Chondromatosis Research Articles

Imaging of Tumor-like and Cyst-like Lesions of the Temporomandibular Joints.

“Rice bodies” symptom are a secondary clinical manifestation of a number of pathologies involving the synovial tissue. The conditions associated with this phenomenon include rheumatoid arthritis, tuberculosis, juvenile idiopathic arthritis, infectious arthritis, systemic lupus erythematosus, sarcoidosis, and reactions to orthopedic implants. It is possible that other nosological entities may be involved, although no data is currently available. “Rice bodies” present as multiple round-shaped bodies located both intra-articularly and periarticularly in synovial bursae and tendon sheaths. The etiology of this condition remains unknown, reliable statistics on its prevalence are not found in the literature, and its pathogenesis remains controversial. Clinically, the condition may be associated with pain and/or functional limitations, but it can also be asymptomatic and discovered incidentally. The optimal method for diagnosis is magnetic resonance imaging, while the preferred treatment is surgical extraction of the structures along with the adjacent components of hypertrophied synovium, followed by mandatory histopathological examination and conducting differential diagnostics with synovial chondromatosis and villonodular synovitis. These patients require a team-based multidisciplinary approach led by a specialist responsible for treating the underlying disease.

Abstract Introduction Atraumatic limb pain is a common presentation to urgent and emergency services. The differential is broad, and misdiagnosis can lead to morbidity and mortality. A diagnosis can frequently be reached by the appropriate use of same-day investigations, and secondary care follow up is rarely needed. This case illustrates an example of a more tortuous diagnostic journey with involvement of several clinical teams and uncertainty persisting until the very end. The culprit is a rare manifestation of a common disease, and modified the authors’ diagnostic thought processes. Case description An otherwise well 27-year-old man with a history of left tibial plateau fracture 13 years prior presented to minor injuries after waking with a large, tender effusion to his left knee. He reported that his knee had given way the previous day. This had been happening intermittently since his historical injury. Septic arthritis was unlikely given the absence of pyrexia, a lack of risk factors, and unremarkable inflammatory markers. His x-ray ruled out a fracture and confirmed a large effusion. A soft tissue injury was felt most likely in the context of his knee having given way, so the patient was issued a knee splint and crutches and discharged with orthopaedic follow-up. In clinic two weeks later a large effusion persisted and the patient was unable to straight leg raise. MRI was organised to assess for meniscal pathology, but instead showed an area of well-demarcated bone erosion to the lateral margin of the patella which had been replaced by a 22x15x12mm mass of indeterminate soft tissue material. Radiological differentials included inflammatory and neoplastic causes, gout, pigmented villonodular synovitis, or a giant cell tumour of the patella. He was referred to the sarcoma MDT who added synovial chondromatosis as a further differential. Core biopsy of the lesion was arranged. Histology demonstrated variably-sized deposits of pale, acellular, crystalline material surrounded by fibrous tissue. There was a florid histiocytic and foreign body giant cell reaction to these deposits. His serum urate was 595µmol/L. A diagnosis of tophaceous gout was made on the basis of these findings, and urate lowering therapy commenced. Discussion Gout is a common cause of atraumatic arthralgia but is relatively rare in those under the age of 30 with an estimated prevalence of 0.4% [Li 2019]. Gouty tophi are considered a feature of advanced gout and typically emerge after at least 10 years of uncontrolled gout [Rana 2021]. It is unusual for tophi to be the presenting complaint for a patient with gout [Salavastru 2020], and the patella is a rare location for tophi to occur [Clark 2016]. This patient posed a diagnostic challenge due to this very unusual combination of features combined with his previous traumatic history. Urgent care, rheumatology, orthopaedics, sarcoma MDT, radiology, and histopathology teams were all involved in reaching this diagnosis, which reflects the complex structure of the modern medical system. The process of ruling out a life-threatening cause and arriving at a solution proceeded efficiently thanks to effective communication between teams, appropriate referrals, and the availability of expertise. Unfortunately, despite the prescription of urate lowering therapy for over a year the patient’s uric acid has not fallen. Allopurinol dosing has been uptitrated with no effect. We suspect poor concordance with treatment is the most likely cause, which is a challenge particularly prevalent in younger patients [Khalid 2018]. This is of particular concern given the increased cardiovascular risk conferred by an early-onset gout diagnosis [Ferguson 2024]. There is scant reporting in the literature of tophaceous gout as the index presentation of gout, the development of this advanced form of the disease in young patients, and how this should be considered in the management of the long-term health of such patients. The authors would be interested in the thoughts and experiences of CBC attendees regarding these areas. How far would our fellow attendees go in looking for genetic and endocrinological bases for this presentation, for example? Key learning points • Gout should be actively considered in the differential diagnosis of atraumatic, or mildly traumatic, joint pain in young adults. • Early-onset gout is associated with increased cardiovascular risk. • Tophi can be the first presenting feature of gout, and can affect the patella. • Tophi can go unnoticed on plain imaging. • Radiologically, gouty tophi can be indistinguishable from several inflammatory and neoplastic conditions. • Biopsy can be necessary to positively identify gouty tophi. • Gout is not always easily diagnosed, and does not necessarily follow a straightforward diagnostic pathway.

Popliteal cysts are common lesions, primarily characterized by soft tissue swelling, which may occasionally present with calcifications or small osteochondromas, and can rarely lead to restricted movement. We report a case involving a spherical coral-like synovial chondroma located within a popliteal cyst, which caused significant pain and limited the flexion and extension of the knee joint. Notably, the appearance of the synovial chondroma was strikingly similar to that of spherical coral, and its distinctive imaging features are previously unreported in the literature. Following the excision of both the popliteal cyst and the intra-cystic spherical coral-like synovial chondroma, the patient’s range of motion in the knee joint returned to normal. The unusual morphology may arise from constrained growth within the cyst under pressure during joint movement, potentially influenced by the hyperuricemic microenvironment. Clinicians should consider synovial chondromatosis in the differential diagnosis of complex or calcified popliteal cysts.

Introduction: Synovial chondromatosis is a rare, benign condition characterized by the formation of multiple cartilaginous nodules within the synovial membrane leading to attached or unattached loose body. It can arise either spontaneously (idiopathic) or secondary to osteoarthritis (OA). The aim of this study is to highlight the importance of early diagnosis and effective management of synovial chondromatosis. Case presentation: A 66-years-old female complained of pain in the left knee for a year accompanied with swelling and stiffness 6 months later and limitation to walk occurs 8 months since the first complaint. An X-Ray of left knee showed multiple mass calcification and narrowing joint spaces. The patient treated with total knee arthroplasty due to severe joint damage and conducted complete evacuation of loose bodies with excision and performed a biopsy, which confirmed the diagnosis. Range of motion (ROM) exercise and weight bearing was started in second post operative day and proper education was given to the patient before discharge. Following 2 months follow up, patient left knee flexion extension ROM ranged from 0-150˚ and no further swelling experienced by the patient. Discussion: The rarity of synovial chondromatosis results in a delay in the diagnosis. Atypical symptoms of synovial chondromatosis are commonly confused with OA itself. Secondary synovial chondromatosis is associated with joint abnormalities, such as mechanical or arthritic conditions, as presented in this case. The choice of management is based on the patient’s clinical condition, degree of joint damage, and the involvement of the loose bodies. Early detection may allow for management with arthroscopic debridement. But, if severe joint damage takes place, total knee arthroplasty following the removal of loose bodies is an effective treatment that give favorable result with satisfactory functional outcomes. Conclusion: Synovial chondromatosis, a rare benign synovial disease-causing knee pain and limited motion, was successfully managed in this case by removing loose bodies during total knee arthroplasty, with the patient showing significant improvement, highlighting the need for regular exercise and follow-up to prevent recurrence. Clinical Importance: Early diagnosis of synovial chondromatosis is crucial to prevent severe joint damage, and total knee arthroplasty with removal of loose bodies can yield excellent functional outcomes. Keywords: excision, synovial chondromatosis, osteoarthritis, total knee arthroplasty

Tumors of the Synovium.

Intracranially extending temporomandibular joint (TMJ) lesions may be radiologically misinterpreted as primary intracranial or skull base pathologies, leading to diagnostic delays or inappropriate management. This systematic review aimed to characterize the clinical and imaging features of such TMJ lesions and evaluate the impact of radiologic misclassification. We also aimed to develop a diagnostic framework for when to consider an intracranially extending TMJ lesion, based on clinical and radiologic features. A comprehensive search of MEDLINE, SCOPUS, and Embase, conducted in accordance with PRISMA guidelines, yielded 2,255 records. After screening with a pre-determined inclusion and exclusion criteria, 128 studies involving 152 patients were included in the final analysis. Statistical analyses were performed using STATA software. We also identified 3 patient cases through our institutional neuroradiology practice who were clinically and radiologically assessed for intracranially extending TMJ lesions. Patients had symptoms for an average of 34 months prior to diagnosis (47% female, mean age 50 years). The most common pathologies were pigmented villonodular synovitis/tenosynovial giant cell tumor (43%) and synovial chondromatosis (24%). Neurological symptoms were reported in 48% of cases, most frequently hearing loss (70%). Nearly one-third (33%) of cases with an imaging differential did not list a TMJ pathology (18/55). In cases with accurate imaging diagnosis, 90% had both CT and MRI performed. Most lesions were non-enhancing (CT 83%, MRI 75%) and demonstrated no adjacent brain edema (96%). In two cases, a TMJ ganglion cyst and pseudogout were misdiagnosed as intracranial tumors, resulting in unnecessary intervention, including repeat craniotomy and radiotherapy. Inherent biases of case report literature, including variability in the reporting of the imaging and clinical features, management and follow-up. TMJ lesions with intracranial extension often present with non-specific symptoms and can mimic extra-axial tumors, leading to misdiagnosis on imaging. Recognition of hallmark imaging features, including lack of parenchymal invasion and distinct imaging patterns, may help improve radiologic accuracy and prevent overtreatment. We propose a diagnostic framework outlining when to suspect intracranially extending TMJ lesions based on clinical and imaging features, and how to avoid common diagnostic pitfalls.

Rationale:Osteochondromas are rare benign tumors that can occur in the temporomandibular joint (TMJ). These lesions can cause functional and aesthetic impairments of the jaw. Most studies have discussed surgical management and reconstruction within a single department. Establishing a patient-specific treatment plan through a multidisciplinary approach, involving various dental specialists can lead to better clinical outcomes. This case report illustrates the successful multidisciplinary management of a TMJ osteochondroma, emphasizing the importance of comprehensive diagnostic imaging, surgical intervention, and coordinated postoperative care.Patient concerns:A 50-year-old male visited the hospital to consult about implant treatment for the missing 1st and 2nd molar region in his right mandible. Imaging studies revealed a pedunculated mass on the right condyle.Diagnoses:Based on clinical and radiographic examinations, a provisional diagnosis of osteochondroma was established. After the surgery, the final diagnosis was confirmed by an oral and maxillofacial pathologist as osteochondroma and secondary synovial chondromatosis of the right TMJ.Interventions:A multidisciplinary team discussed the patient’s treatment plan. The patient underwent a low condylectomy and dental implant surgery followed by rehabilitation comprising physical therapy, jaw exercises, and the use of an occlusal stabilization splint.Outcomes:Postoperative evaluations showed gradual improvement in jaw function and stable occlusion. Six months after surgery, the patient had adapted well to the new occlusion and expressed satisfaction with the rehabilitation outcome, with follow-up imaging confirming the absence of recurrence.Lessons:Multidisciplinary management is crucial for achieving favorable outcomes in the treatment of TMJ osteochondromas. This case underscores the importance of comprehensive and coordinated treatment strategies.

Objective: To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA). Methods: A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results: All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference (t=0.231,P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference (t=1.792,P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation (t=6.282,P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference (t=2.635,P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up (t=22.630,P<0.01). Conclusion: The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Surgical Options for Primary Synovial Chondromatosis of the Knee: A Systematic Review

Retrospective Evaluation of Synovial Chondromatosis with Histopathological and Clinical Features

The aim of this study is to classify knee osteoarthritis, synovial chondromatosis, Osgood-Schlatter disease, os fabella pathologies that can be diagnosed with plain knee X-rays, and normal knee radiographs with deep learning and machine learning methods. This study was performed on 540 knee osteoarthritis, 151 Osgood_Schlatter disease, 191 knee chondromatosis, 152 os fabella and 523 normal knee X-ray images. First, classification was performed with the VGG-16 network, which is a pre-trained deep learning model. Then, the features extracted with the VGG-16 convolution layer were classified with random forest, support vector machines, logistic regression and decision tree machine learning algorithms. With VGG-16 model, 95.3% accuracy, 95.1% sensitivity, 98.7% specificity, 96.8% precision, and 95.9% F1 score results were obtained. In classifying the features extracted from the VGG- 16 convolution layer with machine learning algorithms, 98.2% accuracy, 99.0% sensitivity, 98.9% specificity, 98.2% precision and 98.5% F1 score results were obtained with the logistic regression classifier. In this study, which was conducted to classify radiographically detectable knee pathologies, successful results were obtained with the VGG-16 network. The features extracted from the convolution layer of the VGG-16 model were reclassified with machine learning algorithms, logistic regression, support vector machines and random forest classifiers, and improvements in performance metrics were obtained compared to the VGG-16 model. With this proposed method, the performance of deep learning models can be further improved.

BACKGROUND: The hip joint is an essential anatomical and functional component of the human skeleton, providing support and mobility for the lower limbs. Hip joint disorders significantly impair quality of life. Hip joint diseases are a major concern in modern medicine, particularly considering the increased life expectancy and prevalence of degenerative conditions. Recent studies demonstrate that hip arthroscopy for chondromatosis and other joint pathologies provides favorable clinical outcomes, high patient satisfaction, and low recurrence rates. AIM: This study aimed to assess the efficacy of hip arthroscopy in the treatment of synovial chondromatosis, including the development and implementation of a novel surgical technique, assessment of clinical outcomes, patient satisfaction, and recurrence rates, and analysis of postoperative rehabilitation. METHODS: This was a single-center, prospective, interventional, controlled study. It included patients with synovial chondromatosis of the hip treated at the N.N. Priorov National Medical Research Center of Traumatology and Orthopedics between October 29, 2012, and July 25, 2024. Medical interventions included preoperative assessment (medical history, physical examination, MRI), surgical treatment (placement of a damper system on the hip joint, hip arthroscopy with removal of intra-articular loose bodies, coblation of affected capsular areas, and joint debridement), and personalized rehabilitation (exercise therapy to restore joint range of motion). The 12-year follow-up period enabled the assessment of both short- and long-term treatment outcomes. The primary endpoint was improved hip function and pain reduction. Assessment methods included pre- and postoperative clinical examinations, follow-up MRI, and assessment of joint mobility. RESULTS: The study included 9 patients, all of whom completed follow-up. The mean age was 37 years. The findings demonstrated improved hip function, pain reduction, and absence of intra-articular loose bodies on follow-up MRI. Long-term follow-up allowed for the assessment of recurrence risk and confirmed the long-term efficacy and safety of the arthroscopic technique, contingent on adherence to postoperative recommendations and exercise therapy. CONCLUSION: Arthroscopy was effective in the treatment of synovial chondromatosis, with favorable clinical outcomes, high patient satisfaction, and low recurrence rates.

ABSTRACTObjectiveThe synovial chondromatosis is an exceptionally rare benign condition, predominantly found in the knee joint, and can result in pain, restricted mobility, and potential irreversible damage to the joint and cartilage. Despite the utilization of arthroscopic techniques in the surgical management of synovial chondromatosis, there remains a paucity of long‐term assessment regarding its efficacy. The main objectives of this study include: (i) investigating the long‐term efficacy of arthroscopic surgery in patients with knee synovial chondromatosis;(ii) identifying factors influencing functional improvement in patients post‐surgery function.MethodsWe conducted a retrospective analysis of all patients with synovial chondromatosis of the knee who underwent arthroscopic synovectomy and loose body removal at our institution between June 2009 and January 2020. The follow‐up period for all cases exceeded 5 years. Data collection included demographic details, clinical efficacy indicators(VAS, KOOS, WOMAC, etc.), imaging findings, and subjective satisfaction of patients with surgical outcomes. Data analysis selected t‐tests, ANOVA, non‐parametric tests, and correlation methods based on normality test results.ResultsWe enrolled a total of 13 patients, including 4 men and 9 women, with a mean follow‐up of 113.15 ± 30.45 months (range 61–145). There were no postoperative complications, recurrence, or malignant transformation in all patients, and the VAS scores, KOOS scores, WOMAC scores, and Lysholm scores of all patients were significantly improved at 3 months, 6 months, 1 year, 5 years, and the last follow‐up (p < 0.05). However, one patient experienced osteoarthritis progression, necessitating arthroplasty.ConclusionThis retrospective study demonstrated that arthroscopic treatment for knee synovial chondromatosis is effective and safe. It leads to immediate post‐intervention improvement in symptoms and function, with sustained long‐term benefits.

We describe a rare case of synovial chondromatosis in the subacromial bursa that led to rotator cuff damage and progressive glenohumeral osteoarthritis. A 66-year-old woman initially presented with shoulder pain and limited motion, and imaging revealed a loose body in the subacromial bursa and partial-thickness rotator cuff tear. Conservative treatment was initially effective, but symptoms recurred after migration of the loose body into the rotator cuff. Arthroscopic removal and partial synovectomy were performed, resulting in symptom relief. Histology confirmed benign osteochondroma. This case highlights the importance of early surgical intervention to prevent irreversible rotator cuff damage in similar cases.

Tenosynovial giant cell tumor (TGCT) is a benign but locally aggressive synovial neoplasm that affects both adults and children. In pediatric patients, it commonly involves the knee and ankle, presenting with pain, swelling, and mechanical symptoms, which can mimic other joint disorders. Early and accurate identification is crucial to prevent joint damage and functional impairment. Ultrasound is the first-line imaging modality due to its accessibility and ability to assess synovial proliferation and vascularity, but MRI is the reference standard for diagnosis, showing characteristic low signal intensity on T1- and T2-weighted images and blooming artifact on gradient-echo images due to hemosiderin deposition. Advanced imaging techniques, such as diffusion-weighted imaging and dynamic contrast-enhanced MRI, further enhance lesion characterization. Treatment is primarily surgical, with arthroscopic resection preferred for localized TGCT and open synovectomy required for diffuse disease. This review explores the epidemiology, clinical presentation, imaging features, and treatment of pediatric TGCT, with an emphasis on the differential diagnosis, which includes juvenile idiopathic arthritis, hemophiliac arthropathy, venous malformation, primary synovial chondromatosis, synovial sarcoma, fibroma of the tendon sheath, desmoid-type fibromatosis, and epithelioid sarcoma. The role of multimodal imaging in diagnosis and management is also discussed.

ABSTRACTSynovial chondromatosis (SC) is a rare joint disorder characterized by cartilaginous loose bodies, yet its cellular underpinnings remain incompletely understood. To define the cellular landscape in SC, single‐cell RNA sequencing was performed on synovial tissue obtained from both healthy individuals and SC patients. Analysis of this comprehensive dataset revealed significant alterations in the cellular composition and unique transcriptional profiles of key synovial cell populations within SC synovium. Specifically, a marked increase in the proportion of distinct fibroblast subpopulations (F3 and F4) engaged in extracellular matrix (ECM) synthesis and degradation was observed. Concurrently, the macrophage compartment exhibited a notable shift towards M2‐like and M4‐like phenotypes. Furthermore, an expanded and dynamically transitioning proliferative immune cell (ProIC) population was identified, with distinct C0 and C1 subpopulations showing unique functional characteristics and a differentiation trajectory from C0 to C1. Beyond individual cellular characteristics, interrogation of intercellular communication networks revealed potentially enhanced signaling, particularly between fibroblasts and macrophages mediated by FTL‐SCARA5 interactions, and between macrophages and ProICs via CD74‐MIF/other CD74 ligand interactions. These findings offer a comprehensive and detailed characterization of the cellular heterogeneity and altered cellular states associated with SC. This detailed cellular atlas provides a crucial foundation for future functional studies aimed at dissecting the precise roles of these observed cellular alterations in SC pathogenesis and exploring potential therapeutic targets.

Background: Synovial chondromatosis is a benign proliferation of the synovial membranes surrounding joints and tendon sheaths that may cause serious joint instability and dysfunction. If left untreated, loose bodies generated within the joint can lead to accelerated joint destruction. Arthroscopic synovectomy with loose body removal has been recommended in certain cases to limit the rate of recurrence. Past techniques have utilized suction as well as manual removal of larger loose bodies. Indications: The patient had extensive right hip synovial chondromatosis as well as femoral acetabular impingement and a labral tear. Thus, she was indicated to receive arthroscopic labral repair along with a femoroplasty and removal of foreign bodies to return functionality and prevent future joint damage. Technique Description: This technique uses a large 5.5-mm bur with the inner bur piece removed from its sleeve. Usage of the sleeve as a vacuum for suctioning small and large loose bodies allows for the minimization of manual removal and soft tissue disruption. Results: Arthroscopic bur sleeves allowed for efficient removal of loose bodies in the setting of synovectomy and symptomatic synovial chondromatosis. Discussion/Conclusion: For this case, removal of synovial chondromatosis utilizing the loose body vacuum resulted in good clearance of larger loose bodies while minimizing soft tissue disruption. Utilization of the same instrument for both arthroscopic debridement and loose body removal is both efficient and cost-effective. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Diagnosis of Early-Stage Synovial Chondromatosis in Temporomandibular Joint

Synovial chondromatosis is a rare condition which affects the synovial joints, tendon sheath, bursa. Mostly commonly seen in 3rd to 5th decade with male predominance. The exact etiology is unknown. usually manifest clinically as synovitis. Clinical evaluation with appropriate radiological evaluation is necessary for the diagnosis. Surgical intervention is appropriate either open or arthroscopic. It involves arthrosopic loose body removal with extensive synovectomy. Histopathological evaluation is required for confirmation of diagnosis. Long term follow up is needed