What is Pellegrini Stieda Syndrome and How is it Treated?
What is Pellegrini Stieda Syndrome?
Pellegrini-Stieda Syndrome is a pathological condition in which an individual has pain and limitations in range of motion of the knees following an injury to the medial collateral ligament of the knee.1 This injury to the MCL is normally caused due to ossification of the femoral attachment. The calcified lesion formed thereof is termed as Pellegrini-Stieda Lesion. Normally the Pellegrini-Stieda lesions are asymptomatic. A condition is said to be Pellegrini-Stieda Syndrome when this calcified lesion becomes symptomatic causing pain and restriction of movement of the knee.
What are the Causes of Pellegrini Stieda Syndrome?
The root cause of Pellegrini-Stieda Syndrome is an injury at the attachment site of the Medial Collateral Ligament to the Medial Condyle. This injury can occur due to direct trauma to the femur like being hit by ball on the inside part of the knee at good speed such as when playing ice hockey. It can also occur after an injury due to over stretching of the medial collateral ligament. Due to this, there can be development of edema or hematoma along with inflammation.
What are the Symptoms of Pellegrini Stieda Syndrome?
The classic presenting symptom for Pellegrini-Stieda Syndrome is pain and localized swelling immediately following the injury.2 Unlike the other similar injuries to the knees which resolve with a period of rest, ice, and anti-inflammatory medication, Pellegrini-Stieda Syndrome does not resolve and in fact worsens with time. Over time, the knees become increasingly stiff and the movement of the knee becomes significantly limited. The patient suffering from Pellegrini-Stieda Syndrome also finds it tougher to stretch and twist the knee. In some cases of Pellegrini-Stieda Syndrome, a lump is also seen in the knee which is tender to palpation.
How is Pellegrini Stieda Syndrome Diagnosed?
In order to diagnose Pellegrini-Stieda Syndrome, the treating physician will conduct a detailed physical examination of the patient. On taking the history, the patient would have complaints of recurrent pain and swelling in the inner part of the knee.3 The patient may give a history of an injury may be a few month back or even further. There will be palpable tenderness over the medial part of the knee. Physical examination will also show difficulty and pain with passive extension of the knee.
How is Pellegrini Stieda Syndrome Treated?
To begin with, the treatment of Pellegrini-Stieda Syndrome is started with taking NSAIDs in the form of Tylenol or aspirin. In case if this treatment is not effective then a steroid can also be administered. In some cases of Pellegrini-Stieda Syndrome, surgery is recommended which has shown good results for treatment of Pellegrini-Stieda Syndrome. Post surgery, the patient does not complain of pain and has full range of motion.
Physical therapy is also an important aspect of treatment of Pellegrini-Stieda Syndrome. Once the inflammation has calmed down, then the patient can start with certain knee exercises like heel slides, seated knee bending exercises, and knee bending to the stomach. The patient can also do knee strengthening exercises in order to treat Pellegrini-Stieda Syndrome.
The physical therapy exercises for treating Pellegrini-Stieda Syndrome are:
Physical Therapy Exercises #1 For Treating Pellegrini-Stieda Syndrome- Heel Slides: This exercise is done to improve range of motion of the knee. To do this exercise, you need to lie down on a hard surface on your back. The heel is now slowly moved towards the buttocks as far as comfort allows. Maintain this position for a few seconds and then come back to normal. You can repeat this exercise three or four times.
Physical Therapy Exercises #2 For Treating Pellegrini-Stieda Syndrome- Knee Bending: To do this exercise, you need to stand straight. Now try and bend the knee as much as possible and as much as comfort allows. Maintain the position for a few seconds and then come back to normal position. Repeat this two to three times a day.
Physical Therapy Exercises #3 For Treating Pellegrini-Stieda Syndrome- Knee Bending to the Stomach: This is also an easy exercise. In this you need to lie down on your back and then bend the legs at the knees and bring them up to as close to the stomach as possible and as comfort allows. Repeat this three to four times a day.
Once you can do these exercises comfortably you can increase the number of times you do these exercises for treating Pellegrini-Stieda Syndrome.