Open Synovectomy Research Articles

Synovial chondromatosis of the shoulder: A rare case report

Synovial chondromatosis is a monarticular svnovial proliferative disease in which cartilaginous or osteocartilaginous metaplasia occurs within the synovial membrane of joints, bursae or tendon sheaths. The disease has been classified into three phases. 1: Early: with svnovial chondrometaplasia but no loose bodies; 2: Transitional: with active svynovial disease and loose bodies; 3: Late: With loose bodies but no synovial disease.Cartilaginous metaplasia from joint, tendo, or bursal synovial lining differentiates this entity from loose bodies arising from degenerative arthritis, osteochondritis dissecans. and osteochondral fractures. A 54 Year Hindu male presented to the orthopaedic OPD with complains of pain and swelling in left shoulder which was insidous in onset, gradually progressive in nature and not relieved by medications. Patient also complained of clicking noise during shoulder movements which was insidous in onset and gradually progressive in nature. Synovial chondromatosis is a synovial lesion seen generally in adults with a male predominance. It occurs most commonly in the knee, unsually also occuring at the hand, wrist, elbow and shoulder. It can lead to mechanical symptoms, decreased range of motion and effusion. Histopath shows nodules of moderately cellular hyaline cartilage. D/D can include Myositis Ossificans, Synovial Chondrosarcoma and Synoval Sarcoma. Treatment is usually observation if asymptomatic. It symptomatic, then arthroscopic or open synovectomy can be done, arthroscopy increases chances of recurrence.

A Case of Baker’s Cyst with Synovial Chondromatosis of Knee

Synovial chondromatosis is a benign condition which arises from synovial membrane or bursae around the joints. Joint abnormalities in the form of arthritic or mechanical conditions such as detachment of osseocartilaginous fragments from the articular surface are its secondary associations. Rarely there maybe involvement of the Baker’s cyst. Here we report a case in which a 60-year-old female came with complaints of pain, swelling and restriction of movement of right knee joint for the past one year. After careful clinical and radiological examination, it was diagnosed as Baker’s cyst complicated by synovial chondromatosis. After the diagnosis the patient underwent the following procedures: open synovectomy, cyst removal and thorough joint debridement. Synovial chondromatosis was confirmed histopathologically. Secondary synovial chondromatosis has features of osteoarthritic changes, lack of extensive synovial proliferation and complicated Baker's cyst which is not seen in primary synovial chondromatosis.
 Synovial chondromatosis (SC) is caused by metaplasia of the synovium into chondrocytes and is a rare benign disorder.[1,2] Primary synovial chondromatosis (PSC) is a self-limited process that occurs in an otherwise normal joint.[3] When synovial chondromatosis develops in a joint previously affected with disease, often posttraumatic or degenerative osteoarthritis, it is called as secondary synovial chondromatosis.[4] SC may involve any joint, but the most common joint involved is knee joint followed by hip joint, and small joints of the hand and wrist. Least involvement is seen in elbow and shoulder joint. [5] The disease is categorised into three phases according to Milligram classification: active intrasynovial disease without any loose bodies observed in the early phase, active disease and loose bodies observed in the transitional phase, and multiple loose bodies without any intrasynovial disease observed in the late phase.
 In orthopaedic practice, popliteal cysts are common occurrence; many of them are associated with degenerative or rheumatoid arthritis. The differential diagnoses become more complex when loose bodies and calcifications are noted within the joint on a radiograph. Here in, we are presenting a case of Baker’s cyst with synovial chondromatosis of knee treated by surgical excision and confirmed by histopathology.

АРТРОСКОПИЧЕСКАЯ ХОЛОДНО-ПЛАЗМЕННАЯ АБЛЯЦИЯ ПРИ РЕДКИХ ЗАБОЛЕВАНИЯХ СИНОВИАЛЬНОЙ ОБОЛОЧКИ КОЛЕННОГО СУСТАВА. КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ

Background. Over a long period, an open capsular synovectomy technique was recommended for villous nodular synovitis and synovial chondromatosis of the knee joint. However, such surgical treatment is accompanied by significant trauma to the joint tissue and frequent postoperative recurrence. Currently, it is advisable to assess the possibilities of modern treatment methods (arthroscopic cold plasma ablation) for rare diseases of the knee joint. The aim of the study. To assess the possibilities of arthroscopic cold plasma ablation in a series of clinical observa-tions of the surgical treatment of patients with rare diseases of the knee joint synovium in a statistically small sample. Material and methods. Surgical treatment was performed in 14 patients with diseases of the knee joint synovium. We carried out clinical and radiological examinations, computed tomography and magnetic resonance imaging, multi-detector computed tomographic angiography, ultrasound examination, Dopplerography of the vessels of the lower extremities, biochemical examination of synovial fluid, arthroscopy with targeted biopsy and subsequent morphological examination of the synovial membrane. Results. In 7 patients with pigmented villous nodular synovitis, the following surgeries were performed: in 1 patient with the diffuse form – an open subtotal capsular sinovectomy; in 6 patients with the nodular form – an arthroscopic partial cold plasma capsular sinovectomy of the knee joint. In 7 patients with synovial chondromatosis, an arthroscopic removal of cartilage flaps and partial cold plasma ablation of synovial folds and knee joint villi were carried out. Conclusion. Arthroscopic cold plasma ablation with bipolar electrodes in various modes of the Qvantum-2 (Arthro-Care, USA) using anterior, posterolateral and suprapatellar approaches makes it possible to carry out less traumatic and radical, without damaging deep layers of cartilage and capsule, surgical treatment of rare diseases of the knee joint synovium. In diffuse forms of pigmented villous nodular synovitis, it is advisable to continue comparative studies of various surgical methods of capsular sinovectomy (open and arthroscopic techniques).

E69 Localised intraarticular pigmented villonodular synovitis in an adolescent patient: a case-based review of the literature

Abstract Introduction Pigmented villonodular synovitis (PVNS) is a rare, locally aggressive subtype of tenosynovial giant cell tumours that affect the synovium of the joints and tendons, occurring either focally or diffusely associated with the deposition of hemosiderin into the involved joint(s) and soft tissues. Although PVNS is historically considered an inflammatory process, recent evidence suggests the possibility of a neoplastic transformation. In addition, despite being typically found as a monoarticular knee disorder, other large and small joints can also be affected. The disease is rarely reported in African children, with most reported cases not histologically confirmed. We, therefore, present the first histologically proven case of localised intraarticular PVNS in an African teenager who presented with unilateral left knee swelling and pain. Method/Setting We report the case of a 16-year-old male teenager who presented to the rheumatology clinic with a nine-month history of non-traumatic anterior left knee swelling and pain that increased over time with associated difficulty walking and standing without aid. After clinical examination and relevant investigations, Magnetic Resonant Imaging (MRI) was done to confirm our suspicion of PVNS. Findings/Treatment Examination revealed a tender, swollen knee with a fluctuant palpable infrapatellar mass. Knee arthrocentesis yielded about 200mls of non-clotted hemorrhagic effusions. The patient had an open synovectomy following MRI, which was highly suggestive of pigmented villonodular synovitis with extensive suprapatellar bursitis. Specific histological findings (below) further confirmed the diagnosis. He commenced early physiotherapy, and symptoms resolved without recurrence of swelling eleven months after surgery. Conclusion This case highlights the visual presentation of an uncommon joint disorder and suggests it is considered a differential diagnosis of non-traumatic monoarticular pain and swelling in our rheumatology clinic set-up and among teenagers in whom juvenile rheumatoid arthritis would have been the first differential. Key words: Pigmented villonodular synovitis, Synovectomy, Multinucleated giant cells Contribution statement: AA conceived the idea to write the case report, draft the first manuscript, and manage the patient. YA, HO and AF edited the manuscript, while AIL interpreted the histological findings. All the authors approved the final version of the manuscript. Disclosure statement: None declared. Ethics and patient consent: This case report adheres to the Helsinki declaration, and the patient’s parents gave written consent to publish the details of the information. Additional information: Any institution did not fund this publication. Acknowledgements: We thank Dr Isaac Akanbi and Dr Bukar for interpreting the MRI and performing the surgery.

Features of preoperative preparation in the treatment of the knee joint in patients with hemophilia

Hemophilia is considered a hematological-orthopedic disease that develops as a result of damage to various anatomical structures of the musculoskeletal system, among which the synovial joints (so-called "target joints") dominate in almost all patients with hemophilia. The purpose of the study was to develop and implement a modern preoperative preparation algorithm for surgical treatment of knee joint pathology in patients with hemophilia. In order to carry out our research, we analyzed 61 cases of hemophilia that were under inpatient and outpatient treatment at the "Kyiv City Clinical Hospital No.9" in the period from 2008 to 2022. Open or arthroscopic knee synovectomy was performed in 22 (36.1%) examined patients of our study. Indications for synovectomy were the presence of hemarthrosis 4–5 times a year or more, presence of deformity and pain syndrome. Total knee arthroplasty was performed in 39 (63.9%) patients. The indication for this operation was the presence of deforming arthrosis of the knee joint with impaired walking and standing function.The expanded algorithm of preoperative preparation included additional instrumental methods of research and calculation of the deficiency of blood coagulation factors, which made it possible to prevent hemorrhagic complications in this category of patients. Operations on patients with hereditary coagulation disorders should be performed under the supervision of hematologists specializing in coagulation disorders and preferably working in specialized centers that have all the necessary resources for the proper diagnosis and treatment of hemophilia. In order to minimize the risks of hemorrhagic complications, we strongly recommend treating such patients with the participation of a multidisciplinary team of specialists, drawing up an individual therapy plan before the operation, and conducting the operation in centers specializing in the treatment of patients with hemophilia. Keywords: orthopedics, hematological and orthopedic diseases, preoperative preparation algorithms.

Geniculate Artery Endovascular Embolization Post-Total Knee Arthroplasty for Hemarthrosis Treatment: A Systematic Review of the Literature

Purpose: To provide an updated systematic review on the use of geniculate artery embolization (GAE) in the management of recurrent hemarthrosis post-total knee arthroplasty (TKA). Materials and Methods: A systematic literature review was conducted, and all clinical reports in the English language from inception to July 2022 were identified. References were manually reviewed to identify additional studies. Demographics, procedural techniques, post-procedural complications, and follow-up data were extracted and analyzed using STATA 14.1. Results: A total of 20 studies (9 case reports, 11 case series; n= 214) were included for review. In all cases, patients underwent coil embolization of one or more geniculate arteries. Procedure success was reported in 94.8% (n=203/214) of cases without perioperative adverse events. Improvement of symptoms was seen in 72.6% (n=119/164) of cases, with 30.7% (n=58/189) of cases requiring repeat embolization. Recurrent hemarthrosis occurred in 22.2% (n=22/99) of cases over a mean follow-up of 48 months. Conclusion: GAE appears to be a safe and effective treatment for recurrent hemarthrosis following TKA. Future studies in the form of randomized controlled trials should be conducted to further evaluate such embolization techniques and compare outcomes between GAE and standard techniques. Clinical Impact Conservative management of post total knee arthroplasty (TKA) hemarthrosis is successful in only one third of cases. Geniculate artery embolization (GAE) has recently gained attention due to its minimally invasive nature compared to open or arthroscopic synovectomy promising faster rehabilitation, decreased infection rates and less additional surgeries. The purpose of this article was to summarize current literature, provide an updated review on the use of GAE in the management of recurrent hemarthrosis post-TKA and describe immediate and long-term outcomes in an effort to help optimize current treatment algorithms.

Lipoma arborescence of knee joint in an adolescent male patient: a case report

<p>A very uncommon benign synovial membrane tumor is called lipoma arborescens. It often affects a single articulation, the knee. Despite a conventional imaging assessment, the lesion’s histological analysis is still required for the ultimate diagnosis. A 15-year-old boy attended the outpatient clinic of the Lahore General Hospital Lahore, Pakistan with pain and swelling in his left knee that had been steadily worsening over the previous 4 years. There were no concomitant prodromal symptoms, and the swelling was soft and non-tender while also inhibiting knee flexion. Soft tissue shadows were observed on radiographs. A large amount of subarticular erosion in the nearby tibial and femoral condyle was caused by the frond-like proliferation of fatty synovium, according to magnetic resonance imaging. Only the left knee joint showed focused areas of unusually elevated radionuclide uptake during the Technetium (Tc99m) bone scan. After an open synovectomy, the specimen underwent histological analysis, which revealed villiform fatty tissue, a hallmark of Lipoma arborescens coated by somewhat thicker synovium. Although infrequent, open synovectomy is currently the preferred course of treatment for lipoma arborescens, which should be taken into account when making a differential diagnosis of knee diseases. Approximately 3 months after surgery, the patient underwent his most recent follow-up and was asymptomatic with a small amount of joint effusion.</p>

Radiosynovectomy for the Treatment of Chronic Hemophilic Synovitis: An Old Technique, but Still Very Effective.

A radiosynovectomy (RS) should be indicated when recurrent articular bleeds related to chronic hemophilia synovitis (CHS) exist, established by clinical examination, and confirmed by imaging techniques that cannot be constrained with hematological prophylaxis. RS can be performed at any point in life, mainly in adolescents (>13−14 years) and adults. Intraarticular injection (IAI) of a radioactive material in children might be arduous since we need child collaboration which might include general anesthesia. RS is our initial option for management of CHS. For the knee joint we prescribe Yttrium-90, while for the elbow and ankle we prescribe Rhenium-186 (1 to 3 IAIs every 6 months). The procedure is greatly cost efficient when compared to surgical synovectomy. Chemical synovectomy with rifampicin has been reported to be efficacious, inexpensive, simple, and especially practical in developing countries where radioactive materials are not easily available. Rifampicin seems to be more efficacious when it is utilized in small joints (elbows and ankles), than when utilized in bigger ones (knees). When RS and/or chemical synovectomy fail, arthroscopic synovectomy (or open synovectomy in some cases) should be indicated. For us, surgery must be performed after the failure of 3 RSs with 6-month interims. RS is an effective and minimally invasive intervention for treatment of repeated articular bleeds due to CHS. Although it has been published that the risk of cancer does not increase, and that the amount of radioactive material used in RS is insignificant, the issue of chromosomal and/or deoxyribonucleic acid (DNA) changes remains a concern and continued surveillance is critical. As child and adulthood prophylaxis becomes more global, RS might become obsolete in the long-term.

Synovectomy in juvenile idiopathic arthritis: A systematic review and meta-analysis.

Juvenile idiopathic arthritis (JIA) is an inflammatory arthropathy with onset in children younger than 16 years. Treatment is primarily medical; however, surgical interventions, such as arthroscopic or open synovectomy, can be beneficial. Many studies have investigated synovectomy in JIA, but the results of these studies have not been synthesized to our knowledge. Therefore, we performed a systematic review of the literature reporting synovectomy as a treatment for JIA to provide clinical recommendations regarding its risks and benefits. On March 8, 2022, we searched the Cochrane Library, Embase, PubMed, Scopus, and Web of Science for studies evaluating clinical outcomes of open or arthroscopic synovectomy to treat JIA in patients younger than 18 years. We included only studies published in English and excluded studies of synovectomy to treat other arthropathies, septic arthritis, hemophilia, or foreign body arthropathy. The level of evidence for included studies was determined by using the Oxford Centre for Evidence-Based Medicine criteria. We qualitatively analyzed clinical outcomes data, including patient-reported pain relief, rates of symptom recurrence, and postoperative complications. Of 428 articles assessed, 14 were included in our analysis. One was a randomized trial, 1 was a case-control study, and all others were case-series. Studies consistently reported that synovectomy was associated with improved function and decreased pain postoperatively. However, comparisons with modern medical therapy were lacking. Rates of arthritis recurrence varied, with increasing symptom recurrence with longer follow-up and re-synovectomy rates up to 15%. Oligoarticular disease and early disease course were associated with better response to synovectomy, whereas systemic and polyarticular disease were associated with poor response. Stiffness requiring manipulation under anesthesia was the most common complication (4% of all included patients). Although synovectomy is associated with positive functional outcomes and pain reduction postoperatively, there was inadequate comparison thus inadequate evidence to recommend it over modern medical therapy. The current literature suggests that synovectomy should be offered only to patients for whom medical management has failed, while noting the risks of decreased range of motion and symptom recurrence over time.

Primary synovial chondromatosis of the hip joint (PrSC of the hip): A retrospective cohort analysis and review of the literature

IntroductionPrimary synovial osteochondromatosis (SOCM) or Synovial chondromatosis (SC) of the hip is a benign metaplastic condition of the synovium that is rare and may present with a spectrum of clinical features and radiological findings. Patients and methodsA retrospective search using the keyword ‘Synovial chondromatosis’ (SC) of the hip was performed at a tertiary care orthopaedic referral centre in the UK and a hospital in India. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), over 15 years. The patient's data was collated with Electronic Patient Records (EPR), RIS, and correlated with histo-pathology laboratory records where available. The demographic details of the patients, their clinical symptoms, imaging details, and management outcomes were collected. ResultsWe found 15 cases, with a mean age of 36.53 years (range: 14–50 years). There were 9 male and 6 female patients. The follow-up ranged from 1 year to 6 years. Predominantly unilateral presentation with insidious onset of symptoms was found. A spectrum of radiological Imaging was undertaken. Management strategies included supervised observation, arthroscopic or open synovectomy, and hip arthroplasty. No malignant transformation was found in the analysed cohort. ConclusionPrimary ‘Synovial chondromatosis’ of the hip had a male preponderance in our cohort, presenting with a range of clinical features. Radiologically, Magnetic Resonance Imaging (MRI) was the commonest modality of cross-sectional imaging utilised and crucial for the diagnosis, evaluating underlying articular involvement including guiding appropriate patient management presenting with Primary ‘Synovial chondromatosis’ of the hip.

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.

Arthroscopic Capsular Shrinkage Is Safe and Effective in the Treatment of Midcarpal Instability in a Pediatric Population: A Single-Center Experience of 51 Cases.

Objective Treatment of palmar midcarpal instability (PMCI) remains controversial and children can develop PMCI from asymptomatic hypermobility. Recently, case series have been published regarding the use of arthroscopic thermal shrinkage of the capsule in adults. Reports of the use of the technique in children and adolescents are rare, and there are no published case series. Methods In a tertiary hand center for children's hand and wrist conditions, 51 patients were treated with arthroscopy for PMCI between 2014 and 2021. Eighteen out of 51 patients carried additional diagnosis of juvenile idiopathic arthritis (JIA) or a congenital arthritis. Data were collected including range of movement, visual analog scale (VAS) at rest and with load, and grip strength. Data were used to determine the safety and efficacy of this treatment in pediatric and adolescent patients. Results Mean follow-up was 11.9 months. The procedure was well tolerated and no complications were recorded. Range of movement was preserved postoperatively. In all groups VAS scores at rest and with load improved. Those who underwent arthroscopic capsular shrinkage (ACS) had significantly greater improvement in VAS with load, compared with those who underwent arthroscopic synovectomy alone ( p = 0.04). Comparing those treated with underlying JIA versus those without, there was no difference in postoperative range of movement, but there was significantly greater improvement for the non-JIA group in terms of both VAS at rest ( p = 0.02) and VAS with load ( p = 0.02). Those with JIA and hypermobility stabilized postoperatively, and those with JIA with signs of early carpal collapse and no hypermobility achieved improved range of movement, in terms of flexion ( p = 0.02), extension ( p = 0.03), and radial deviation ( p = 0.01). Conclusion ACS is a well-tolerated, safe, and effective procedure for PMCI in children and adolescents. It improves pain and instability at rest and with load, and offers benefit over open synovectomy alone. This is the first case series describing the usefulness of the procedure in children and adolescents, and demonstrates effective use of the technique in experienced hands in a specialist center. Level of Evidence This is a Level IV study.

Arthroscopic Synovectomy of the Hip Joint: The Regional Surgical Technique

Synovial disease is a common reason for hip joint dysfunction. Although traditionally treated with open synovectomy, with the popularization and development of arthroscopic techniques, arthroscopic synovectomy has become the main surgical treatment for synovial diseases. Given the long soft tissue channel and learning curve, arthroscopic synovectomy of the hip joint has high surgical requirements for surgeons. However, there is currently no standardized surgical protocol for arthroscopic synovectomy of the hip joint to guide the surgeon to perform hip synovectomy in an orderly manner. During the past 3 years, we have employed a novel technique, wherein we divided the synovium of the hip into seven regions based on the anatomical structure and the operating range of the arthroscopic portals. With the assistance of flexion, extension, and traction of the hip joint, synovectomy was sequentially performed under arthroscopic guidance. This regional surgical technique can be popularized and likely has the potential to become a standardized arthroscopic synovectomy protocol of the hip joint.

"Secondary Lipoma Arborescens of the Knee Associate with Giant Popliteal Synovial Cyst. A Case Presentation"

Lipoma arborescens is a rare, mainly intra-articular lesion characterized by diffuse replacement of subsynovial tissue by mature fat cells. It can be primary or secondary. The secondary type of lipoma arborescens is the more common. It is associated with an underlying chronic joint inflammation and irritation and is usually affecting the elderly patients. In this paper, we report an unusual case of Lipoma arborescens secondary to gouty arthritis affecting the left knee of a young male associated with a giant popliteal cyst and degenerative changes. An open synovectomy and excision of the popliteal cyst was performed.

Extensile Anterior and Posterior Knee Exposure for Complete Synovectomy of Diffuse Tenosynovial Giant Cell Tumor (Pigmented Villonodular Synovitis).

Extensile Anterior and Posterior Knee Exposure for Complete Synovectomy of Diffuse Tenosynovial Giant Cell Tumor (Pigmented Villonodular Synovitis).

Scope Assisted Ankle Arthrodesis in a Young Male with Hemophilic Arthritis: A Case Study

Category:Ankle Arthritis; ArthroscopyIntroduction/Purpose:Arthritis is a debilitating condition that negatively affects an individual's ability to carry out activities of daily living. While osteoarthritis is a term many have become familiar with, as it is the most common form of arthritis encountered, hemophilic arthritis is a condition not frequently seen or discussed. Hemophilia is a congenital bleeding disorder caused by the absence or decrease of clotting factor VIII (Hemophilia A) or XI (Hemophilia B). When severe, this X-linked disease commonly results in intra-articular bleeding which, can progress to joint destruction1-4. This subsequently leads to the progressive destruction of articular cartilage and bone6-7.Methods:Arthroscopic assisted ankle arthrodesis with calcaneal autograft was performed. Calcaneal autograft was acquired through a small linear incision along the lateral wall of the calcaneus, a power graft harvester was introduced into the medullary bone to procure the graft. The left lower extremity was then placed into a non-invasive Gould Ankle distraction system and the standard anteromedial and anterolateral ankle scope portals were established. A scope and shaver were utilized to extensively debride all visualized hemorrhagic synovium. The shaver was then exchanged for a burr following debridement to remove the articular cartilage to both the talus and tibia. Following adequate preparation of the joint margins for fusion, the ankle joint was filled with the calcaneal autograft and rhPDGF-BB.Results:Various treatments have been described for patients suffering from hemophilic arthritis. While the use of clotting factor concentrations (CFCs) may reduce the risk of hemarthrosis, the risk of bleeding cannot be completely avoided2. Arthroscopic or open synovectomies has been described to remove the pathogenic synovium. Chemical or radioisotopic synoviorthesis is an option for less severe cases, but the treatment of choice is joint fusion or arthrodesis for advanced stages of arthropathy3.Conclusion:In patients with hemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. The pathogenesis of hemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Our case report presents a unique pathology and the successful outcome that can be accomplished through surgical intervention and a multidisciplinary treatment approach.

Intra and extraarticular localized pigmented villonodular synovitis

<p class="abstract">A 28 year old woman had a history of knee trauma and presented with unilateral knee acute swelling and pain symptoms with sudden onset, which was there from last 2 years. She had been treated for seronegative rheumatoid patient for 1 year. Recent expansion of the LPVNS (localized pigmented villonodular synovitis) caused the development of a tender palpable soft tissue mass in the anterolateral aspect of the knee and acute reduced mobility. Preoperative magnetic resonance imaging of the knee revealed the presence of only the soft tissue mass and mild degenerative changes. Open synovectomy was performed successfully to excise the mass. Intraoperatively, macroscopic features of the bright brown inflamed synovium suggested LPVNS, which was confirmed histopathologically. Postoperatively, the symptoms of limited mobility and pain were appreciably relieved. Recurrence was not observed during the clinical follow up at 1, 6 or 18 months after surgery. Here, we reported the unique case of localized pigmented villonodular synovitis of the knee in a misdiagnosed patient with intra and extraarticular lesion, which might be attributed to the history of knee trauma and the focal defect of the lateral patellar retinaculum. Open synovectomy effectively relieved the symptoms of limited mobility and pain and no recurrence was observed prior to 18 months postoperatively. To reduce misdiagnosis, MRI examinations are recommended for all patients suspected of having PVNS, including those who have a history of hyperuricemia.</p>

PVNS Of The Knee: A Consecutive Series of 53 Patients Treated Either Arthroscopically or With Open Synovectomy

Pigmented villonodular synovitis (PVNS) is a subtype of tenosynovial giant cell tumor. Such tumors are rare and locally aggressive, though benign, with an average annual incidence between 1.8 and 9.2 cases per million in the U.S. [1] This low incidence of disease makes clinical trials difficult to conduct. Clinically, PVNS is separated into localized (LPVNS) and diffuse (DPVNS) disease. Surgical options include open, arthroscopic and combination arthroscopic/ open approaches for disease involving both anterior and posterior compartments of a joint. Despite surgical resection being the most common treatment modality for PVNS, recent medications have been developed targeting the colony stimulating factor 1 receptor (CSF1R) pathway.[2] In our case series, we selected 53 patients meeting inclusion criteria and treated between 2002-2019

Arthroscopic management of synovial chondromatosis of the shoulder: A case report

Synovial chondromatosis of the shoulder is a rare entity that is generally mono-articular and uncommon in diarthrodial joints. Treatment of synovial chondromatosis of the shoulder includes open arthrotomy retrieval of loose bodies and synovectomy. With advances in arthroscopy, the same could be achieved using arthroscopic techniques. This case report describes a case report of a 35-year-old male patient who presented with complaints of pain and restriction of movement for 6 months. The MRI of the patient was suggestive of multiple loose bodies in the shoulder joint, in the subdeltoid region, and subscapularis muscle with subacromial bursitis. Arthroscopically more than 100 loose bodies were retrieved with subacromial decompression. Shoulder synovial chondromatosis has been rarely reported in the literature. The malignant transformation although rare, but it is still a possibility. The recurrence rate varies from 3.2% to 22.3%. Open arthrotomy, synovectomy, and retrieval of loose bodies cause delayed recovery and more morbidity with high chances of subscapularis insufficiency due to the need of subscapularis tenotomy. Arthroscopic treatment although have limitations such as limited visualization, limited synovectomy, and difficult interventions around the axillary recess or biceps sheath, but provides with the advantage of lesser morbidity and early rehabilitation. Synovial chondromatosis can be successfully treated arthroscopically as it provides intra-articular and extra articular access with early rehabilitation, lesser morbidity, and early recovery.

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.