Pellegrini-Stied syndrome. Degenerative calcifying periarthritis - Pellegrini-Stida disease in the knee joint Treatment of calcifying periarthritis

Pellegrini - Shtidy's disease(A. Pellegrini, Italian surgeon; A. Stieda, German surgeon, 1869-1945; synonym: Pellegrini-Stied syndrome, calcifying periarthritis of the knee joint) - a disease characterized by foci of heterotopic bone formation in the periarticular tissues of the medial epicondyle of the femur due to previous trauma. For the first time, the clinical, radiological and pathomorphological picture of the disease was described by A. Pellegrini (1905), believing that it was characterized by calcification of the tibial collateral ligament of the knee joint. A. Shtida (1907) considered the formation of ossification to be a consequence of avulsion of the epicondyle of the femur, resulting from direct injury or sharp contraction of the adductor magnus muscle of the femur. Modern morphological and histochemical studies have shown that the disease is based on a perverted regeneration reaction in response to damage. It is believed that in the occurrence of this metaplasia, in addition to trauma, hemorrhage, necrosis, and prolonged tissue edema, the individual predisposition of the body plays a large role.

The disease develops more often in men aged 25-45 years, mainly among those involved in physical labor or sports. The triggering mechanism is usually a direct blow to the area of ​​the medial epicondyle of the femur, forced abduction of the tibia, or a sharp uncoordinated contraction of the adductor magnus muscle of the thigh. As a result, hemorrhages occur at the site of attachment of the tibial collateral ligament and the tendon of the adductor magnus muscle of the thigh to the epicondyle and aseptic necrosis of tissue in the damaged area.

The main symptom of Pellegrini-Stied disease is pain, which always corresponds to the location of the ossification, and can spread along the obturator nerve or the infrapatellar branch of the saphenous nerve to the anterior surface of the leg. In 1/3 of patients, the pain intensifies at night and is of a burning, boring nature. In addition, there is a limitation of movements in the knee joint, both flexion and extension, which are usually combined with swelling of the soft tissues of the knee joint, local hyperthermia, hyperesthesia or hypoesthesia in the area of ​​edema, as well as atrophy of the muscles of the thigh and lower leg.

In the early period after injury,

Treatment is often conservative. Physiotherapeutic methods are often ineffective, because provide only temporary improvement. The use of ultrasound therapy in combination with electrophoresis of a novocaine solution or 10% sodium chloride solution is effective only in the first 3 months after injury. A lasting positive effect is usually achieved by injections of hydrocortisone with novocaine into the focus of ossification.

Surgical interventions are performed if there is no effect from conservative measures, but not earlier than 3 months after the injury if there are signs of ossification maturity. To do this, the density, structure of the ossification, and the clarity of the sclerotic border are determined on radiographs. Radionuclide data are also used. When combining P. - Sh. b. with internal injuries of the knee joint, especially if the ossification is located near the nerve trunks or when it is introduced into the joint cavity, treatment is only surgical. To prevent recurrence of ossification after surgery, the scars surrounding the ossification are carefully removed,

Pellegrini-Stied disease occurs as a result of frequent injury or severe trauma to the knee joint. In this case, excessive growth of bone tissue occurs, which replaces the cartilage of the internal epicondyle. For a long time, the pathology is asymptomatic and is discovered accidentally during radiography.

The predisposition to developing the disease is inherited and affects mainly young people.

What it is?

Pellegrini-Stied disease is a pathological growth of bone, or in scientific language - ossification of para-aticular tissues in the area of ​​the internal epicondyle of the knee joint. It occurs as a result of injury or frequent microtrauma with significant loads on the joint. The disease does not cause symptoms for a long time, and subsequently leads to ankylosis and immobilization of the knee joint.

Causes

Pellegrini-Stied pathology develops as a result of exposure to the following factors on the human body:

• the presence of a hereditary predisposition;
• hard physical labor;
• playing sports;
• excess body weight;
• frequent hypothermia of the lower extremities;
• presence of varicose veins;
• history of trauma;
• trophic disorders;
• arthritis;
• hormonal imbalances.

Exposure to one or more of these factors provokes increased ossification in the area of ​​the medial epicondyles of the knee. Heredity and the presence of the disease in one of the closest relatives play a huge role in the development of the disease. This is due to the genetically determined characteristics of bone growth. But even in this case, the development of Pellegrini-Stied disease will require severe trauma or prolonged microtrauma.

Symptoms of Pellegrini-Stied disease

For a long time, the pathology is asymptomatic. In this case, the patient may complain of minor pain in the knee, which intensifies after significant exercise or when the weather changes. Later, symptoms of arthropathy appear in the form of swelling, redness of the skin around the joint, increased temperature and disruption of the normal functioning of the limb. The patient may also experience gait disturbances and lameness. With a long course of the process, the volume of physical activity decreases significantly. At the final stages of the development of the disease, a person is not able to make movements in the knee joint, and develops.

How is it diagnosed?

A traumatologist may suspect the development of Pellegrini-Stied disease during a general examination and when asking about the patient’s well-being. To confirm the diagnosis, an X-ray examination is performed in several projections, which clearly visualizes excess bone growths in the area of ​​the knee joint. To more accurately determine the extent of the lesion, magnetic resonance and computed tomography are used. It is also necessary to take a general blood test and determine the level of calcium in the body. To exclude endocrinological pathology, testing for the content of the main parathyroid hormones is indicated.

Treatment of pathology

Therapy for Pellegrini-Stida disease should be comprehensive and include therapeutic techniques that are used in the early stages of the development of the process. In severe cases, surgery is used. Traditional methods of treatment are used as an additional method before the main therapy. At the initial stages of the disease, non-steroidal anti-inflammatory drugs are used, which relieve signs of inflammation and reduce pain. Muscle relaxants, chondroprotectors and vitamin complexes are also indicated.

Herbal medicine using decoctions of anti-inflammatory herbs will be useful.

If the volume of motor activity of the limb decreases, surgery is performed. During its course, the overgrown bone is removed, and the altered cartilage is removed and replaced with its own cartilage tissue taken from other parts of the body. After surgery, the patient requires a long period of rehabilitation. For this purpose, a complex of physiotherapeutic measures is carried out, therapeutic massage and restorative gymnastics are prescribed.

A. Pellegrini described the disease based on clinical and radiological studies. According to his assumption, the pathological morphology represents calcification of the tibial ligaments of the knee joint. A. Shtida described the formation of heterotopic ossifications as a result of separation of bone fragments of the femoral epicondyle due to injury or unintentional sharp contraction of the thigh muscles.

According to Russian doctors, the disease is based on a distorted reaction of restorative resources to the need to restore tissues calcified and damaged by heterotopic bone growths.

Metaplasia also occurs based on genetic predisposition, due to injuries, internal hemorrhages and tissue death.

The pathology is characterized by the appearance of foci of heterotopic bone formations that grow independently of the main bone tissues on the periarticular soft tissues.

In ICD-10, in classes M70-M79, combining “Other soft tissue diseases,” Pellegrini-Stida disease is designated by code M76.4 under the name “Tibial collateral bursitis.”

With the simple development of periarthritis, the pain is minimal and is felt in the affected joint with sudden movements. A slight limitation of mobility begins, and a slight limp is possible.

Acute periarthritis develops after injury or in the absence of timely treatment.

Chronic periarthritis, or “blocked joint,” develops over several years, and irreversible changes form in the soft tissues.

There are primary and secondary forms of Pellegrini-Stida syndrome. Secondary syndrome develops against the background of another disease.

Pathogenesis of Pellegrini-Stida syndrome

The onset of pathological changes is characterized by the formation of tendon ruptures and foci of necrosis in the periosteal muscle tissue. There are no external manifestations yet, so Pellegrini-Stida disease on the knee joints often remains untreated.

The progression of the disease is manifested by severe symptoms and reactive periarthritis. First, the tendon is affected, then the pathology affects the synovial tissue.

Periarthritis is accompanied by tendobursitis - soft tissues in the structure of the knee joint swell. Clinical manifestations are severe limitation of movements, acute prolonged pain.

Targeted therapy leads to the disappearance of pathological signs. Otherwise, residual manifestations of the disease are observed, which leads to its chronic form.

During physical and motor stress, frequent injuries against the background of acute periarthritis, some soft tissues are not supplied with blood and remain vascularized. Foci of necrosis develop on them. Subsequently, the affected tissues become calcified, sclerosed, and secondary reactive inflammation occurs in them.

Tibial collateral bursitis is also called Pellegrini-Stida syndrome in honor of the two scientists who first described its symptoms and clinical picture.

This pathology is post-traumatic in nature. In the area of ​​the periarticular tissues of the medial epicondyle, foci of heterotropic bone tissue formation are formed. The main reason for the development of the disease is the abnormal recovery reaction of the body.

Development usually begins after:

• direct blow to the medial epicondyle of the femur;
• too fast and sharp abduction of the lower leg;
• sharp contraction of the adductor magnus muscle.

Main causes:

• genetic predisposition of the body;
• injury;
• hemorrhage;
• tissue necrosis;
• swelling for a long time.

• the disease manifests itself as sharp pain right at the site of bursitis formation. Over time, it can radiate along the obturator nerve or to the anterior surface of the leg. the pain becomes stronger at night and has a burning, boring character;
• a person feels limited in movements;
• swelling forms in the soft tissues around;
• skin may be hotter and redder than usual;
• the muscles of the lower leg and thigh gradually atrophy.

The problem in diagnosing is that the first manifestations are very similar to a number of other diseases. It is differentiated from an avulsion fracture of the medial epicondyle of the femur, as well as from the process of restructuring in the epicondyle of traction origin.

The formation of bursitis can be determined after about a month using an x-ray. If ossification is felt during palpation, but is not yet visible on the image, it is carried out from several angles to accurately determine the location and nature of the formation.

To understand how mature the ossification is, a radionuclide study is carried out.

In most cases, conservative treatment is carried out. Physiotherapy in this case is ineffective and can only provide temporary improvement.

Ultrasound therapy and electrophoresis with a solution of novocaine or sodium chloride are used. This measure is most effective in the first three months after injury.

The best results are shown by injections into the site of bursitis with a mixture of hydrocortisone and novocaine.

If conservative treatment does not produce results, surgery is performed after three months. To do this, the neoplasm must be already formed and mature. This is determined by x-rays.

Be sure to remove ossification, which is accompanied by damage to the knee or if it is located next to the nerves, as well as when inserted into the joint cavity.

All ossification is carefully removed along with scars to avoid relapse. Cavities in soft tissues are also eliminated.

With timely treatment, the limb is fully restored and the person can lead a normal active life.

To avoid re-formation, you should protect the limb from injury and too much stress. If the slightest problems with bones or joints arise, they should be eliminated immediately, as they can provoke a relapse.

Important manifestations of pathology are tissue damage, compactions and nodules in muscle tissue, painful on palpation or during movement. The muscles themselves become tense. Signs of pathology depend on its location.

Pellegrini-Stida syndrome in the knee joint is characterized by pathology of the muscle tendons and is localized in the soft tissues surrounding the joint.

• pain at the site of inflammation;
• swelling and redness of the skin;
• pain on palpation;
• restriction of motor volume
• decreased tactile sensations.

The disease significantly worsens the quality of life: it brings discomfort, sleep disturbance due to pain, suffering. In the absence of timely treatment, working capacity and the possibility of free movement are limited.

Tibial collateral bursitis - symptoms and treatment

Experts use a combination of several therapy methods:

• conservative;
• medicinal;
• physiotherapeutic;
• surgical

Surgery is used in cases where traditional treatment does not produce results.

Conservative treatment is the main method. Non-steroidal anti-inflammatory drugs are prescribed. As the disease progresses, hormonal drugs and novocaine blockades are added. For severe pain, codeine and intra-articular steroid injections are prescribed.

Physiotherapeutic treatment is prescribed simultaneously with medications to improve blood supply to the affected tissues:

• vibration and electric massage;
• thermal procedures;
• mud applications;
• compresses;
• magnetic laser procedures;
• shock wave procedures;
• ultrasound;
• electrophoresis.

The combination of medication and physiotherapeutic treatment helps improve blood supply to affected tissues and enhance regeneration processes.

Timely treatment of Pellegrini-Stida disease completely restores the function of the knee. Prevention of relapses and transition of the disease to the chronic stage is to prevent knee injuries, physical and motor overload.

The most complete answers to questions

Pellegrini - Stied's disease (m. Pellegrini - Stied), peritendinitis of the knee joint, Stied's shadow or fracture, Stied's disease - Pellegrini, post-traumatic paracondylar ossification of the thigh, paraosseous accompanying shadow of Pellegrini, Keller - Pellegrini - Stied disease. It was first described in 1905 by the Italian physician Pellegrini A., and in 1907 by the German surgeon Stied A. Ossification, located in the soft tissues in the area of ​​the internal femoral condyle. What is it, what are the causes and symptoms, as well as treatment methods, we will consider further.

What kind of disease is this?

Pellegrini-Stida disease is a post-traumatic ossification of paraarticular tissues in the area of ​​the medial epicondyle of the femur. Most authors consider it a disease of traumatic origin. When the internal ligament is torn from the femoral condyle at the site of its attachment, the periosteum rises and a subperiosteal hematoma is formed, which undergoes ossification. The disease develops more often in men aged 25-45 years, mainly among those involved in physical labor or sports.

Most patients are asymptomatic or with minor pain in the medial part of the knee joint.

In cases of timely contact with specialists and the correct prescription of therapy, the prognosis in most cases is favorable and the patient’s complete recovery is observed.

• ICD-10 code: in classes M70-M79, combining “Other soft tissue diseases”, Pellegrini-Stida disease is designated by code M76.4 under the name “Tibial collateral bursitis”.

Causes of the syndrome

The triggering mechanism is usually a direct blow to the area of ​​the medial epicondyle of the femur, forced abduction of the tibia, or a sharp uncoordinated contraction of the adductor magnus muscle of the thigh. As a result, hemorrhages occur at the site of attachment of the tibial collateral ligament and the tendon of the adductor magnus muscle of the thigh to the epicondyle and aseptic necrosis of tissue in the damaged area.

Factors that increase the risk of periarthritis:

• injuries in sports and at work;
• heart attacks;
• arthrosis;
• mental disorders;
• endocrine dysfunction;
• neuroreflex dysfunctions;
• long exposure to dampness;
• age over 40 years.

Exposure to one or more of these factors provokes increased ossification in the area of ​​the medial epicondyles of the knee. Heredity and the presence of the disease in one of the closest relatives play a huge role in the development of the disease. This is due to the genetically determined characteristics of bone growth. But even in this case, the development of Pellegrini-Stied disease will require severe trauma or prolonged microtrauma.

Symptoms of Pellegrini-Stied disease

The onset of pathological changes is characterized by the formation of tendon ruptures and foci of necrosis in the periosteal muscle tissue. There are no external manifestations yet, so Pellegrini-Stida disease on the knee joints often remains untreated.

The progression of the disease is manifested by severe symptoms and reactive periarthritis. First, the tendon is affected, then the pathology affects the synovial tissue.

Characteristic signs of knee joint disease:

• pain in the area of ​​ossification formation;
• irradiation of pain to the front of the leg;
• severity of torment at night;
• dysfunction of active flexion and extension of the knee;
• swelling of soft periarticular structures;
• local increase in skin temperature;
• increased or decreased sensitivity;
• atrophy of the muscular frame of the affected lower limb.

Pellegrini Stied disease may have similar symptoms and signs to other knee diseases, so consult your doctor for an accurate diagnosis.

Diagnostic methods

A doctor may suspect Pellegrini-Stied disease of the knee joint after a physical examination and palpation of the affected area.

Pellegrini-Stied disease on x-ray (left knee joint)

1. To confirm the diagnosis, the patient is prescribed an X-ray examination in several projections simultaneously.
2. In case of a pronounced pathological process, the image clearly visualizes excess bone growths in the area of ​​the diseased knee joint.
3. To determine the extent of the lesion, MRI and CT are required. A blood test is also required to determine the amount of calcium in the body.

Treatment

Pellegrini Stide's disease of the knee joint can be treated with conservative methods and surgery, below we will look at these 2 methods.

Conservative treatment method:

• Pharmacotherapeutic - a course of injections of 1% Novocaine or anesthetic with Hydrocortisone into the area of ​​bone formation.
• Physical - ultrasound therapy: electrophoresis with an anesthetic solution or with 10% sodium chloride, diathermy, course of Bernard diadynamic currents.
• Simultaneously with taking medications, physiotherapeutic treatment is recommended to improve blood circulation in the affected area. The following procedures are particularly effective: electromassage, mud applications, magnetic laser procedures, ultrasound, electrophoresis.

Knee surgery

Surgical interventions are performed if there is no effect from conservative measures, but not earlier than 3 months after the injury if there are signs of ossification maturity.

• To do this, the density, structure of the ossification, and the clarity of the sclerotic border are determined on radiographs. Radionuclide data are also used.
• When Pellegrini-Stida disease is combined with internal damage to the knee joint, especially if the ossification is located near the nerve trunks or when it is introduced into the joint cavity, treatment is only surgical.
• To prevent recurrence of ossification after surgery, the scars surrounding the ossification are carefully removed, since they retain the potential for metaplasia into bone tissue.

A very important factor is competent implementation of postoperative therapy, since there are direct risks of relapse. In the rehabilitation process, electrophoresis, hydrokinesitherapy and therapeutic gymnastics are used.

With timely and competent treatment, as well as the patient’s compliance with therapeutic recommendations, the prognosis for recovery is favorable. After a rehabilitation period, the affected limb regains its function over time. However, the possibility of the disease returning cannot be ruled out.

Tibial collateral bursitis is also called Pellegrini-Stida syndrome in honor of the two scientists who first described its symptoms and clinical picture.

This pathology is post-traumatic in nature. In the area of ​​the periarticular tissues of the medial epicondyle, foci of heterotropic bone tissue formation are formed. The main reason for the development of the disease is the abnormal recovery reaction of the body.

Most often, such bursitis is diagnosed in young men 25-45 years old who engage in heavy physical labor or sports.

Development usually begins after:

• direct blow to the medial epicondyle of the femur;
• too fast and sharp abduction of the lower leg;
• sharp contraction of the adductor magnus muscle.

Main causes:

• genetic predisposition of the body;
• injury;
• hemorrhage;
• tissue necrosis;
• swelling for a long time.

Symptoms

• the disease manifests itself as sharp pain right at the site of bursitis formation. Over time, it can radiate along the obturator nerve or to the anterior surface of the leg. the pain becomes stronger at night and has a burning, boring character;
• a person feels limited in movements;
• around it is formed in soft tissues;
• skin may be hotter and redder than usual;
• the muscles of the lower leg and thigh gradually atrophy.

The problem in diagnosing is that the first manifestations are very similar to a number of other diseases. It is differentiated from an avulsion fracture of the medial epicondyle of the femur, as well as from the process of restructuring in the epicondyle of traction origin.

The formation can be determined in about a month using an x-ray. If it is felt during palpation, but is not yet visible on the picture, it is carried out from several angles to accurately determine the location and nature of the formation.

To understand how mature the ossification is, a radionuclide study is carried out.

Treatment

In most cases, conservative treatment is carried out. Physiotherapy in this case is ineffective and can only provide temporary improvement.

Ultrasound therapy and electrophoresis with a solution of novocaine or sodium chloride are used. This measure is most effective in the first three months after injury.

The best results are shown by injections into the site of bursitis with a mixture of hydrocortisone and novocaine.

If conservative treatment does not produce results, surgery is performed after three months. To do this, the neoplasm must be already formed and mature. This is determined by x-rays.

Be sure to remove ossification, which is accompanied by damage to the knee or if it is located next to the nerves, as well as when inserted into the joint cavity.

All ossification is carefully removed along with scars to avoid relapse. Cavities in soft tissues are also eliminated.

With timely treatment, the limb is fully restored and the person can lead a normal active life.

To avoid re-formation, you should protect the limb from injury and too much stress. If the slightest problems with bones or joints arise, they should be eliminated immediately, as they can provoke a relapse.