Cartilaginous Loose Bodies Research Articles

Synovial Chondromatosis of Wrist Joint: A Rare Case Report

Synovial chondromatosis is an uncommon and non-malignant transformation of the synovial membrane which leads to development of numerous cartilaginous bodies within the joint. Synovial chondromatosis occurs rarely in the wrist, and there have been a lack of reports of this occurrence in the literature. Hereby we reported a case of synovial chondromatosis occurred in the wrist joint treated with marginal excision. A 52-year-old male complained lump on his right wrist accompanied by mild pain. On physical examination, there was lump on ulnar side of the right wrist with normal underlying skin, palpable hard and immobile. There was slight limitation on wrist flexion and extension, whereas radial – and ulnar deviation and pronation – supination range of motion were within normal limit. The plain x-ray of the right wrist showed multiple calcified intra-articular cartilaginous loose bodies in the distal radioulnar joint. Biopsy showed multilobulated cartilage tissue that contained chondrocytes without atypia, and some cartilage tissue accompanied with mild atypia. We diagnosed the patient as primary benign soft tissue tumor at right distal radio-ulnar joint due to synovial chondromatosis and we performed marginal excision. The clinical result was reported good, but complete data could not be obtained because the patient refused to do routine follow up. The rarity of synovial chondromatosis involving the wrist joint could be an obstacle in performing diagnostic procedures and treatment for the case, but with the thoughtful application of resources and surgical principles, synovial chondromatosis of the wrist joint can be safely and effectively managed. Keywords: Synovial chondromatosis, Wrist joint, Marginal excision

Giant Synovial Chondromatosis of the Shoulder: The Limits of Arthroscopic Treatment and Technical Tips

Synovial chondromatosis (SC) is a rare disease. It is a chondrocytic metaplasia and is characterized by the presence of cartilaginous loose bodies in the involved joint, bursa or tendon sheath, it occurs most often in those aged 30_50 years and 3 times more in males than females, The shoulder is an exceptional location. It causes significant functional disability in young people. The clinical presentation is not specific, and the diagnosis is based on MRI. Confirmation is still anatomopathological. Classically, the mainstay treatment for SC of the shoulder has been open arthrotomy and removal of loose bodies, followed by either complete or partial synovectomy, removing the affected tissue, with recent advances in arthroscopic techniques and methods, arthroscopy becomes the gold standard. We present this case report of a 26-year-old man, who was left-hand dominant, a maintenance technician, amateur football player presented a left shoulder inflammatory pain; ; plain radiography demonstrated multiple calcific densities over the glenohumeral joint , the MRI showed multiple calcified intra-articular loose bodies around the anterior and posterior joint and axillary recess ; At arthroscopy, a large number of loose bodies were observed together with marked synovitis ,it only allowed the removal of small foreign bodies < 1 cm, partial synovectomy was performed with a shaver ; anatomopathological examination confirmed the diagnosis of sc. the extraction of giant fragments >2 cm was impossible so it was subsequently removed by open surgery. This was carried out one month later using a delto-pectoral approach: all foreign bodies > 1 cm were successfully extracted. We report this case report in order to review the role of shoulder arthroscopy and magnetic resonance imaging (MRI) in diagnosis and treatment and to highlight the operative difficulties, technical tips of arthroscopic extraction of giant Synovial chondromatosis of the shoulder.

Osteochondroma of Hoffa’s fat pad

Infrapetellar osteochondroma is a rare benign osteochondromatous proliferation involving the infrapatellar fat pad. The pathogenesis of these lesions is unclear, but is thought to result from metaplasia of mesenchymal cells as a consequence of chronic infra-patella fat pad infringement or end stage of Hoffa’s disease1. Given its uncommon occurrence, it can be mistaken for more common conditions about the knee. The extra-articular location is distinct from cartilaginous loose bodies and synovial chondromatosis, which involve the joint space. Despite the name, this condition is not related to osteochondroma of bone. We report a case of infrapatellar fat pad osteochondroma and discuss features to distinguish this condition from morphologically similar lesions. Reference 1.Turhan E, Doral MN, Atay AO, et al. A giant extrasynovial osteochondroma in the infrapatellar fat pad: end stage Hoffa's disease. Arch Orthop Trauma Surg 2008; 128: 515–9.

Primary Synovial Chondromatosis of the Shoulder With Concomitant Intra-Articular and Extra-Articular Involvement: More Than a Simple Removal of Loose Bodies

Primary synovial chondromatosis is a rare, benign disorder due to metaplastic proliferation of the synovium, leading to the formation of cartilaginous loose bodies. Typically monoarticular and intra-articular, its occurrence in the shoulder is uncommon, and concomitant extra-articular involvement is

Synovial Chondromatosis in the Shoulder

In this case report we present a 49 years old male patient with clinical suspicion of a rotator cuff injury and multiple Synovial Chondromatosis (SC). He had a compatible USG and X-rays for the pathology. He was treated with a shoulder arthroscopy with resection of loose bodies and supraspinatus tenoplasty. Synovial Chondromatosis is a rare pathology, and even more in the shoulder. It is a benign disorder of unknown cause characterized by synovial metaplasia and proliferation, causing cartilaginous loose bodies. These loose bodies have a relatively similar size, can be ossified and can create either blocking mechanical symptoms or erosive injuries in articulations.

A Rare Case of Primary Synovial Chondromatosis of the Ankle

ABSTRACT Synovial chondromatosis is a condition where the synovial lining of joints, tendons, or bursa undergoes metaplasia into cartilaginous loose bodies. Primary synovial chondromatosis of the ankle joint is very rare and less commonly reported in literature. We report a case of primary synovial chondromatosis of the ankle that we encountered in our clinic. A 33-year-old male patient presented with a history of multiple swellings around his right ankle joint, along with dull aching pain. Both the clinical examination and X-rays were suggestive of primary synovial chondromatosis of the ankle. We performed an open loose body removal and synovectomy of the ankle. Histopathology confirmed the diagnosis of primary synovial chondromatosis. We report this case owing to its rarity of presentation. How to cite this article Chathoth V, Sankaranarayanan S. A Rare Case of Primary Synovial Chondromatosis of the Ankle. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):53-55.

顎関節穿刺吸引細胞診が有効であった滑膜軟骨腫症の1例

Synovial chondromatosis is a disease with cartilaginous metaplasia of the connective tissue in the synovial membrane, but reports of synovial chondromatosis in the temporomandibular joint (TMJ) are rare. Many reports of synovial chondromatosis in the region include images of calcification in the radiological imaging examination. However, it is difficult to diagnose the disease state in the case of an image without calcification. In this paper, we report that magnetic resonance imaging (MRI) and fine-needle aspiration cytology (FNAC) were useful for diagnosing synovial chondromatosis without calcification in radiological images. A 35-year-old woman was referred to our hospital with a slight preauricular swelling in the left TMJ region. The calcification image was not found in the region by orthopantography and computed tomography. The MRI revealed a low T1 signal and high T2 signal. The FNAC revealed that it was not chondrosarcoma or synovial sarcoma, but was highly suspicious of chondromatosis. When the left upper articular cavity was opened, there were many cartilaginous loose bodies, and so resection of all these bodies and synovectomy were performed under a diagnosis of synovial chondromatosis. Histological examination of the loose bodies demonstrated synovial chondromatosis. There has been no recurrence for 19 months after surgery.

Fibroblast growth factor 2 involved in the pathogenesis of synovial chondromatosis of temporomandibular joint

Synovial chondromatosis (SC) of temporomandibular joint (TMJ) is a rare proliferative disorder characterized by the formation of cartilaginous or osteocartilaginous nodules in synovium and joint space. Fibroblast growth factor 2 (FGF-2) is frequently applied in chondrogenic differentiation assays. Therefore, we hypothesized that FGF-2 might involved in the pathogenesis of SC. SC synovium and loose bodies (LBs) specimens were observed by histological and immunohistochemical methods. Real-time PCR was conducted for comparing genes expressions in SC and normal synovium. SC synoviocytes were stimulated by FGF-2 in the presence or absence of its antagonist long pentraxin-3 (PTX3) for 6days. Real-time PCR and alkaline phosphatase (ALP) activity were performed to examine the effects exerted by FGF-2 and PTX3. SC synovium, no matter facing the articular cavity or covering LB, was characterized by increased quantity of synoviocytes and blood vessels. FGF-2 was expressed in chondrocytes and fibroblast-like cells of LBs, and the wall of blood vessels. Expressions of chondrogenic genes (Sox9 and Wnt-4), osteogenic genes (Foxc2), FGF-2, and VEGF-A mRNA were significantly higher in SC synovium than that of the control group. The stimulation of FGF-2 on SC synoviocytes increased ALP activity and expressions of chondrogenic genes (Sox9, Col2α1, and Aggrecan), osteogenic genes (Foxc2, osteocalcin, and Col1α1), and VEGF-A, but PTX3 inhibited these effects. FGF-2 was responsible for the formation of cartilaginous loose bodies and involved in the pathogenesis of SC.

Operative Fixation of Chondral Loose Bodies in Osteochondritis Dissecans in the Knee: A Report of 5 Cases.

Background:Osteochondritis dissecans (OCD) can progress to loose body formation, with or without subchondral bone attachment to the lesion. The efficacy of internal fixation of chondral loose bodies has not been determined.Hypothesis:Operative fixation of cartilaginous loose bodies would result in (1) healed OCD at second-look arthroscopy, (2) restored cartilage appearance on magnetic resonance imaging (MRI), and (3) nearly normal knee function, as determined by patient-reported outcome scores.Study Design:Retrospective case series; Level of evidence, 4.Methods:Five patients who underwent cartilaginous loose body fixation were identified. Lesions were located on the lateral trochlea (n = 2) and medial femoral condyle (n = 3) (mean size, 2.5 cm2). Loose bodies were reattached with compression screws through mini-arthrotomy or arthroscopy. Patients were nonweightbearing for 12 weeks postoperatively. After 12 weeks, screws were removed arthroscopically, and OCD stability was evaluated. Three patients underwent MRI to determine articular cartilage status. Images were evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score. Patients were interviewed and completed the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire.Results:Four patients had stable lesions at 12 weeks after surgery. One patient had slight motion to one-third of the lesion and stability to the remaining two-thirds. Three patients underwent an MRI. The mean time from surgery to MRI was 3.1 years. Mean MOCART score was 72.0 ± 10.4. One patient required repeat arthroscopy 1 year after initial fixation for debridement and arthroscopic drilling of an incompletely healed area of the lesion. Four patients completed the KOOS questionnaire. The mean time to KOOS completion was 4.6 years. Mean KOOS subscales for knee pain (91.0 ± 8.9), knee symptoms (83.0 ± 7.9), and function in activities of daily living (91.9 ± 10.6) were similar to published age-matched controls; however, scores for sports and recreation function (70.0 ± 17.8) and knee-related quality of life (67.2 ± 12.9) were lower.Conclusion:Operative fixation of chondral loose bodies, without macroscopically visible subchondral bone attachment, resulted in lesion stability at second-look arthroscopy. At final follow-up, patients had no substantial pain and normal function in activities of daily life compared with controls; however, knee-related quality of life and sport and recreation function were reduced, and 1 patient required reoperation for an unhealed portion of the lesion.

Three Case Reports of Synovial Chondromatosis of Temporomandibular Joint: Histopathologic Analyses of Minute Cartilaginous Loose Bodies From Joint Lavage Fluid and Comparison With Phase II and III Cases

0 Synovial chondromatosis (SC) is a benign monoarticular lesion characterized by chondrometaplasia of the synovial membrane with cartilaginous loose bodies often found released into the joint spaces. It is a condition that mainly affects the large joint areas, such as the knee, hip, and elbow, and SC of the temporomandibular joint (TMJ) is rarely seen. The common characteristics of SC of the TMJ include swelling, unilateral pain, occlusal changes, clicking, crepitation, deviation, and limited mandibular function. In he early stages of SC of the TMJ, the cartilaginous odules or loose bodies are often undetectable on lain radiographs. The symptoms are similar to that of emporomandibular disorder (TMD); consequently, any months or years often pass before the correct iagnosis is made. Milgram divided the conditions of SC into 3 separate phases, and each developmental stage was fur-

Bilateral synovial chondromatosis of the temporomandibular joint

Purpose To report an exceptional case of bilateral synovial chondromatosis (SC) of the temporomandibular joint (TMJ) and discuss diagnostic approaches, treatment options and follow-up data. Patients and methods A 38-year-old woman presented with left preauricular swelling. Initial imaging studies revealed TMJ effusion only. Six years later, synovial calcifications were detected in the left TMJ; the right TMJ space was widened and presented incipient calcium deposits. Open arthrotomy of the left TMJ was performed, with removal of multiple cartilaginous loose bodies and complete synovectomy. Periodic controls proved the asynchronic development of intra-articular bodies in the right TMJ. Results SC is a metaplastic arthropathy that is uncommon in the TMJ. Bilaterality is exceptional. Diagnosis is often delayed due to the non-specific symptoms, progressive developmental stages and clinicians’ lack of awareness of the condition. Magnetic resonance imaging (MRI) is particularly helpful in defining disease extension, excluding a possible tumour and detecting internal derangement. Definitive diagnosis requires arthroscopic or open examination and histopathological analysis. Recurrences are infrequent after arthrotomy, removal of loose bodies and complete synovectomy. Conclusion SC is an uncommon condition in the TMJ. Bilateral involvement is extremely rare. MRI is effective for diagnosis and postoperative follow-up. Complete synovectomy usually yields an excellent prognosis.

Primary synovial osteochondromatosis of a subdeltoid bursa

Primary synovial osteochondromatosis (SOC) is known to be intra-articular and wherever it is observed outside a synovial joint, it is associated with the involvement of the nearby joint. Primary SOC has not been reported to involve a subdeltoid bursa. We present a case of a 52-year-old woman having a large number of loose bodies in a large tumor in the subdeltoid bursa. The swelling was first noticed by the patient 2 years back. Plain roentgenogram revealed soft tissue swelling only with no areas of calcification. On MRI, multiple nonosseous loose bodies were visualized in the bursa deep to the deltoid muscle. A surgical excision of subdeltoid bursa was done. A biopsy confirmed it to be cartilaginous loose bodies in synovial lining sugestive of metaplastic transformation of the synovial tissue.

Synovial Chondromatosis of the Foot and Ankle

Synovial chondromatosis (SC) is a benign condition where the synovial lining of joints, bursae, or tendon sheaths undergoes metaplasia and ultimately forms cartilaginous loose bodies. Synovial chondromatosis of the foot and ankle is exceedingly rare, and outcomes following surgical excision are largely unknown. An Institutional Review Board-approved retrospective review of our institution's surgical database from 1970 to 2006 revealed 8 patients with SC of the foot and/or ankle confirmed by pathology. Eight patients (4 female and 4 male) presented with pain, locking, or stiffness. Average age at presentation was 37 (range, 19 to 60) years. Average followup was 9.5 (range, 1 to 31) years. Six patients had involvement of the ankle, and two, the midfoot. Four patients underwent ankle synovectomy with loose body removal, and were pain-free at last followup. One patient underwent excision and midfoot arthrodesis for severe midfoot destruction. Three patients ultimately underwent below knee amputation, one for multiple recurrences and two for malignant transformation to low-grade chondrosarcoma. To our knowledge, this is the largest reported series of patients with SC of the foot and ankle. In half the patients, synovectomy with excision of loose bodies resulted in pain free return to normal function, without recurrence, at last followup. However, recurrence occurred in 3 (37.5%) of 8 patients with subsequent malignant transformation to low-grade chondrosarcoma occurring in 2 patients.

Pauciarticular severe destructive arthropathy in a child secondary to synovial osteochondromatosis

Synovial osteochondromatosis (SOC) is a benign neoplasm characterized by synovial proliferation and chondrometaplasia and may affect the synovial lining of a joint, bursa, or tendon sheath. The disease is usually monoarticular. Joints mostly affected are knee, hip, shoulder, elbow and ankle. The affected synovium undergoes metaplastic transformation into cartilage forming chondroblasts, which mature into chondrocytes to form nodules of hyaline cartilage [1]. Immunohistological studies showed that these cartilaginous loose bodies are the result of metaplasia of the synovium. The histologic appearance of this process shows well-defined cartilage nests embedded in a layer of synovium. There may be significant pleomorphism. There may be evidence of advancing stageswithmaturation of the cartilage with mineralization and ossification [2]. Usual clinical presentation is that of intermittent joint pains, swelling, stiffness and restriction of movements and instability. Occasionally, locking or internal derangement due to impingement by loose body may be the presenting symptom, this being more common in the knee where it may mimic a meniscal tear [1].

Case report: A rare condition of secondary synovial osteochondromatosis of the shoulder joint in a young female patient

Primary synovial osteochondromatosis is a rare condition characterized by chondrometaplasia of the synovium.2 The cause of this condition is unknown, but the pathogenesis involves the development of chondroid foci in the synovial membrane that eventually break free to become cartilaginous loose bodies within the joint. In contrast, secondary synovial osteochondromatosis is a condition that results from the growth of separated particles from the articular cartilage or osteophyte in joint diseases, such as osteochondritis dissecans, osteoarthritis, and osteochondral fractures.

Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases.

We made a prospective arthroscopic study of 106 skeletally mature male sportsmen with an average age of 28.35 years (16.8 to 44) who presented with an acute haemarthrosis of the knee due to sporting activities. We excluded those with patellar dislocations, radiographic bone injuries, extra-articular ligamentous lesions or a previous injury to the same joint. The anterior cruciate ligament (ACL) was intact in 35 patients, partially disrupted in 28 and completely ruptured in 43. In the patients with an ACL lesion, associated injuries included meniscal tears (17 patients), cartilaginous loose bodies (6), and minimal osteochondral fractures of the patella (2), the tibial plateau (3) or the femoral condyle (9). We found no age-related trend in the pattern of ACL injuries. Isolated injuries included one small osteochondral fracture of the patella, and one partial and one total disruption of the posterior cruciate ligament. Three patients had cartilaginous loose bodies, and no injury was detected in five. Acute traumatic haemarthrosis indicates a serious ligament injury until proved otherwise, and arthroscopy is needed to complement careful history and clinical examination. All cases with a tense effusion developing within 12 hours of injury should have an aspiration. If haemarthrosis is confirmed, urgent admission and arthroscopy are indicated.

The Role of Arthroscopy in the Management of Synovial Chondromatosis of the Shoulder A Case Report

A case of synovial chondromatosis of the shoulder is reported in a 28-year-old man with long-standing shoulder pain after a remote episode of trauma. Although plain roentgenograms were normal, arthrograms revealed the characteristic findings of synovial chondromatosis. Treatment consisted of arthroscopic removal of multiple cartilaginous loose bodies and partial synovectomy. Synovial chondromatosis of the shoulder treated with arthroscopic debridement and synovectomy rather than traditional open arthrotomy seems not to have been reported previously.

Differentiation of the osteochondrogenic cells of the periosteum in chondrotrophic environment.

The behaviour of the cells in free periosteal graft was studied in growing rabbits in three chondrotrophic recipient milieus: costal cartilage, ear cartilage and synovial fluid of the knee joint. The periosteal grafts first formed cartilage, which was then quite rapidly transformed into bone on the costal cartilage, quite slowly and in smaller amounts in the ear cartilage, whereas no bone was found in the cartilaginous loose bodies formed in the knee joint. In bone formation vascularization plays a major role, but other factors are also involved.

A Case Report of Arthritis Mutilans with Numerous Cartilaginous Loose Bodies in Bilateral Elbow Joints

A 34 year old female suffering from Rbeumatoid arthritis since her 20th year of age. She has been noticed tumorous swelling of medial condyle of bilateral humerus since December, 1969. These tumors enlarged gradually and then developed claw hand with sensory disturbance of 4th and 5th fingers. In x-ray findings of bilateral elbow joints, humerus, radius and ulna were all remarkably destructive and absorptive, that is classical Arthritis mutilans. Synovectomy in right elbow-joint was carried out in April, 1971. There were numerous cartilainous loose bodies in the capsule and respectively semitransparent substances from ant-egg to the head of little finger in size. In histological study, cartilaginous loose bodie were constituted with fibrinoid lucid substances and Synovial membrane thickened and infiltrated with chronic iuflammatory cells. Synovectomy in left elbow-joint was carried out in october 1971. Abundant free bodies were detected similary.