Calcific tendonitis of the quadriceps tendon

A 61-year-old woman presented with chronic anterior pain and stiffness in the distal left thigh. Examination revealed swelling and tenderness immediately proximal to the patella. Radiographs showed opacities in the distal anterior thigh whilst MRI identified enlargement of the distal quadriceps tendon with splayed fibres separated by solid conglomerates. Dystrophic calcification of the quadriceps tendon was diagnosed. Blood tests revealed no systemic abnormalities in calcium handling. Arthroscopy of the left knee identified calcific deposits in the supra-patella pouch with surrounding synovitis. An open debridement of the tendon was performed; biopsy of the excised tendon showed chronic tenosynovitis with dystrophic calcification without evidence of malignancy. Post-operatively her knee was braced in extension enabling progressive flexion over 4 weeks. Anterior knee pain diminished post-operatively and 10 months following surgery the patient was pain free, able to walk normally and scored 99/100 on the Fulkerson modification of the Lysholm score.