Case Of Loose Body Research Articles

Migratory Loose Bodies from the Ankle Joint into the Flexor Hallucis Longus Tendon Sheath

Objective: Loose bodies resulting from any form of osteochondral insult can migrate out of their intra-articular position to adjacent compartments. This retrospective study aims to illustrate the phenomenon of loose bodies migration from the ankle joint into the flexor hallucis longus (FHL) tendon sheath. Materials and Methods: Cases of loose bodies in the FHL tendon sheath were identified from the authors' radiological database by way of keyword interrogation, covering the modalities of CT, MRI, and ultrasound over a period of 11 years. The imaging features of the loose bodies were recorded, together with the presence of ankle instability and osteoarthritis. Patient demographics and relevant history, including trauma and surgery, were collected. Results: Thirty-four cases including 33 patients, with a total of 125 loose bodies in the FHL tendon sheath, were identified. There were 58 loose bodies (46.4%) in Zone 1 of the FHL tendon sheath, 65 loose bodies (52%) in Zone 2, and 2 loose bodies (1.6%) in Zone 3. All patients had features of ankle osteoarthritis on imaging, 14 of which had imaging features of ankle instability, and 19 patients had previous ankle trauma. Conclusion: Osteochondral loose bodies originating from the ankle joint can migrate into the FHL tendon sheath. It is important to recognise this phenomenon as a distinct entity, different from primary tenosynovial chondromatosis of the FHL tendon sheath, which may have a different surgical management and clinical outcome. Detection of FHL tendon sheath loose bodies should also prompt closer examination for articular disease in the ankle joint.

Knee Locking in Osteoarthritis due to Synovial Lipoma: A Case Report

Intra-articular synovial lipomas are very rare and only few cases have been reported till now. We are reporting a rare case of a unilateral intra-articular lipoma of osteoarthritic knee joint in a 62 years old male. Patient had two episodes of sudden locking of knee joint, which resolved spontaneously. A plain X-ray showed changes which were suggestive of osteoarthritis. Clinically, patient was diagnosed as a case of loose bodies in left knee joint. An arthrotomy was performed. After a Histopathological Examination (HPE) of loose bodies, a diagnosis of an intra-articular synovial lipoma was made. Due to wide differentials and varied clinical behaviour of loose bodies, lipoma should be included in differential diagnosis of osteroarthritic patients who complain of episodic locking of knees. Intraarticular lipomas, on arthroscopic guided excision, get cured permanently, with no recurrence. The differentiation of an intra-articular lipoma from a relatively more common entity, Lipoma arborescens, has also been discussed.

Radiological study of three cases of loose bodies in the temporomandibular joint

According to the literature, loose bodies in the temporomandibular joint (TMJ) primarily prompt to synovial chondromatosis (SC). SC is a cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue of the joints. Its main characteristic is the formation of cartilaginous nodules in the synovium and inside the articular space, described as loose bodies. The main symptoms are pain, limitation of jaw movement, crepitation and inflammation. Diagnosis is made by panoramic radiograph, computed tomography scan and mainly magnetic resonance imaging. SC is usually monoarticular. We report two cases of bilateral loose bodies in TMJ and one monoarticular evaluated through plain radiograph and cone beam volumetric tomography (CBVT). Clinical and radiologic findings are reviewed and discussed. References for diagnosis of SC affecting TMJ are supported. Patients presenting preauricular swelling, pain and restriction of TMJ movements should be evaluated with plain radiography, CBVT and if necessary, magnetic resonance imaging. If loose bodies are found, synovial chondromatosis must be the first suspicion. The definitive diagnosis depends on histology. A differential diagnosis of chondrosarcoma should be considered because of the life-threatening features of chondrosarcoma.

An unusual case of loose body in the elbow-joint

An unusual case of loose body in the elbow-joint

A Case of Loose Bodies in Both Elbow Joints, with a History of an Unusual Accident

A Case of Loose Bodies in Both Elbow Joints, with a History of an Unusual Accident

A Case of Loose Body in the Knee-Joint

A Case of Loose Body in the Knee-Joint

Osteochondritis Dissecans

THE observation of several cases of osteochondritis in rather unusual sites is the basis for the résumé of this entity. The first description of this type of loose body was by Franz Koenig, in 1888. When he described the segregation of a portion of cartilaginous and subchondral tissue into the joint space, giving it the name “osteochondritis dissecans,” he suggested that it might be the result of a low grade infectious process. The condition is not unusual—indeed far from rare—as numerous reports of cases are found in the literature, particularly since 1910, when Freiberg and Wooley described the process in the English literature. The most commonly reported sites of the process are in the external condyle of the humerus and the lateral portion of the mesial condyle of the femur, the patella being mentioned in a few cases. It occurs chiefly in males of young adult age, although it has often been noted in young adolescents, particularly by Panner. Although Koenig mentioned several cases of loose bodies in the hip joint and ascribed the etiology to osteochondritis dissecans, Phemister has drawn attention to the fact that in several of these cases the head was detached from the neck near the region of the epiphyseal line and that this is not the site of separation in loose bodies of this classification. As regards the etiology there is considerable diversity of opinion. Although the roentgen examination has afforded a valuable means of observing the development and progress of the lesion, it has not afforded an explanation as to the cause. Barth was one of the earliest writers who regarded the condition, not as the result of a disease named osteochondritis dissecans by Koenig, but as a pathological process definitely the result of trauma. The lack of a definitely traumatic history in many cases and the occasional occurrence of a bilateral case, has inspired a great many theories to explain the characteristic separation of the fragments from a free articular surface. Barth felt that the pull of ligaments at their insertion was a common cause of the condition. Kappis believed that the knee and elbow, due to their anatomical resemblance, were predisposed to a traumatic fissure of the cartilage and this resulted in a lesion of the convex articular surface. Freiberg offers another theory. He believes that the occurrence of a long tubercle on the mesial tibial spine in a position of flexion and external rotation of the tibia or the femur results in a localized trauma to an arteriole in the mesial femoral condyle. Colvin takes a different view and has demonstrated the presence of capillaries in the fibro-cartilage, which have grown after detachment of the fragment. He believes that this indicates a vital process. He believes that the production of fibro-cartilage along the line of cleavage causes the fragment to bulge toward the joint and finally fracture, the thin hyalin plate holding it in place.

Case of Loose Bodies in Left Shoulder-joint.

Case of Loose Bodies in Left Shoulder-joint.

A Case of Loose Body in the Kneejoint due to Detachment of Articular Cartilage, with Remarks on the Frequency of Such an Occurrence

A Case of Loose Body in the Kneejoint due to Detachment of Articular Cartilage, with Remarks on the Frequency of Such an Occurrence