist. ACP is an unusual, painful, monoarticular, periarticular inflammatory process associated with juxtaarticular deposits of amorphous calcium hydroxyapatite. ACP is a distinct clinical subset of hydroxyapatite deposition disease. ACP has a high rate of misdiagnosis because of its rare occurrence and its clinical resemblance to other entities. Clinical presentation may simulate infection, and the associated periarticular calcifications may be mistaken for gout, pseudogout, or other entities. One third of patients with ACP provide a history of antecedent trauma. Treatment is conservative. Patients typically will have a reduction in symptoms within 4-7 days after the acute onset of pain. Radiographically, the periarticular mineralization usually resolves or markedly decreases within 2-3 weeks, although on occasion, some calcifications may remain visible for months. Failure to recognize and correlate the typical clinical and radiographic presentation of this disease may lead to unnecessary diagnostic tests, invasive procedures, and inappropriate medication.

Calcific Tendinosis and Periarthritis

Calcification within tendon and periarticular soft tissues with or without a history of pain is commonly encountered in the interpretation of musculoskeletal MR imaging (MRI) studies. This article presents a pictorial illustration of both the classic and atypical MR imaging (MRI) features of soft tissue calcifications in the musculoskeletal system. Familiarity with this topic can help to avoid pitfalls in imaging diagnosis.

Calcium pyrophosphate dihydrate and calcium hydroxyapatite crystal deposition diseases: imaging perspectives

Calcium pyrophosphate dihydrate crystal deposition disease and calcium hydroxyapatite deposition disease are common crystal diseases that have characteristic imaging appearances. This article gives a background on each disorder and discusses the qualities that distinguish them from each other and from other arthropathies.