Extra-articular calcification of the lateral collateral ligament (LCL) presenting with recurrent acute knee periarthritis: A case-based review

Aim of the work

To present a case with extra-articular calcification of the lateral collateral ligament (LCL) presenting with recurrent acute knee periarthritis.

Case presentation

A 53-year-old Saudi male patient presented with acute onset of right-sided knee pain, localized swelling and tenderness along the lateral aspect after sport related activity. He reported a similar attack at the same knee joint a few years earlier. Plain X-ray and magnetic resonance imaging (MRI) after the initial attack showed calcification along the LCL. On examination, the patient had mild knee effusion, painful knee extension, and localized swelling along the LCL. A recent MRI and complementary computerized tomography (CT) showed a fragmented calcific shadow along the LCL. The latter was associated with soft tissue hyperintensity, which indicated extensive local inflammatory reaction. After ruling out internal derangement and infection, it was concluded that the patient had an acute episode of peri-arthritis caused by calcification along the LCL of the affected knee joint. Intramuscular (IM) betemetazone sodium dipropionate/phosphate was used to treat the peri-arthritis and as such deposits may cause a potent neutrophilic chemotactic response and intense inflammation, colchicine was added for its anti-inflammatory properties and other known mechanisms that are effective in treating crystal-induced arthritis. On the second day following treatment, a significant improvement was seen. A case-based review was presented.

Conclusion

Despite the rare incidence of symptomatic LCL calcification, fragmentation of the calcific deposits may lead to acute intense inflammatory exacerbation and peri-arthritis. Successful and optimum management may involve IM steroid with oral colchicine.