CPPD or HADD in quadriceps tendon?

[Michael Shilton]

Hi Stephen
I was interested in your video describing calcification in tissues and if I understood you correctly you were suggesting it’s CPPD when in articular cartilage and HADD when in tendons?
I have a case this week of a gentleman with acute knee pain and swelling for 3 weeks. X ray and ultrasound show CPPD in his menisci and femoral trochlear cartilage? My question concerns the calcific deposits at the distal quadriceps tendon, would this best be described as calcific tendinopathy, HADD or is this also CPPD?
Thanks
Mike

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[Stephen Bird]

Nice images Mike,

This is a very typical example of CPPD in the meniscus
The deposition is less classic on the trochlear cartilage as it is on the surface of the cartilage rather than buried int he middle of it. But I still think this is CPPD as there is so much in the other knee structures.

The quadriceps tendon is interesting. There is multi focal areas of crystal deposition. In this patient age group I think HADD is unlikely. I also think CPPD may be unlikely in this location.

I am not suggesting there is no possibility of either of these, just that it is not my preferred first choice.

In this demographic I think the areas of echogenicity in the quadriceps tendon most likely represent areas of dystrophic calcification from prior tendon overuse and tenocyte death many years ago. You see a similar appearance commonly in the distal patella tendon.

If it is HADD it should be acutely tender and I bet it was not.

So I am going for CPPD in the knee and dystrophic calcification in the quad tendon

Steve

[Michael Shilton]

Many thanks

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