Pelligrini-Stieda lesions are believed to be calcifications of prior medial collateral ligament (MCL) injuries.  They typically occur in the proximal segment of the ligament. Differential Diagnosis:  MCL sprain/tear, medial meniscal tear, osteochondroma, medial knee osteoarthritis, semimembranosis/semitendinosis tendinitis, myositis ossificans.

Pellegrini-Stieda can result from excessive stress to the inner knee from trauma, such as strains, sprains, or crushing injuries to the outside of the knee joint. Injury to the medial collateral ligament often occurs with injury to other knee structures, such as the anterior cruciate ligament and medial meniscus.

With traumatic injury, there may be momentary sudden pain over the inner side of the knee, or severe pain causing total loss of range of motion (ROM) and joint effusion and swelling. As calcification forms, pain becomes continuous.

A complete history and physical examination with a medial collateral ligament test, along with x-rays, magnetic resonance imaging (MRI), arthrograms, or arthroscopy may confirm the diagnosis.

Exercises to strengthen knee muscles may often correct the problem. Additional treatment may require injection into the calcified area, or surgical removal of calcified flakes. Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation may be administered.

There may be residual weakness of the joint and susceptibility to reinjury. Pain may be chronic. Rehabilitation may take five to six months. There may be a need to modify activities of daily living (ADL).

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• May be entitled to special monthly compensation where the veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Total plus 60% – Special Monthly Compensation (SMC).

• The minimum compensable evaluation may be assigned under 38 CFR 4.59 based on subjective painful motion, and does not require objective evidence of painful motion.

• To properly rate arthritis disability, accurate measurement of joint movement limitations is required and must be reported in degrees. The use of a goniometer (device for measuring joint movements and angles) in the measurement of range of motion in a joint is indispensable 38 CFR 4.46 [Accurate measurement].

• To properly rate disability, it is important to understand the range of motion chart Plate I & II, 38 CFR 4.71 [Measurement of ankylosis and joint motion] and 38 CFR 4.71a [Schedule of ratings - musculoskeletal system]. A rater should keep in mind that while the chart shows 95 to be normal for forward flexion a given individual may have normal forward flexion of 90 if so stated by the examiner. Range of motion can be limited by non-OA factors such as heavily developed calf muscles or tight hamstring muscles, none of which constitute loss of function due to service-connected disability of OA.

• See VAOPGCPREC 9-2004, VAOGCPREC 09-98, and VAOPGCPREC 23-97

• Consider this condition pursuant to 38 CFR 4.27 and 38 CFR 4.20, when applicable. Analogous ratings are utilized when a specific disability is not listed in 38 CFR Part 4. Certain hyphenated codes do not necessarily denote analogous ratings – a hyphenated DC may also be used to identify the proper evaluation of a disability or a residual from disease. Diagnostic Codes (DCs) must be carefully selected as a condition specifically listed in the rating schedule may not be rated by analogy (exceptions include systemic issues like multiple sclerosis or ALS). 

• When multiple DCs apply to a given disability, consider whether separate evaluations are warranted, and/or which DC will result in the most advantageous outcome for the claimant. Based on the facts found, the DC most appropriate to the findings and that results in the highest evaluation should be selected.

• Note to DCs 5013 through 5024: Evaluate the diseases under diagnostic codes 5013 through 5024 as degenerative arthritis, based on limitation of motion of affected parts.