Abstract
BackgroundDiffuse pigmented villonodular synovitis (PVNS) of the knee is a rare proliferative joint disease associated with high recurrence rates following surgical treatment. Intra-articular joint instability in conjunction with PVNS implies complex reconstructive strategies due to the destructive nature of the disease.Case presentationHere, we present the case of a young patient with refractory PVNS and a chronic ipsilateral anterior cruciate ligament (ACL) rupture. Clinically, the patient presented with a grade 3 pivot shift phenomenon, indicating anterolateral rotational instability. Usually, PVNS implies a contraindication for ACL reconstruction due to the degenerative and pro-inflammatory joint microenvironment that is induced and maintained by PVNS. Therefore, we have performed a modified Lemaire extra-articular stabilization resulting in significant clinical improvement and subjective joint stability. In the latest follow-up examination at 12 months, the patient reported subjective joint stability and no swelling. In the clinical examination, the patient showed dynamic joint stability during walking. Additionally, the patient presented with grade 0 in pivot-shifting compared to the contralateral knee. The Lachman test exhibited no increased side-to-side difference and a firm endpoint.ConclusionsExtra-articular anterolateral stabilisation of the knee in patients having anterolateral knee instability combined with PVNS is a safe and efficient surgical treatment option yielding significant clinical improvement as well as subjective joint stability.
Highlights
Diffuse pigmented villonodular synovitis (PVNS) of the knee is a rare proliferative joint disease associated with high recurrence rates following surgical treatment
Extra-articular anterolateral stabilisation of the knee in patients having anterolateral knee instability combined with PVNS is a safe and efficient surgical treatment option yielding significant clinical improvement as well as subjective joint stability
As far as we are aware, we describe the first case of a young patient with diffuse PVNS and chronic anterolateral instability to undergo an isolated modified Lemaire extra-articular stabilisation of the knee
Summary
Diffuse pigmented villonodular synovitis (PVNS) is a rare proliferative disease (prevalence of 1.8 cases per 1 million) with recurrence rates as high as 48% after surgical procedures [1]). Lateral extra-articular tenodeses can reduce rotatory laxity of the knee [11] This technique may be considered to restore native joint kinematics in a subset of patients after careful consideration of chances and risks. As far as we are aware, we describe the first case of a young patient with diffuse PVNS and chronic anterolateral instability to undergo an isolated modified Lemaire extra-articular stabilisation of the knee. The patient opted for intensive physical therapy to stabilise the joint During this time, he described an acute rotational trauma while exiting his car resulting in a small bucket handle tear in the white-white zone of the medial meniscus of the ipsilateral knee. A renewed medial meniscus suturing was performed arthroscopically, as again a complex tear of the posterior horn was present.
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