Case report
Pellegrini–Stieda syndrome: More than a radiological sign
Síndrome de Pellegrini–Stieda: más allá que un signo radiológico
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A la derecha en la adquisición coronal con información T1 de la rodilla se hace evidente una osificación en el extremo proximal del ligamento colateral medial, en relación con una lesión antigua, configurando una lesión de Pellegrini-Stieda. Se observan además cambios artrósicos por formación de osteofitos marginales en el compartimento medial.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Pablo Restrepo, María del Pilar Molina" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Juan Pablo" "apellidos" => "Restrepo" ] 1 => array:2 [ "nombre" => "María del Pilar" "apellidos" => "Molina" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2444440516300498" "doi" => "10.1016/j.rcreue.2016.12.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444440516300498?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S012181231630024X?idApp=UINPBA00004N" "url" => "/01218123/0000002300000003/v1_201609170050/S012181231630024X/v1_201609170050/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2444440516300395" "issn" => "24444405" "doi" => "10.1016/j.rcreue.2016.09.002" "estado" => "S300" "fechaPublicacion" => "2016-07-01" "aid" => "82" "copyright" => "Asociación Colombiana de Reumatología" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "crp" "cita" => "Rev Colomb Reumatol. 2016;23:213-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1965 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 1500 "PDF" => 415 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Co-existence of peripheral neuropathy secondary to lead poisoning and chronic polymyositis: Case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "213" "paginaFinal" => "217" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Coexistencia de neuropatía periférica secundaria a intoxicación crónica por plomo y polimiositis: Reporte de caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 776 "Ancho" => 932 "Tamanyo" => 96150 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Immunohistochemical study with presence of types 1 and 2 fibers with “chessboard” distribution. 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At the right side in the coronal acquisition with T1 information of the knee becomes evident an ossification in the proximal end of the medial collateral ligament, in relation with an old-injury, configuring a Pellegrini–Stieda lesion. Osteoarthritic changes with formation of marginal osteophytes in the medial compartment are also observed.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 51-year-old male patient who 12 years ago presented traumatic twisting of the right knee; a rupture of the anterior cruciate ligament was diagnosed by MRI, which was managed conservatively with NSAID, immobilization and physical therapy with complete resolution of his clinical picture. Five years later the patient began having pain in both knees, mainly in the right, that was exacerbated with physical activity and improved with rest at the beginning of the clinical picture. Subsequently, it became permanent and for this reason various types of NSAIDs were prescribed without having achieved pain control for several years. The patient consulted to Rheumatology where the diagnosis of osteoarthritis of the knees was considered, but in view of the finding of pain localized in the inner side of the right knee.</p><p id="par0010" class="elsevierStylePara elsevierViewall">It was performed a MRI scan that reported: thickened and irregular anterior cruciate ligament with poor definition of its fibers and apparent intrasubstance cicatrization, osteophytes in the medial femorotibial compartment and in the inferior pole of the patella, intrasubstance chondromyxoid degenerative changes of the posterior horn of the medial meniscus; similar findings in the articular cartilage of the medial tibial plateau and the posterior region of the femoral condyle, in addition to the existence of a bone fragment of 11<span class="elsevierStyleHsp" style=""></span>mm in length on the inside of the medial collateral ligament (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). With the above-mentioned findings it was considered that the patient coursed with a knee osteoarthritis secondary to traumatic meniscal injury and a Pellegrini–Stieda syndrome (PSS), therefore, it was performed lateral infiltration in the medial collateral ligament, physical therapy, and acetaminophen 1<span class="elsevierStyleHsp" style=""></span>g TID with partial improvement of his pain.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Literature review</span><p id="par0015" class="elsevierStylePara elsevierViewall">Pellegrini in 1905 was the first to describe the sign of Pellegrini–Stieda<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and, subsequently, in 1908 Stieda reported the first series of 5 cases.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> The radiological sign of Pellegrini–Stieda is the proximal calcification of the medial collateral ligament of the knee, after a direct or indirect trauma thereof. The radiological findings plus the clinical symptomatology of pain and restriction in the ranges of motion are known under the name of PSS.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> The incidence of the PSS is unknown, but the preponderance in the male gender between 25 and 40 years of age is clear,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> being rare in children and older people. There is always a relationship with a trauma on the knee or in a distant site such as the skull or the vertebral column,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> but the repetitive traumatic antecedent is not necessary for its appearance. Calcification may occur in the month following the trauma and, in some cases, it has exceptionally spontaneously disappeared.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> The pathophysiology of the disease is also unclear. The trigger for the PSS could be an avulsion of the medial femoral condyle or a tear of ligaments, tendons (ischiocondylar portion of the adductor magnus). It is postulated that soft tissue edema and the subsequent deposition of hydroxyapatite or calcium pyrophosphate is generated after a traumatic injury. The majority of patients are asymptomatic. In the clinical examination can be found pain localized in the medial aspect of the knee and limitation of the flexion–extension movements of the joint. On conventional radiology can be observed a linear or curved calcification that starts from the origin the medial collateral ligament and that may extend almost to the insertion thereof.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Mendes et al., described 4 types of ossification: I: beak-shaped with inferior orientation and union to the femur, II: drop-shaped with inferior orientation and parallel to the femur, III: elongated with superior orientation, IV: with superior orientation and inferior attached to the femur.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> The treatment of the PSS is usually conservative. Measures such as rest, physical therapy, steroids and lidocaine injections have been successfully used. In severe cases where there is limitation in the movements of damage of the medial collateral ligament, surgical excision of the calcification and ligament repair have been performed with good outcomes. Their removal in early stages of the disease is not recommended because of the high risk of relapse.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Ethical disclosures</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare they do not have any conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres790699" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec788999" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres790700" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec789000" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Literature review" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-07-06" "fechaAceptado" => "2016-03-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec788999" "palabras" => array:4 [ 0 => "Ossification" 1 => "Heterotopic" 2 => "Medial collateral ligament" 3 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec789000" "palabras" => array:4 [ 0 => "Osificación" 1 => "Heterotópica" 2 => "Ligamento colateral medial" 3 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Pellegrini–Stieda sign is a calcification of the medial collateral ligament of the knee after trauma. The presence of symptoms associated with radiological findings is known as Pellegrini–Stieda syndrome. Pain is the main element that characterizes the disease. Treatment ranges from rest, physical therapy, use of NSAIDs, glucocorticoid injection, and even surgery in severe and recalcitrant cases.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El signo de Pellegrini–Stieda es la calcificación del ligamento colateral medial de la rodilla posterior a trauma. La presencia de síntomas asociados a los hallazgos radiológicos se conoce con el nombre de síndrome de Pellegrini–Stieda. El dolor es el principal elemento caracterizador de la enfermedad. El tratamiento varía desde reposo, fisioterapia, uso de antiinflamatorios no esteroides, infiltración con glucocorticoides hasta cirugía, en casos severos y recalcitrantes.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Restrepo JP, Molina MP. Síndrome de Pellegrini–Stieda: más allá que un signo radiológico. Rev Colomb Reumatol. 2016;23:210–212.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1005 "Ancho" => 2500 "Tamanyo" => 318426 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">At the left side on the AP radiography of the knees is observed calcification of the medial collateral ligament in its proximal portion, in addition to a decrease in the medial femorotibial space. At the right side in the coronal acquisition with T1 information of the knee becomes evident an ossification in the proximal end of the medial collateral ligament, in relation with an old-injury, configuring a Pellegrini–Stieda lesion. Osteoarthritic changes with formation of marginal osteophytes in the medial compartment are also observed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic calcification of the collateral tibial ligament of the knee joint" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. 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Ercidogan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PHM.0b013e318174eb1b" "Revista" => array:5 [ "tituloSerie" => "Am J Phys Med Rehabil" "fecha" => "2008" "volumen" => "87" "paginaInicial" => "514" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18496254" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-traumatic para-articular ossification of the knee joint (Pellegrini–Stieda's disease)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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Bryce" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMicm040406" "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "354" "paginaInicial" => "e1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16394294" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pelligrini–Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of tibial collateral ligament-anatomic and imaging investigation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.F.A. Mendes" 1 => "M.L. Pretterklieber" 2 => "J.H. Cho" 3 => "G.M. Garcia" 4 => "D.L. Resnick" 5 => "C.B. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00256-006-0174-5" "Revista" => array:6 [ "tituloSerie" => "Skeletal Radiol" "fecha" => "2006" "volumen" => "35" "paginaInicial" => "916" "paginaFinal" => "922" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16988801" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24444405/0000002300000003/v1_201701180108/S2444440516300498/v1_201701180108/en/main.assets" "Apartado" => array:4 [ "identificador" => "53647" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24444405/0000002300000003/v1_201701180108/S2444440516300498/v1_201701180108/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444440516300498?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 39 | 1 | 40 |
| 2024 October | 274 | 28 | 302 |
| 2024 September | 327 | 48 | 375 |
| 2024 August | 308 | 25 | 333 |
| 2024 July | 474 | 14 | 488 |
| 2024 June | 311 | 20 | 331 |
| 2024 May | 352 | 14 | 366 |
| 2024 April | 289 | 7 | 296 |
| 2024 March | 322 | 17 | 339 |
| 2024 February | 329 | 10 | 339 |
| 2024 January | 398 | 18 | 416 |
| 2023 December | 285 | 18 | 303 |
| 2023 November | 335 | 38 | 373 |
| 2023 October | 512 | 13 | 525 |
| 2023 September | 269 | 5 | 274 |
| 2023 August | 243 | 5 | 248 |
| 2023 July | 279 | 23 | 302 |
| 2023 June | 233 | 11 | 244 |
| 2023 May | 273 | 14 | 287 |
| 2023 April | 305 | 9 | 314 |
| 2023 March | 301 | 23 | 324 |
| 2023 February | 238 | 15 | 253 |
| 2023 January | 265 | 14 | 279 |
| 2022 December | 187 | 22 | 209 |
| 2022 November | 235 | 13 | 248 |
| 2022 October | 246 | 26 | 272 |
| 2022 September | 297 | 17 | 314 |
| 2022 August | 297 | 25 | 322 |
| 2022 July | 237 | 15 | 252 |
| 2022 June | 353 | 26 | 379 |
| 2022 May | 379 | 21 | 400 |
| 2022 April | 290 | 18 | 308 |
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| 2022 January | 324 | 17 | 341 |
| 2021 December | 316 | 29 | 345 |
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| 2021 October | 308 | 26 | 334 |
| 2021 September | 217 | 16 | 233 |
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| 2021 July | 254 | 10 | 264 |
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| 2021 May | 250 | 26 | 276 |
| 2021 April | 503 | 24 | 527 |
| 2021 March | 259 | 37 | 296 |
| 2021 February | 229 | 25 | 254 |
| 2021 January | 343 | 22 | 365 |
| 2020 December | 454 | 17 | 471 |
| 2020 November | 518 | 22 | 540 |
| 2020 October | 270 | 18 | 288 |
| 2020 September | 324 | 14 | 338 |
| 2020 August | 333 | 26 | 359 |
| 2020 July | 261 | 16 | 277 |
| 2020 June | 226 | 18 | 244 |
| 2020 May | 259 | 24 | 283 |
| 2020 April | 186 | 8 | 194 |
| 2020 March | 234 | 10 | 244 |
| 2020 February | 252 | 20 | 272 |
| 2020 January | 202 | 11 | 213 |
| 2019 December | 203 | 15 | 218 |
| 2019 November | 249 | 6 | 255 |
| 2019 October | 233 | 14 | 247 |
| 2019 September | 230 | 6 | 236 |
| 2019 August | 159 | 5 | 164 |
| 2019 July | 184 | 18 | 202 |
| 2019 June | 280 | 32 | 312 |
| 2019 May | 356 | 63 | 419 |
| 2019 April | 233 | 52 | 285 |
| 2019 March | 120 | 20 | 140 |
| 2019 February | 126 | 33 | 159 |
| 2019 January | 89 | 17 | 106 |
| 2018 December | 97 | 22 | 119 |
| 2018 November | 78 | 23 | 101 |
| 2018 October | 67 | 9 | 76 |
| 2018 September | 57 | 25 | 82 |
| 2018 August | 17 | 58 | 75 |
| 2018 July | 13 | 22 | 35 |
| 2018 June | 16 | 16 | 32 |
| 2018 May | 11 | 33 | 44 |
| 2018 April | 11 | 22 | 33 |
| 2018 March | 10 | 10 | 20 |
| 2018 February | 4 | 10 | 14 |
| 2018 January | 10 | 15 | 25 |
| 2017 December | 8 | 11 | 19 |
| 2017 November | 10 | 16 | 26 |
| 2017 October | 9 | 9 | 18 |
| 2017 September | 9 | 3 | 12 |
| 2017 August | 9 | 17 | 26 |
| 2017 July | 12 | 20 | 32 |
| 2017 June | 10 | 28 | 38 |
| 2017 May | 22 | 21 | 43 |
| 2017 April | 21 | 19 | 40 |
| 2017 March | 18 | 11 | 29 |
| 2017 February | 7 | 16 | 23 |
| 2017 January | 4 | 1 | 5 |
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