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MR Imaging of Calcification of the Lateral Collateral Ligament of the Knee: A Rare Abnormality and a Cause of Lateral Knee Pain

S. E. Anderson1, C. Bosshard2, L. S. Steinbach3 and F. T. Ballmer4

1 Department of Radiology, University Hospital of Bern, Inselspital, Bern CH 3010, Switzerland.
2 Department of Orthopedic Surgery, Spital Bern, Tiefenau, Bern CH 3010, Switzerland.
3 Department of Radiology, University of California at San Francisco, San Francisco, CA 94143.
4 Department of Orthopedic Surgery, University Hospital of Bern, Inselspital, Bern CH 3010, Switzerland.



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  		Fig. 1A. —38-year-old man with acute atraumatic knee pain of 48-hr duration that feels worse at night and provisional clinical diagnosis of lateral collateral ligament (LCL) tear, lateral meniscus tear, or fracture. Radiograph shows calcification (arrows) in region of LCL. Ten days later, patient was asymptomatic, and within 4 weeks, calcium had resorbed on follow-up conventional radiographs (not shown).

 


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  		Fig. 1B. —38-year-old man with acute atraumatic knee pain of 48-hr duration that feels worse at night and provisional clinical diagnosis of lateral collateral ligament (LCL) tear, lateral meniscus tear, or fracture. Coronal STIR image (TR/TE, 180/30; flip angle, 180°) shows thickening of intact LCL (arrows) and focus of low signal (asterisk) that corresponds to region of calcification on radiograph. Bone marrow signal is normal.

 


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  		Fig. 1C. —38-year-old man with acute atraumatic knee pain of 48-hr duration that feels worse at night and provisional clinical diagnosis of lateral collateral ligament (LCL) tear, lateral meniscus tear, or fracture. Axial contrast-enhanced T1-weighted fat-saturated MR image (780/14) shows LCL thickening and calcification (arrow). Popliteal recess and tendon are normal.

 


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  		Fig. 2A. —39-year-old man who presented with acute pain of 3 days' duration, joint effusion, and clinical provisional diagnosis of infection. Radiograph shows calcification (arrows) in region of lateral collateral ligament (LCL).

 


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  		Fig. 2B. —39-year-old man who presented with acute pain of 3 days' duration, joint effusion, and clinical provisional diagnosis of infection. Coronal STIR image (TR/TE, 4500/30; inversion time, 180 sec) that was obtained after patient reported sudden unexplained decrease in pain shows thickening and calcification of LCL (thick arrows) and additional calcification between LCL and biceps femoris tendon (thin arrows), possibly representing rupture of LCL calcific tendinitis into LCL—biceps femoris bursa. Normal popliteal tendon (asterisk) is noted. Other images (not shown) showed moderate-sized effusion and Baker's cyst.

 


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  		Fig. 2C. —39-year-old man who presented with acute pain of 3 days' duration, joint effusion, and clinical provisional diagnosis of infection. Axial contrast-enhanced T1-weighted fat-saturated MR image (646/20) shows focal calcification in LCL (arrow) and adjacent additional calcification (asterisk), possibly in LCL—biceps femoris bursa.

 


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  		Fig. 2D. —39-year-old man who presented with acute pain of 3 days' duration, joint effusion, and clinical provisional diagnosis of infection. Axial contrast-enhanced T1-weighted MR image shows additional calcifications, possibly within LCL—biceps femoris bursa (asterisk) and medial to LCL (short arrow). Biceps femoris tendon (long arrow) and popliteal tendon (arrowhead) are normal.

 


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  		Fig. 3A. —46-year-old man who presented with acute knee pain. Radiograph shows calcification (arrows) in region of lateral collateral ligament (LCL). Calcification and pain resolved 4 weeks later.

 


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  		Fig. 3B. —46-year-old man who presented with acute knee pain. Coronal STIR image (TR/TE, 3740/18; inversion time, 90 msec) shows thickened proximal LCL with focal calcification in LCL (arrow) and marked adjacent soft-tissue reaction (arrowheads). Popliteal tendon is normal.

 


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  		Fig. 3C. —46-year-old man who presented with acute knee pain. Coronal T1-weighted MR image (460/15) that corresponds to B shows calcification in LCL (arrows).

 

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