Diffuse Pigmented Villonodular Synovitis Research Articles

Unveiling the Role of Radiotherapy in Managing Pigmented Villonodular Synovitis (PVNS): A Unique Case Analysis

Background and Aims: Pigmented villonodular synovitis (PVNS) is an uncommon but aggressive proliferative process affecting the synovium. Diffuse pigmented villonodular synovitis (DPVNS) is a type that affects the whole joint and if left untreated, it can lead to joint destruction and osteoarthritis. Only surgical excision can lead to local recurrences in DPVNS. Postoperative radiotherapy can significantly lower the incidences of local recurrences and improve functional outcomes. Materials and Methods: Here we present a rare case report of a lady with biopsy-proven DPVNS where postoperative radiotherapy was given. Results: At a 48-month follow-up, the patient is free of disease with improved joint function. Discussion: Given the improved local control, low morbidity and remarkable improvement in joint functions, postoperative radiotherapy should be routinely considered in cases of DPVNS if complete excision is doubtful.

Diffuse pigmented villonodular synovitis treated with arthroscopic total synovial peel

BackgroundDiffuse pigmented villonodular synovitis (PVNS) is prone to recurrence after surgery, and it is difficult to achieve a long-term complete cure.ObjectiveTo reduce the recurrence rate of PVNS, the author pioneered the arthroscopic total synovial peel (ATSP).MethodsFrom March 2014 to July 2020, a total of 19 patients (6 males and 13 females) with diffuse PVNS of the knee were treated in our department and underwent ATSP. It’s ‘peel’ rather than simple excision. This method is similar to peeling bark. Relapse rates and functional scores were determined, with follow-ups ranging from 12 to 72 months, on average 36 months.ResultsTreatment efficacy was assessed by imaging and functional scores. Imaging results indicated a recurrence rate of 10.5%. In patients without recurrence, the visual analog score (VAS) decreased from 4.76 ± 2.02 preoperatively to 1.56 ± 1.15 postoperatively. The Tegner-Lysholm knee function score (TLS) score increased from 67.76 ± 15.64 preoperatively to 90.32 ± 8.32 postoperatively. Compared with the literature, ATSP significantly reduces the postoperative recurrence rate of diffuse PVNS. The preliminarily findings suggest that this approach could greatly reduce the recurrence rate of postoperative PVNS in follow-up studies.ConclusionThis approach may be a viable option for treating diffuse PVNS via arthroscopy and is worthy of clinical consideration.

Arthroscopic treatment of diffuse pigmented villonodular synovitis of the elbow

IntroductionPigmented villonodular synovitis (PVNS) is a rare pathology of the elbow, but presents a risk of progression with cartilage destruction. Surgical treatment consists in synovectomy, as complete as possible. Arthroscopy is an excellent tool for the exploration and treatment of intra-articular lesions in the elbow, but the results in PVNS of the elbow have never been evaluated. The aim of this study was to assess the recurrence rate of PVNS of the elbow after arthroscopic synovectomy, and secondarily to assess pain, joint range of motion, functional scores and complication rate. Material and methodsWe performed a retrospective study of a continuous series of 8 patients operated on between February 2012 and February 2019, with a mean age of 43.7 years. The operated side was the dominant side in 75% of cases. Surgery consisted in the most complete synovectomy possible, performed arthroscopically. Recurrence, clinical evaluation, with pain at rest and on mpvement on visual analogue scale (VAS) and joint range of motion, functional MEPS and DASH scores, and any complications were collected. ResultsAt a mean 66.4 months’ follow-up, 2 patients required revision surgery for recurrence. At the last follow-up, VAS for pain at rest was 0.9 and 1.9 for pain on movement. MEPS score was 85.6 and DASH score 82.2. No neurological, vascular or infectious complications of arthroscopic synovectomy were found in our series. DiscussionArthroscopic synovectomy in the treatment of PVNS of the elbow was a reliable and safe therapeutic alternative, with a low complications rate and 2 cases of recurrence (25%) in our study. This was the first study to report the results of arthroscopic surgical treatment of elbow PVNS. Level of evidenceIV Retrospective study without control group.

Combined Arthroscopic and Endoscopic Synovectomy for Diffuse Pigmented Villonodular Synovitis (PVNS) of the Ankle

The current treatment of choice for diffuse-type pigmented villonodular synovitis (PVNS) is surgical excision. Complete synovectomy is necessary because of the local aggressiveness of the disease, with a significant recurrence rate and a minor chance of malignant transformation. The recurrence rate is even greater in those cases with extra-articular extension. Arthroscopic and endoscopic synovectomy have the advantage of avoidance of extensive soft-tissue dissection, which is associated with open synovectomy. The purpose of this Technical Note is to describe the details of combined arthroscopic and endoscopic synovectomy as treatment for diffuse PVNS of the ankle. By a combination of different arthroscopic and endoscopic approaches of the ankle region, a complete synovectomy of both intra-articular and extra-articular components of diffuse-type PVNS is feasible.

A Rare Cause of Knee Pain and Swelling: Venous Malformation Masquerading as Diffuse Pigmented Villonodular Synovitis

This case report recounts the history of a 21-year-old patient who presented with a 19-year history of recurrent unilateral knee pain, swelling, and restricted movement. At age 10, the patient had a diagnostic knee arthroscopy which resulted in a provisional diagnosis of pigmented villonodular synovitis. The patient was treated for this condition for several years through medical and surgical means. Despite treatment, symptoms did not resolve. Only after the case was discussed by the multidisciplinary team was further imaging through ultrasound (US) suggested. A new diagnosis of venous malformation (VM) was made after US, and the patient was treated accordingly. This case report adds to the literature examining intra-articular VMs, the use of multimodal imaging in the diagnosis of intra-articular lesions of the knee, and the importance of multidisciplinary discussion in the diagnosis of complex knee pathology.

Outcome of Arthroscopic Synovectomy for Diffuse Pigmented Villonodular Synovitis of the Knee in Sudanese Patients

Background: Diffuse pigmented villonodular synovitis (DPVNS) of the knee is a difficult tumor to eradicate, the gold standard treatment has traditionally been surgical excision with total synovectomy of the affected joint, either with an open or arthroscopic approach. In this study, we are focusing on arthroscopic surgical synovectomy. Objectives: Aimed to study the outcome of arthroscopic synovectomy for diffuse pigmented villonodular synovitis of the knee in Haj Alsafi Teaching Hospital. Methodology: Observational retrospective hospital-based study, performed in the Orthopedic Department, 12 patients (8 males and 4 females) with the diffuse form of PVNS of the knee were enrolled in the study after qualification. The clinical diagnosis was confirmed by magnetic resonance imaging and post-surgical histo-pathological examination. All patients underwent complete synovectomy through standard anterior, medial and lateral, then medial, lateral suprapatellar and posteromedial portals. Each patient was evaluated before and after treatment and followed up for a minimum of 18 months (range: 18 – 54 months) using the Lysholm score and International Knee Documentation Committee (IKDC) score. Results: The average age group of patients was (9–63years) with male predominance (66.7 %). Left knee more frequently affected (58.3%). None of the study participants had previous surgical history 100%. Both Lysholm and IKDCscores were significantly improved in all study participants. Regarding paired sample statistics, the mean for the score preoperatively and postoperatively was improved from 54.9 to77.9. Recurrence reported in one participant (8.3%). There was a statistical association between pre and post-operative LYSHOLM and IKDC scores and recurrence, hence p-value =0.000. Conclusion:Arthroscopic synovectomy is an appropriate treatment for knee DPVNS with a good clinical and functional outcome and with a low recurrence rate.

Outcome of Arthroscopic Synovectomy for Diffuse Pigmented Villonodular Synovitis of the Knee in Sudanese Patients

Background: Diffuse pigmented villonodular synovitis (DPVNS) of the knee is a difficult tumor to eradicate, the gold standard treatment has traditionally been surgical excision with total synovectomy of the affected joint, either with an open or arthroscopic approach. In this study, we are focusing on arthroscopic surgical synovectomy.
 Objectives: Aimed to study the outcome of arthroscopic synovectomy for diffuse pigmented villonodular synovitis of the knee in Haj Alsafi Teaching Hospital.
 Methodology: Observational retrospective hospital-based study, performed in the Orthopedic Department, 12 patients (8 males and 4 females) with the diffuse form of PVNS of the knee were enrolled in the study after qualification. The clinical diagnosis was confirmed by magnetic resonance imaging and post-surgical histo-pathological examination. All patients underwent complete synovectomy through standard anterior, medial and lateral, then medial, lateral suprapatellar and posteromedial portals. Each patient was evaluated before and after treatment and followed up for a minimum of 18 months (range: 18 – 54 months) using the Lysholm score and International Knee Documentation Committee (IKDC) score.
 Results: The average age group of patients was (9–63years) with male predominance (66.7 %). Left knee more frequently affected(58.3%). None of the study participants had previous surgical history 100%. Both Lysholm and IKDC scores were significantly improved in all study participants. Regarding paired sample statistics, the mean for the score preoperatively and postoperatively was improved from 54.9 to77.9.Recurrence reported in one participant (8.3%). There was a statistical association between pre and post-operative LYSHOLM and IKDC scores and recurrence, hence p-value =0.000.
 Conclusion: Arthroscopic synovectomy is an appropriate treatment for knee DPVNS with agood clinical and functional outcome and with a low recurrence rate.

Modified posterior approach of the knee in patients with diffuse pigmented Villonodular synovitis: case series of a single Institution’s experience

BackgroundDiffuse pigmented villonodular synovitis (DPVNS) is a challenging tumor-like disorder that mainly occurs in the anterior aspect of the knee joint. The growth may sometimes extend to the posterior knee joint. Surgical excision is the mainstream treatment for DPVNS, and the posterior approach of tumor excision is adopted when the dominant tumor shows posterior extension. However, the optimal surgical approach over the posterior knee remains unknown.MethodsPatients with DPVNS of the knee joint who received the posterior approach of synovectomy from 1995 to 2019 were retrospectively reviewed to describe the modified separate posterior (SP) approaches, and evaluate the treatment outcomes in a case series of DPVNS knees. The results of the SP approach was also compared with those of traditional direct posterior (DP) approach. Postoperative functional outcomes were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) standardized questionnaire and clinician-completed Musculoskeletal Tumor Society (MSTS) functional rating system at outpatient department.ResultsA total of 20 DPVNS knees were included. Thirteen patients who received SP approaches were included in the SP group, while seven patients who received the DP approach were included in the DP group. The median follow-up times were 5.7 years (IQR, 2-8.8) in the SP group and 3 years (IQR, 2-5.3) in the DP group. Both groups showed satisfactory safety. The SP group presented higher postoperative mean WOMAC (91.23 ± 7.20) and mean MSTS (24.23 ± 2.68) than the DP group (mean WOMAC: 76.00 ± 16.57; mean MSTS: 22.43 ± 4.69). The Wilcoxon signed-rank test was use to compare preoperative and postoperative range of motion (ROM) for each group. The significant difference in SP group (p = 0.004) was found while p = 0.131 in DP group.ConclusionsThe SP approach provides an effective approach with satisfactory outcomes for the surgical treatment of DPVNS knees.

Diffuse pigmented villonodular synovitis of the elbow.

Diffuse pigmented villonodular synovitis of the elbow.

Outcomes of arthroscopic management for pigmented villonodular synovitis of the hip.

Early synovectomy is considered as the main treatment of pigmented villonodular synovitis (PVNS) of the hip in young patients with preserved cartilage. The purpose of the study is to evaluate outcomes of arthroscopic management for PVNS of the hip. Patients who underwent primary hip arthroscopy for the treatment of histology-confirmed PVNS by the senior author between January 2012 and December 2016 were retrospectively reviewed. We excluded patients who had less than 1-year follow-up or had undergone primary surgeries with other surgeons and then received revision hip arthroscopic procedures by the senior author. The recurrence of PVNS and postoperative condition of affected hip were assessed by follow-up magnetic resonance imaging (MRI). Patient-reported outcomes of modified Harris hip score (mHHS) and 12-item International Hip Outcome Tool (iHOT-12) were collected at latest follow-up. Nine patients (2 males, 7 females) with a mean age of 24.3 ± 11.2years (range 14-44years) were included in this study. Localized PVNS was observed in four patients, and diffuse PVNS was observed in five patients. No patient presented with advanced osteochondral destruction. Five patients received single adjuvant radiosynoviorthesis. No patient had evidence of recurrence based on follow-up MRI. Patient-reported outcomes were obtained in eight patients at mean 55.8 ± 26.1months (range 24-84months) after the index surgery. The mean mHHS was 94.6 ± 4.9 (range 84.7-100) and the mean iHOT-12 was 93.3 ± 20.2 (range 50-120). No patient needed secondary surgery during the follow-up period. Arthroscopic subtotal synovectomy can offer favorable short to mid-term outcomes in the treatment of hip PVNS in case of no advanced osteochondral damage at presentation.

Clinical outcomes of diffuse PVNS of the knee following arthroscopic complete synovectomy±posterior open resection

IntroductionThis study compares recurrence rates and functional outcomes of patients who underwent anterior arthroscopic synovectomy versus combined anterior arthroscopic/posterior open synovectomy for diffuse pigmented villonodular synovitis (DPVNS). Methods41 patients were grouped by initial procedure and tracked for disease recurrence and functional outcomes (Lysholm Scale). Results24 patients (58.5%) had disease recurrence [16 (57.1%) arthroscopic, 8 (61.5%) combined, chi-square test p = 0.81]. The combined procedure mean Lysholm Score (75.4) exceeded the arthroscopic (68.1) (two-sample t-test p = 0.25). ConclusionsThere is no statistical evidence that the combined procedure harms functionality more than arthroscopic only or that recurrence rates differ between treatment methods.

Results of the surgical treatment of diffuse pigmented villonodular synovitis (diffuse-type tenosynovial giant-cell tumor) of the knee

The aim. To develop a treatment algorithm with the aim of improving the treatment results of diffuse pigmented villonodular synovitis of the knee. To study and analyze the results of surgical treatment of diffuse pigmented villonodular synovitis of the knee. Materials and methods. The study was based on the results of treatment of 48 patients with pathohistologically verified diagnosis of diffuse pigmented villonodular synovitis (tenosynovial giant cell tumor) of the knee undergoing treatment at the State Institution “Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine” from 2010 to 2019. Results. The best functional results can be achieved in patients with diffuse pigmented villonodular synovitis of the knee in stage I of the disease. Using the method of mathematical statistics to evaluate the results obtained, we see that scores obtained through the Lysholm Scoring Scale were statistically significantly different in stages before a surgery (P = 0.000782), 3 months (P = 0.00005) and 6 months after the surgery (P = 0.04); but over time, these differences diminished and became actually insignificant 12 months after the surgery (P = 0.89). Conclusions. Applying our therapeutic algorithm for the treatment of patients with diffuse pigmented villonodular synovitis of the knee, the outcome of the Lysholm score was excellent in 22 % of patients, good – in 45 %, satisfactory – in 21 % and poor – in 12 % of patients.

A case series of intra-articular diffuse pigmented villonodular synovitis of the knee: Prognosis of complete synovectomy under arthroscopic surgery.

The purpose of this study is to evaluate the outcome and prognosis of complete synovectomy performed under arthroscopic surgery in the treatment of diffuse pigmented villonodular synovitis (DPVNS) of the knee. We retrospectively reviewed 7 cases (6 female and 1 male) diagnosed with diffuse pigmented villonodular synovitis (DPVNS) of knee from 2013 to 2017. All of these cases were treated with knee arthroscopy-assisted complete synovectomy. The follow-up period ranged from 36 months to 60 months (average: 48.0 months). The pain score, range of motion and functional outcome of the knee joint were evaluated after surgery. Symptoms and signs were monitored and magnetic resonance imaging (MRI) were routinely requested to note for possible recurrence during clinical follow up. During and after the surgeries of complete synovectomy under arthroscope by the same surgeon, no complications were noted in the ward or the clinic. Significant improvements were achieved in terms of the range of motion and Lysholm knee function score. There was no recurrence of DPVNS observed in our patients during a follow-up of 4 years. Intra-articular DPVNS of the knee can successfully be treated by complete synovectomy under arthroscope. This case series emphasized the technique of multiple portals and cycling different shavers to achieve satisfactory outcomes.

Functional improvement and low recurrence rate after combined staged synovectomy and external radiotherapy for diffuse pigmented villonodular synovitis of the knee: a minimum 2 years' follow-up case series

ObjectiveTreatment of diffuse pigmented villonodular synovitis (DPVNS) of the knee is problematic and controversial with a high rate of morbidities and local recurrence. The purpose of this study is functional evaluation of patients with diffuse knee PVNS treated with combined surgical and external radiosynovectomy.MethodsBetween June 2011 and May 2015, twelve patients (four males and eight females) with DPVNS of the knee were treated by staged surgical synovectomy (arthroscopic anterior and open posterior) followed by low-dose external radiation. SF-36, Musculoskeletal Tumor Society (MSTS), Lysholm, International Knee Documentation Committee (IKDC) scores and range of motion (ROM) were assessed preoperatively and at the final follow-up.ResultsAfter a mean follow-up period of 46.7±15 (25–72) months, there were statistically significant improvement of ROM from 72.5±17.6 to 94.2±7.01, Lysholm score from 42.8±5.2 to 78.1±5.1, IKDC from 39.6±8.3 to 75.3±6, MSTS from 5.6±2.7 to 19.7±6.06 and SF-36 score from 29.4±7.5 to 72.3±17.5. Apart from limited range of motion, three mild complications were encountered (superficial wound infection, repeated effusion and transient neuropraxia).ConclusionCombined staged synovectomy and external radiotherapy provide functional improvement of the knee and quality of patients’ lives with low rate of recurrence for knee DPVNS cases.Level of evidenceProspective case series; level IV.

Mid-Term Results of Arthroscopic Synovectomy for Pigmented Villonodular Synovitis of the Hip

To analyze mid-term outcomes after arthroscopic synovectomy of both diffuse and nodular hip pigmented villonodular synovitis (PVNS). This is a retrospective case series of patients that underwent hip arthroscopy for hip PVNS with a single senior surgeon between 2007 and 2016. Inclusion criteria were magnetic resonance imaging evidence, arthroscopic visualization, and/or histologic confirmation of PVNS; and a minimum of 3 years of follow-up. Concomitant pathology such as femoroacetabular impingement also was treated at the time of surgery. Primary outcome measures were recurrence of hip PVNS and the rate of revision hip surgery. Secondary outcomes were complications, visual analog scale pain score, pain relief, and patient satisfaction, and 6 patient-reported outcome measures were collected at latest follow-up. In a case series of 14 patients consisting of 6 (42.9%) male and 8 (57.1%) female patients, the mean operative age was 32.69 ± 12.73 years with a mean follow-up was 6.66 ± 1.87 years. PVNS type was determined intraoperatively: 5 (35.7%) patients had diffuse hip PVNS and 9 (64.3%) had nodular type. There was only 1 case (7.14%) of recurrence that was treated arthroscopically and no cases (0%) progressed to revision open synovectomy or arthroplasty. Mean patient-reported outcome measure scores were notable for a modified Harris Hip Score of 74.08 ± 16.84. The mean visual analog scale pain score decreased by 4.9 ± 1.7, which was significant with a P<.001, with a larger decrease in patients with localized type. This study presents a large case series of hip PVNS managed arthroscopically with mid-term follow-up of slightly over 6.5 years. The survival rate was 93%, with only 1 (7%) recurrence and 0 (0%) progression to revision open synovectomy or arthroplasty with 0 (0%) complications. We conclude that arthroscopic synovectomy is a reliable and effective treatment of hip PVNS. Case Series, Level IV.

The Importance and Side Effects of Radiotherapy For Diffuse Pigmented Villonodular Synovitis; Case Reports and Literature Review

The Importance and Side Effects of Radiotherapy For Diffuse Pigmented Villonodular Synovitis; Case Reports and Literature Review

Pigmented Villo-Nodular Synovitis of Shoulder Joint Leading to Humeral Head Erosion

Pigmented villo-nodular synovitis (PVNS), also known as giant cell tumor of the tendon sheath or benign synovial histiocytoma, is a benign yet locally aggressive tumor of the synovium that affects both the large joints and the tendon sheaths. The most common site for the tumor includes knees, hip, ankle, and wrist joints; shoulder joint being a very unusual site for the occurrence of this tumor. We present here an unusual case of diffuse PVNS of shoulder joint with eroded humerus head treated with surgical synovectomy and adjuvant radiosynovectomy to prevent recurrence. This case report highlights the natural history of this rare disease due to late presentation, difficulty in the diagnosis, and management of recurrence.

Pigmented villonodular synovitis after anterior cruciate ligament reconstruction using active bioprosthetic composite artificial ligament

Pigmented villonodular synovitis (PVNS) is a proliferative disease that develops in the synovium of joints, especially the knee joints. A 52-year-old man visited our hospital with left knee pain, swelling and symptoms of collapse. Twenty-one years earlier, he had undergone anterior cruciate ligament (ACL) reconstruction using an active bioprosthetic composite (ABC) as an artificial ligament. T1 and T2 weighted magnetic resonance imaging of the knee joint showed rupture of the ABC ligament and low signal intensity of hyperplastic synovium. Arthroscopic total synovectomy without ACL reconstruction was performed and the lesion was histopathologically diagnosed as diffuse PVNS. Clinical outcomes included good pain relief and no recurrence of the disease after 5years of follow-up.

Pigmented villonodular synovitis of the knee confused with juvenile rheumatoid arthritis in a 3-year-old child: A case report

Pigmented villonodular synovitis (PVNS) is rare and characterized by diffuse synovial cell proliferation with the development of villi, or round/ovoid lobulated nodules of varied sizes. It usually presents in adults between the ages of 30 and 40 years and is uncommon in the pediatric population. We herein report a 3-year-old female patient with PVNS causing a femoral subchondral lesion in the right knee. Her symptoms started at the age of one and she had gotten treatment for juvenile rheumatoid arthritis for 2 years. The patient was operated, and the tumor was excised. Arthrotomy was performed for diffuse PVNS and diagnosis was made histopathologically. She was followed-up for 18 months with clinical examinations and MRI, as necessary. She had no pain or limitation in range of motion. She is currently fully functional and ambulatory.

Short-Term Outcomes of Synovectomy and Total Knee Replacement in Patients with Diffuse-Type Pigmented Villonodular Synovitis.

Diffuse-type pigmented villonodular synovitis is a rare benign disease that causes disorders of the knee, including erosion of subchondral bone and cyst formation, with eventual osteoarthritis. The purpose of this study was to evaluate the short-term outcomes of synovectomy and total knee replacement in patients with the diffuse type of pigmented villonodular synovitis. From November 2011 to May 2015, we performed synovectomy and total knee replacement in 28 patients with diffuse pigmented villonodular synovitis diagnosed on the basis of histopathology of biopsy specimens. Clinical data were collected perioperatively and during follow-up for evaluation of surgical efficacy. No intraoperative complications were encountered. Mean operative duration was 73.4 minutes (range: 47-115 minutes); mean estimated blood loss was 223.9 mL (range: 50-600 mL). The mean duration of follow-up was 58.7 months (range: 36-84 months). Mean range of motion improved from 86.1 ± 11.3 degrees (range: 60-100 degrees) to 107 ± 11.4 degrees (range: 90-130 degrees). Average Knee Society clinical scores improved from 38.9 ± 9.5 (range: 17-54) to 84.4 ± 6.1 (range: 75-98); functional scores improved from 48.9 ± 13.1 (range: 25-80) to 84.6 ± 6.1 (range: 75-95; p < 0.05 for both). Postoperative radiographs showed no signs of prosthesis loosening, periprosthetic fractures, or dislocation. The short-term efficacy of synovectomy and total knee replacement in treating patients with diffuse pigmented villonodular synovitis was satisfactory.