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.

[Symptomatic calcification of the lateral collateral knee ligament]. / Symptomatische Verkalkung des lateralen Kniegelenkkollateralligaments.

We describe a case of symptomatic calcification of the lateral collateral knee ligament in a 53-year-old female patient. The calcification became extremely painful and increased in size and it was decided to resect the calcification operatively because of pain progression. After operative resection of the deposits the patient is currently free of complaints and relapse-free after 4.5 years. In the literature four cases of calcification of the medial collateral ligament are described which were also successfully treated by operative resection.

Anatomical considerations in multiligament knee injury and surgery.

The management of multiligament knee injury mandates a comprehensive understanding of the anatomy on all sides of the joint. Imperative to repair or reconstructive procedures is an intimate knowledge of the structure of the cruciate and collateral ligaments, as well as the complex confluence of structures that comprise the posteromedial and posterolateral corners. Beyond the ligamentous anatomy, the surgeon must also be aware of the potential for neurologic and vascular compromise-both from injury and from treatment-that can often complicate multiligament knee injuries. In this article, we outline the basic anatomy and biomechanical function of the ligamentous structures of the knee, structures at risk, and the patterns of injury seen with knee dislocations and multiple ligament knee injuries in general.

[Soft tissue management in knees with varus deformity. Computer-assisted sequential medial ligament release]. / Weichteilmanagement bei der Varusgonarthrose. Der navigationsgestützte schrittweise mediale Bandrelease.

BACKGROUND: Knees with severe varus deformities and contractures of the medial and lateral collateral ligaments and the posterior capsule require special soft tissue management to gain a stable knee over the full range of movement. The introduction of navigation systems into knee surgery has now made precise measurement of the leg axis and gap size possible. METHODS: Ten knee joints received a computer-assisted total knee replacement (Ci navigation system DePuy) I-Orthopaedics, Munich). The change of the leg axis and the size of the mediolateral gaps were measured and documented when performing a standardized medial ligament release sequence. RESULTS: We found a significant effect after each release step regarding the change of the leg axis as well as the gap width (p<0.001). The highest effect was seen for the 6-cm capsule release in extension and the release of the medial collateral ligament in 90 degrees flexion. CONCLUSION: Implementation of computer-assisted navigation facilitates visualization and quantification of the effect of the sequential medial soft tissue release in total knee arthroplasty.