Pelligrini-Stieda lesion


Stieda fracture: bony avulsion injury of the medial collateral ligament at the medial femoral condyle. Calcification may form a few weeks following the initial injury (Pellegrini-Stieda lesion).

Pellegrini-Stieda lesion: ossification in or near the tibial collateral ligament (medial femoral collateral ligament) adjacent to the margin of the medial femoral condyle. Ossified post-traumatic lesion (presumed secondary to Stieda fracture)

Pellegrini-Stieda syndrome: medial knee pain following previous medial collateral ligament injury and Pellegrini-Stieda lesion (which are most commonly asymptomatic).

Pelligrini-Stieda lesion - Right knee
Pelligrini-Stieda lesion – Right knee

History of the Pelligrini-Stieda lesion

1903Alban Köhler reported a case of a 56-year-old male who injured his knee during piling of wood in 1903 (published 1905)

56 jähr. Mann. Vor 4 Jahren beim Holzaufstapeln verschüttet. Verrenkung des Hüftgelenks, Kontusion des Kniegelenks… seither keine Beschwerden in der Hüfte, aber immer im Knie, wenig beim langsamen Gang, Stechen beim schnelleren Gehen und Tragen von Lasten.

Radiogramm: Am aüsseren Condylus (im Schatten) knopfförmige kompakte Hervorwölbung, ebenso aussen an Tibia. Am inneren Condylus oben am Übergang in den Schaft im Schatten der Weichteile ein kleiner flacher dunkler Schatten, im Röntgenogramm gerade oben noch zu erkennen, der nur einer bindegewebigen Ossifikation entsprechen kann.

Köhler Plate VII, Fig 12 p140

56 year old man. Injured 4 years ago whilst piling wood. Sprained hip and contusion of the knee joint … since then no complaints in the hip, but ongoing pain in the knee, minimal with slow walking, but stabbing when walking at pace, or carrying loads.

Radiograph: At the outer condyle (in the shadow) a button-shaped, compact protrusion, similarly at the outer Tibia. At the inner condyle, up at the transition to the shaft, in the shadow of the soft tissue, a small, flat, dark shadow, only just discernable on the image, which must correspond to a connective tissue ossification.

Köhler Plate VII, Fig 12 p140

1905Augusto Pellegrini called attention to a traumatic ossification of the collateral tibial ligament of the knee. He reported case of calcification, involving the collateral ligament of the knee in a 36-year-old man who fell at work from a height of 2 m striking the internal knee surface on an iron vessel on October 6, 1904. Pellegrini examined him on March 13th 1905 at the Department of Surgery in Florence and concluded that the cause of ossification in the present case to have resulted from a singular traumatic event. Pellegrini pointed out that the anatomical origin of the ossification, as found upon surgery, lay at the origin of the MCL.

X-ray examination of the affected area reveals a shadow of the perfectly normal distal end of the femur and proximal end of the tibia; the tumour produces a light shadow which is just perceptible at the base of the soft parts: it is located laterally to theMCL of the femur, following its boundaries and becoming separated for a short distance; some discontinuity is perceivable in the shadow close to the distal end of the tumour; the separate portion of the tumour manifests a less intense shadow than the remainder.

Pellegrini 1905
Pellegrini 1905 calcification of the tibial collateral ligament
Pellegrini 1905: X-ray calcification of the tibial collateral ligament

This received minimal international attention as the journal (La Clinica moderna (Firenze)) was taken out of production shortly after his publication

1907Alfred Stieda, unaware of the previous work, again called attention to a semilunar-shaped calcification seen about the superior border of the internal (medial) epicondyle of the distal femur.

Stieda published 5 male cases, aged 20-48 years, post-traumatic injury with knee radiograph findings of bony shadows around the superior femoral medial epicondyle in a 1908 publication. On cadaveric dissection, he found the lesion to be situated at the origin of the medial head of the gastrocnemius.

…it undoubtedly concerns a rupture of the upper part of the internal epicondyle, and in our clinically observed cases, we may also well suppose an analog injury, especially since the position of the shadow in the X-ray fits more with a tear of the muscle insertion (upper portion of the internal epicondyle) than with a tear of the insertion of the inner sideband (lower portion of the internal epicondyle). Further, whether the projection comes off by direct force or because of muscle pull is an interesting question.

Stieda 1908
Über eine typische Verletzung am unteren Femurende 1908
Stieda original drawing (1908): ossification as seen on radiographs

Associated Persons

Alternative names
  • Köhler-Pelligrini-Stieda disease
  • Pellegrini-Stieda disease
  • Pellegrini-Stieda sign
  • Stieda fracture
  • Pellegrini-Stieda syndrome
  • Pellegrini-Stieda phenomenon

  • Perhaps historically this lesion might be named the Köhler-Pellegrini-Stieda lesion


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Resident medical officer in emergency medicine MB ChB (Uni. Dundee)  MRCS Ed. Avid traveller, yoga teacher, polylinguist with a passion for discovering cultures.

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