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Symptomatic calcifications of the rotator cuff tendons is well-known pathologic condition. However, pathologic calcifications may involve other structures of the locomotor system as well. We report about five patients (age 52-66 years) with a painful calcification at the proximal part of the medial collateral ligament of the knee joint. All five patients presented with load-dependent pain pretending meniscus symptoms, but manual valgus stress provoked severe pain at the medial side of the knee. Conventional X-ray examination showed a dense rounded deposit at the proximal part of the medial collateral ligament. Initially all patients were treated conservatively by needling and infiltration with a local anaesthetic. Open resection of the deposit was performed in four patients after unsuccessful conservative treatment. Postoperatively all patients were immediately free of pain. After a mean follow-up of 6 years (patient 1-4) (range=2.5-9.5 years), all patients were still free of pain. Histological evaluation of biopsies obtained during surgery showed nodular deposition of calcium at the collagen fibres, vascular proliferations and inflammative changes. Soft tissue calcifications have to be considered as a rare differential diagnosis in patients presenting with medial knee joint pain. Open resection reduces symptoms immediately. The histological changes seen were comparable to that reported about pathological tendon calcifications of the shoulder. Therefore, both conditions might be of the same aetiology.

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Foreign-body injury of the juvenile knee is frequently seen in the outpatient department. Arthroscopy is the most important diagnostic and therapeutic procedure along with radiographic examination in a case of typical history and clinical symptoms. In this case, an intra-articular thorn in a juvenile knee was not diagnosed at arthroscopy despite typical injury. Five months later, the boy developed knee pain and joint swelling. Bacterial infection of the knee and rheumatoid causes were excluded by serologic blood analysis several times at the children's hospital. Magnetic resonance imaging of the knee revealed an intra-articular foreign body. At a second arthroscopy, the thorn was removed and a hypertrophic plica with dependent cartilage damage of the medial femoral condyle was resected. At follow-up after 4 weeks, the boy was free of pain and swelling. After the first arthroscopy, persistent knee swelling and pain had to be taken as a hint of an intra-articular irritation. All arthroscopic surgeons should do a complete diagnostic examination of the affected joint in case of a foreign-body injury.

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BACKGROUND: The aims of the present study were: determining the extent of the two typical outcomes (valgus deformity and leg overgrowth); examining the extent, limits and duration of possible spontaneous corrections; and analysing the consequences of different types of therapy. METHODS: Metaphyseal tibial fractures in children are rare (incidence 5.6:100,000). Seven children were retrospectively re-examined by their medical records and roentgenograms. The patients' ages at the time of the accident ranged from 1 year 10 months to 10 years 2 months, and the average observation period was 34 months. RESULTS: All the patients experienced a subjective recovery, with the exception of one child who had minor functional problems. All of them were able to move their knee joint freely. Six patients developed a genu valgum (proximal tibia angle between 6 degrees and 16 degrees ); each of them was treated conservatively. Only two patients--both under the age of 5--experienced a partial spontaneous correction. Overgrowth on the side of the fracture was observed in four cases, varying from 0.5 cm to 1.5 cm, most pronounced after complete reduction and stable osteosynthesis. CONCLUSIONS: We recommend surgical correction and osteosynthesis as the preferred method of treatment, even with the increased likelihood of overgrowth. This is based on our observation of valgus deformity occurring in all cases after conservative treatment, with partial remodelling seen only in children up to the age of 5.

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