ate varsity track His discomfort was primarily located laterally in h - PDF document

ate varsity track. His discomfort was primarily located laterally in his left knee and he described an occasional grinding sensation when his knee was fully extended. He could recall no epi-sodes of significant trauma and had no history of igan, U.S.A. Address correspondence and reprint requests to Dr. R. F. LaPrade, pain. Lachman's, McMurray's, and pivot shift �� ams were all negative. Radiographs revealed wh appeared to be a 2-3 mm round calcified loose bo in the lateral compartment. Initially, it was felt 1 patient had a normal knee exam nd his s well as the posterior intercondylar notch were1\ visualized with appeared to be a 3 mm round calcified 10¥ body in the lateral compartment (Fig. I). The . throscopy equipment was reinserted and the late jointsas againexamined tel-ers as ewell \.t this ted of -ealed loose l1e ar-ateral e pos-FIG. 1. Anteroposterior ra-diograph of the left knee dem- novial biopsies revealed no evidence of an inflam-matory process. A diagnosis of semisolid material of toothpaste consistency that arose fromthearea of chondrocalcinosis when probed during arthros-opy. Radiographs taken DISCUSSION Chondrocalcinosis is a term used to describe ei-ther pathologically or radiographically, the ��������cation of fibrocartilage or hyaline cartilage in one or more joints. The types of calcium-containing salts presently identified in this condition include cal-cium pyrophosphate dihydrate, dicalcium phos-p

hate dihydrate (brushite), and calcium hydroxyap-atite (1-7). Chondrocalcinosis is primarily caused by calcium pyrophosphate dihydrate deposition (3), or with hemochromatosis taken 3 weeks cartilage was absent. Arthroscopy, Vol. 8 chondrocalcinosis is generally felt to be an age-related phenomenon. It typically occurs in middle-aged or older patients with an increasing incidence with age (5,36--38).It is felt to be uncommon prior to age 60 years (35, 37,39), but by age 80 years up to 20% of patients may have this pathologic or radiographic finding (37). The onset of familiar cases of chondrocalcino-sis is as early as the third or fourth decades of life (34,35). Polyarticular involvement and severe de-generative changes are usually seen in these pa-tients. In addition to familial cases, another cause of chondrocalcinosis in young adults is felt to be trauma. Trauma-induced chondrocalcinosis tends to be monoarticular, involving the traumatized joint, and in a relatively young age group without any known underlying medical conditions associ-ated with this entity. Trauma-induced monoarticu-lar chondrocalcinosis has been found in internal de-rangements of the knee (2,30,33), hypermobile joints (32), and after surgery (3,31). monoarticular probably represented an earlier stageof lesion, prior to any crystal release from an intra-cartilage location, than the cases previously de-scribed in arthroscopy (30). The subchondral cySl\ and radiolucencies described in advanced chondro calcinosis (25,47) m

ay represent a stage of the dis-ease after the calcium crystals are released or reo sorbed from their intracartilaginous location. Inadá dition, in contrast to synovial biopsies in previous reports that have demonstrated inflammatory and reparative changes indicative of an intraarticular calcium crystal presence (4,7,21,25), the synovium was normal in this patient. The long-term signifi cance of the finding in this athlete is unknown. The initial diagnosis for this patient, an intr arthroscopy. In fact, since this case was seen, another case was seen in referral afteran arthroscopy for a suspected loose body was unsuc-cessful. In retrospect, the radiographs revealeda typical case of chondrocalcinosis. REFERENCES 1. Atkins CJ, McIvor J, Smith PM, Hamilton E, WilliamsR Chondrocalcinosis and arthropathy: studies in haernochro matosis and in radiopathic chondrocalcinosis. Quart J Mid 1970;153:71-82. 2. De Lange EE, Keats TE. Localized chondrocalcinosis j, traumatized joints. Skel Radiol 1985;24:249-56. 3. Doherty M, Watt I, Dieppe PA. Localized chondrocalcinesi in post-meniscectomy knees. Lancet 1982;1: 1207-10. 4. Jensen PS, Putman calcifications in human cartilage. J Bom Joint Surg [Am] 1966;48:309-25. 6. Resnik D, Niwayarna G, Goergen TG, Ursinger D, Sapiro RF, Haselwood DH, Wiesner KB. Clinical, radiographic and pathologic abnormalities in calcium pyrophosphate di-hydrate deposition disease. Pseudogout. Radiology 19ii: 122:1-15. Zal pse 8 U1 lar-dro By\ par; Do( and 104 17. Ho! JB. Ill. S

ch Sen Mo: 1%3;90: ofcartilage, New Engl J Med 1966;275:745-9. áGood AE, . Ann Rheum Dis 1963;22:171-87. Dodds Hypophosphatasia associated with calcium py-rophosphate dihydrate deposits in cartilage. Arthritis Rheum 1970;13:381-8. 1.Jacobelli S, McCarty DJ, ller ERin Wil- :210-7. 29. Collis CH, Dieppe PA, Bullimore JA. Radiation-induced chondrocalcinosis of the knee articular cartilage. CIi" Radial 1988;39:450-1. 30. Altman RD. Arthroscopic findings of the knee in patients with pseudogout. Arthritis Rheum 1976;19:286-92. 31. Andres TL, Trainer.TD . Intervertebral chondrocalcinosis. Arch Pathol Lab Med 1980;104 :269-71. 32. Bird HA, Tribe CR, Bacon PA . Joint hypermobility leading to osteoarthritis and chondrocalcinosis. Ann Rheum Dis 1978;37:203-11. 33. O'Connor RL. The arthroscope in the management of knee: prevalence and association with osteoarthritis of the knee. Arthritis Rheum 1984;27(suppl):S49. 39. Bocher 1, Mankin Hl, Berk RN, Rodman GP. Prevalence of calcified meniscal cartilage in elderly persons. Insall IN. Surgery ofthe knee. New York: Churchill Living-stone, 1984:80-97. 44. Gerster JC, Rappoport G, Ginalski JM. Prevalence of peri-articular calcifications in pyrophosphate arthropathy and their relation to nodal osteoarthritis. Ann Rheum Dis 1984; 43:255-7. 45. Thompson GR, Ting YM, Riggs GA. Calcific tendinitis and soft-tissue calcification resembling gout. J Am Med Assoc 1968;203:464-72. 46. Martel W, McCarter DK, Solsky MA, Good AE, Hart WR, BraunsteinEM, BradyT