ABSTRACT
Introduction: 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). Objective: The aim of the study was to discuss UGPL as management for Pellegrini-Stieda with suspected similar pathomechanism to rotator cuff calcification. Case Report: 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. Conclusion: 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.
ABSTRACT
Background: Proximal tibia vara has drawn interest since the concept of constitutional varus was introduced. Proximal tibia vara is a condition where the knee varus tilt the tibia condyle medially and shift the tibial articular surface medially. This condition affects medial proximal tibial angle measurements and the placement of the tibial implant in knee replacement surgery. Thus, it challenged the neutral knee arthroplasty alignment target because some people may present a proximal tibia vara. This study assesses the prevalence of the proximal tibia vara and the correlation to knee osteoarthritis grade. Methods: This retrospective study was carried out from January 2021 to June 2021. Eighty-five limbs were included with the following inclusion criteria: knee osteoarthritis patients who received a long view lower extremity radiograph. The exclusions criteria were (1) patients who had undergone arthroplasty and lower extremity surgery before and (2) valgus knee deformity. The outcomes in this study were HKAA, MAD, TAD, MPTA, PTRP, LDFA, and PTS. Intraclass correlation (ICC) using two-way mixed was used to assess the reproducibility of the radiographic parameters. Multiple logistic regression was used to evaluate the correlation between knee osteoarthritis grade and radiographs parameters (MAD and TAD). Result: A total 85 limbs from 52 patients were assessed in this study. Proximal tibia vara was found in 18 knees (21%.). The logistic regression was performed to assess the correlation between the severity of the knee osteoarthritis and radiographic parameters (MAD, TAD, LDFA, and PTS) with an overall p-value < 0.001 and pseudo-R2 = 0.29. Conclusion: A significant portion of patients with knee osteoarthritis have proximal tibia vara, and it is a pre-existing condition. Since the pre-existing proximal tibia vara affects preoperative measurements, a long-standing lower extremity x-ray is recommended to be obtained as part of knee replacement preparation.
ABSTRACT
Introduction: Calcification in the tendon (Calcific Tendinitis) occurs commonly in the shoulder, but this condition can happen in other tendon sites. Calcific tendinitis of the hand and wrist occurs rarely, which causes unfamiliarity toward the disease. With the symptoms mimicking other causes, misdiagnosis often happens. This can cause ineffective and over treatment. Case Report: A 51-year-old man presented with a 2-week-pain on his right wrist with localized erythema and tenderness on physical examination. Imaging with ultrasound and X-ray shows calcification on the flexor carpi ulnaris tendon. Patient was treated with splinting for 2 weeks and NSAID for pain management and was free of pain afterwards. Conclusion: Calcific tendinitis mimics the symptoms of various causes. The ability to differentiate this entity to other differential diagnosis leads to an effective and precise treatment.
