Ultrasound and Fluoroscopy-Guided Percutaneous Hydrotenotomy with Open Conversion for Symptomatic Periligamentous Calcification of the Medial Collateral Ligament: A Case Report.

Introduction: Periligamentous calcification of the medial collateral ligament (MCL) is a rare condition that is mechanistically similar to calcific tendinitis, resulting from the deposition of calcium hydroxyapatite crystals in periarticular muscular attachments. Whereas most documented cases of periligamentous MCL calcification resolve with conservative therapy, little guidance exists in the orthopedic literature regarding viable operative treatment options for patients with symptoms refractory to conservative management. To our knowledge, this is one of only two case reports reporting the findings of percutaneous hydrotenotomy applied to MCL calcification, and the first applied specifically to post-traumatic MCL calcification. Case Report: The patient in our report presented with trauma-associated periligamentous calcification of the MCL that failed conservative management. The patient underwent percutaneous hydrotenotomy under ultrasound and fluoroscopic guidance, requiring open conversion for complete access and debridement of the deeper calcific deposits. At 1-year follow-up, the knee was non-tender with a full range of motion, and follow-up radiographs confirmed complete resolution of the calcification. Conclusion: The successful treatment of this patient demonstrates that percutaneous hydrotenotomy can be incorporated into an effective treatment plan for periligamentous calcification of the MCL secondary to traumatic knee injury.