Synovial Osteochondromatosis Research Articles

Indications and Results of Hip Arthroscopy in 288 Consecutive Patients with a Minimum Follow-Up of 6 Months

Objectives:We present the indications and results of hip arthroscopy of a series of 288 consecutive patients with a minimum follow-up of 6 months (to 4 years).Methods:288 patients underwent hip arthroscopy between 2009 and 2013. Forty patients were lost in follow-up. For the clinical assessment of the remaining 248 patients, we used the modified Harris Hip Score (mHHS) pre-operatively and at 3, 6, 12, and 24 months post-operatively. We documented patients in respect to age (mean age was 36, range 16 to 68), sex (178 males, 70 females), indication for arthroscopy (159 femoroacetabular impingement-FAI, 37 osteoarthritis-OA, 15 diagnostic, 10 for osteonecrosis-AVN, 6 post-traumatic(fracture-dislocation), 15 for traumatic labral tear, 5 for synovial osteochondromatosis and one for post-op adhesions), the correlation of pre-operative imaging and arthroscopic findings, surgical time, use of image intensifier and complications. The patient was placed in lateral position in 105 cases and supine in 143 cases.Results:In the majority of patients, FAI was the primary diagnosis where the mHHS showed an improvement from 51 to 92 post-operatively. In 37, OA was the primary diagnosis; 16 required joint replacement within 14 months post arthroscopy. In OA, joint space less than 2 mm and presenceof bone edema of the femoral head in the pre-operative MRI were poor prognostic factors. In ten out of 15 patients diagnostic chondral injuries were present. Complications: One transient femoral nerve palsy, one superficial wound infection, two cases of instrument breakage within the joint which were successfully removed without sequelae and one inability to access safely the central compartment.Conclusion:The main indication for hip arthroscopy today is FAI. With proper indications, hip arthroscopy can significantly improve patient’s symptoms in most cases.

Bilateral Knee Synovial Osteochondromatosis: A Case Report

©2014 Turkish League Against Rheumatism. All rights reserved. Synovial osteochondromatosis (SOC) is a rare and benign monoarticular arthropathy characterized by multi-nodular cartilaginous proliferation in the synovium of the joint, tendon sheath or bursa.1 All major joints including the knee particularly can be affected, followed by the hip, elbow, wrist, ankle, and shoulder joints. Patients usually present in the second to fifth decades of life. Typical symptoms include pain, antalgic gait, locking, and a restricted range of motion. This condition is often considered a metaplastic process, and is usually self-limiting.

Giant solitary synovial osteochondromatosis of the elbow causing ulnar nerve neuropathy: a case report and review of literature

IntroductionGiant or solitary osteochondroma is part of a rare disorder known as synovial osteochondromatosis. It forms part of a spectrum of disease characterized by metaplastic changes within the joint synovium that are eventually extruded as loose bodies. It has been suggested that solitary synovial osteochondroma forms as progression of synovial osteochondromatosis through a process of either coalescence of multiple smaller bodies or the growth of a dominant synovial osteochondroma. Previous studies have shown that it occurs as a late phase of the disease. We report a rare case of giant synovial osteochondromatosis at the elbow causing ulnar nerve neuropathy and mechanical symptoms which has not been previously reported in the literature.Case reportWe report a case of a 56 year old Western European gentleman who presented with ulnar nerve neuropathy and swelling behind the elbow. The patient underwent MR imaging and subsequent biopsy that demonstrated synovial osteochondromatosis. Initially the patient declined surgery and opted for a watch and wait approach. Five years later he returned with worsening symptoms and underwent successful surgical resection of a giant solitary synovial osteochondroma.ConclusionThe unique outcome in our patient despite the long interval between presentation and surgical treatment resulted in early full resolution of symptoms within a short period. It may suggest an improved prognosis as compared to multiple synovial osteochondromatosis in terms of mechanical and neurological outcomes.

肩関節滑膜性骨軟骨腫症の 2 例

肩関節滑膜性骨軟骨腫症の 2 例

Synovial chondromatosis of the shoulder: imaging findings

Synovial chondromatosis is a benign condition characterized by synovial proliferation and metaplasia, with development of cartilaginous or osteocartilaginous nodules within a joint, bursa or tendon sheath. In the shoulder, synovial osteochondromatosis may occur within the glenohumeral joint and its recesses (including the tendon sheath of the biceps long head), and in the subacromial-deltoid bursa. Such condition can be identified either by radiography, ultrasonography or magnetic resonance imaging, showing typical features according to each method. Radiography commonly shows ring-shaped calcified cartilages and periarticular soft tissues swelling with erosion of joint margins. Ultrasonography demonstrates hypoechogenic cartilaginous nodules with progressive increase in echogenicity as they become calcified, with development of posterior acoustic shadow in case of ossification. Besides identifying cartilaginous nodules, magnetic resonance imaging can also demonstrate the degree of synovial proliferation. The present study is aimed at describing the imaging findings of this entity in the shoulder.

Pathology of Articular Cartilage and Synovial Membrane From Elbow Joints With and Without Degenerative Joint Disease in Domestic Cats

The elbow joint is one of the feline appendicular joints most commonly and severely affected by degenerative joint disease. The macroscopic and histopathological lesions of the elbow joints of 30 adult cats were evaluated immediately after euthanasia. Macroscopic evidence of degenerative joint disease was found in 22 of 30 cats (39 elbow joints) (73.33% cats; 65% elbow joints), and macroscopic cartilage erosion ranged from mild fibrillation to complete ulceration of the hyaline cartilage with exposure of the subchondral bone. Distribution of the lesions in the cartilage indicated the presence of medial compartment joint disease (most severe lesions located in the medial coronoid process of the ulna and medial humeral epicondyle). Synovitis scores were mild overall and correlated only weakly with macroscopic cartilage damage. Intra-articular osteochondral fragments either free or attached to the synovium were found in 10 joints. Macroscopic or histologic evidence of a fragmented coronoid process was not found even in those cases with intra-articular osteochondral fragments. Lesions observed in these animals are most consistent with synovial osteochondromatosis secondary to degenerative joint disease. The pathogenesis for the medial compartmentalization of these lesions has not been established, but a fragmented medial coronoid process or osteochondritis dissecans does not appear to play a role.

The state of the art in arthroscopic hip surgery

Hip arthroscopy is among the most rapidly evolving arthroscopic techniques in the last decade and offers the benefits of being both a minimally invasive procedure and an excellent diagnostic tool. Improvements in instrumentation and surgical skills have advanced our ability to accurately diagnose and treat various conditions of the hip joint, and hip arthroscopy has elucidated several pathologies that cause disabling symptoms. Many of these conditions were previously unrecognized and left untreated. The indications for hip arthroscopy include the management of early osteoarthritis, synovial disorders (e. g., synovial osteochondromatosis), labral tears, chondral lesions, and femoroacetabular impingement (FAI), which is increasingly recognized as a disorder that can lead to the development of early cartilage and labral injury. A better understanding of hip arthroscopy, including the anatomy, improved surgical techniques, indications, and complications of the procedure, is essential for its success. This review article discusses the state of the art of arthroscopic hip surgery.

Giant Solitary Synovial Osteochondromatosis of The Knee in a Young Female

Introduction: Giant Synovial osteochondromatosis of Hoffa’s body is very uncommon. Although described as a benign disease, it can be destructive and can cause severe osteoarthritis and pain. Case report: We report an 18 year old female patient presented with a calcified mass inside the Hoffa’s body. Clinically, patient presented with eight-month history of progressively worsening left knee pain with associated swelling. The bony mass in the Hoffa’s body was evident on the X-ray. MRI showed synovial affectation. During the arthroscopy, all pathological synovial was removed and the bony mass was extirpated through a mini-arthrotomy. Diagnosis of a giant synovial osteochondromatosis was confirmed by histology and malignancy was ruled out. Five years after surgery the patient has been asymptomatic and motion range is complete. Conclusion: This case of primary synovial chondromatosis is interesting because it was presented in an age, gender and unusual location. At 5 years of postoperative follow-up the patient has had no recurrence and has showed excellent performance of the knee joint.

Arthroscopic treatment for synovial osteochondromatosis of the elbow

Arthroscopic treatment for synovial osteochondromatosis of the elbow

Synovial osteochondromatosis of the hip joint treated with operation. Report of three cases

Synovial osteochondromatosis of the hip joint treated with operation. Report of three cases

Primary synovial osteochondromatosis of the first interphalangeal joint of the foot: A case report

Primary synovial osteochondromatosis of the first interphalangeal joint of the foot: A case report

Surgical treatment of synovial osteochondromatosis in the middle carpal joint of a pony

Summary A 9-year-old Paint pony gelding presented for signs of left carpal swelling of 1–2 weeks' duration. Radiographic, ultrasonographic and arthroscopic evaluation of the left carpus was consistent with synovial osteochondromatosis. This presumptive clinical diagnosis was confirmed histopathologically. Arthroscopic removal of the osteochondral bodies resulted in resolution of the carpal effusion and return to previous athletic activity by 4.5 months post operatively. Arthroscopic removal of osteochondral bodies is the treatment of choice in cases of suspected synovial osteochondromatosis.

Severe Destructive Arthritis of the Carpometacarpal Joint: A Diagnosis of Exclusion Case Report

We present a case of severe destruction of the thumb carpometacarpal joint (CMCJ) and surrounding structures on a background of osteoarthritis and Seronegative Rheumatoid arthritis. Imaging studies suggested a soft tissue lesion consistent with Pigmented Villonodular Synovitis (PVNS), Synovial Osteochondromatosis or Giant Cell Tumour (GCT). Due to the possibility of malignant transformation and deteriorating symptoms the mass was excised. Histological analysis of the lesion revealed severe degenerative disease with no evidence of malignancy or infection. This represents an atypical presentation of thumb carpometacarpal joint arthritis, which should be diagnosed once more sinister pathology has been excluded.

Synovial osteochondromatosis in the subacromial bursa mimicking calcific tendinitis: Sonographic diagnosis

Synovial osteochondromatosis is an idiopathic benign metaplasia of the synovial membrane rarely found in an extra-articular bursa. We describe the case of a 55-year-old woman with synovial osteochondromatosis in the subacromial bursa mimicking calcific tendinitis. Plain radiographs showed a radiopaque mass over the middle facet of the greater tuberosity, suggesting calcific tendinitis. Sonography, however, showed a loose body in the subacromial bursa, and no evidence of calcification inside the rotator cuff.

Neglected synovial osteochondromatosis of the elbow: a rare case

BackgroundSynovial osteochondromatosis is a benign metaplastic proliferative disorder of the synovium characterised by the formation of multiple cartilaginous nodules in the synovium, many of which detach and become loose bodies. The disease is characteristically monoarticular, most commonly involving the knee. A site in the elbow was first reported in 1918 by Henderson, but any joint may be involved. Very few cases of synovial osteochondromatosis of the elbow have been reported in the literature. The presenting symptoms are usually diffuse discomfort in the affected joint and decreased range of motion with an accompanying gritty or locking sensation. The treatment of choice is excision of the synovium and removal of the loose bodies.Case presentationWe report a rare neglected case covering a 32-year period of a locally aggressive synovial osteochondromatosis of the elbow in a 47-year-old man. Clinical examination revealed a significant increase in size of the left elbow compared to the contralateral one. The simple radiographs and the computed tomography showed multiple rounded, calcified bodies widespread throughout the elbow joint. At surgery we removed and counted a total of 312 loose bodies, varying in size from a few millimeters to 3 cm. The evaluation at 6 months postoperatively showed marked reduction in the volume of the elbow, improvement of extension and flexion and an increase of the Mayo elbow performance score from 50 points before surgery to 80 points at 6 months postoperative.ConclusionSynovial osteochondromatosis is an uncommon condition characterized by the formation of multiple nodules of hyaline cartilage within the sub-synovial connective tissue. The differential diagnosis includes chronic articular infection, osteoarthritis, pigmented villonodular synovitis, mono-articular inflammatory arthritis and periarticular neoplasms like synovial sarcoma. The treatment of choice is excision of the synovium and removal of the loose bodies. The prognosis is good, but recurrences may occur if the removal is incomplete.

Secondary synovial osteochondromatosis of the ankle in a child

We describe a case of a large intra-articular ossifying mass of the ankle joint in a 12-year-old boy who sustained a severe ankle twisting injury at 6years of age. The mass is presumed to be the result of secondary synovial osteochondromatosis originated from a fractured osteochondral fragment of the medial tubercle of the posterior process of the talus. The mass could be differentiated from os trigonum syndrome, Trevor disease and primary synovial osteochondromatosis based on its location, size and radiologic and histological features.

Cytodiagnosis of gouty tophus

To the Editor, Periarticular nodule can prove to be a challenge to both clinicians and pathologists. It covers inflammatory to neoplastic conditions ranging from rheumatoid nodule, gout, giant cell tumor of tendon sheath, synovial osteochondromatosis to synovial sarcoma.[1] Amongst these, gouty tophus is an important differential. Fine Needle Aspiration Cytology (FNAC) is becoming popular in diagnosis of soft tissue nodules; hence it is important for the pathologists to be aware of its varied microscopic features. Here, we present clinical and cytological profile of a case of gouty tophus.[1,2] A 62 year male presented with swelling over left middle toe of 6 months duration. It was painful and gradually increasing in size. On examination it measured 2 cm × 1 cm, immobile, firm to hard, tender with tense overlying skin [Figure 1]. Patient gave a past history of nephrolithiasis about 8 years back for which he was treated. On investigations, his Erythrocyte sedimentation rate (ESR) was 36 mm at the end of 1 h. His hemogram, liver function tests, serum calcium level and rheumatoid factor were within the normal limits. Blood urea was 98 mg/dl, serum creatinine 3.1 mg/dl and serum uric acid 9.1 mg/dl. Radiograph of the lesion showed a soft-tissue swelling without involvement of underlying bone with no evidence of calcification. FNA from the swelling, yielded whitish, and granular material. Smears prepared were wet fixed in 95% ethanol and some were also air dried. The wet fixed smears were stained with H and E and Papanicolaou stains. The air dried smears were stained with May Grunwald Giemsa stain (MGG). Smears revealed amorphous crystalline material intermingled with which were few histiocytes and foreign body giant cells [Figure 2]. The crystalline material on the higher magnification particularly with MGG revealed elongated needle shaped crystals with pointed ends [Figure 3]. The diagnosis of gouty tophus was made on the cytology, which was further supported by elevated levels of serum uric acid. Smears were not examined under polarized microscope as this facility was unavailable. Being a medically treatable condition, excision of the mass was not done and the clinicians directly put the patient on the anti-uric acid drugs. Figure 1 Nodular swelling 2 × 1 × 1 cm in size, firm, immobile, non-tender, with tense overlying skin Figure 2 Amorphous granular material and foreign body giant cell (Papanicolaou ×20) (Inset showing elongated crystals MGG x20) Figure 3 Elongated needle shaped crystals with pointed tips (MGG × 40) FNAC is an easy alternative to synovial biopsy and joint fluid analysis in a case of gouty tophus.[3] Whenever an aspiration yields amorphous or granular material, the cytopathologists should carefully search for characteristic crystals especially in MGG. Although gouty tophus presents classic histological features, definitive diagnosis relies on the demonstration of crystals which are often dissolved in routine tissue processing.[3] However, these crystals are excellently preserved and demonstrated in air dried smears stained with MGG. These monosodium urate crystals are needle shaped rods about 5-20 u in length with pointed tips. They are also strongly birefringent.[4] On histology, gouty tophus shows large amorphous aggregates of urate crystals surrounded by intense inflammatory cells macrophages, lymphocytes, foreign body giant cells, and fibroblastic reaction. However, the morphology of individual crystals cannot be appreciated well. The tissue diagnosis can be of additional help to demonstrate birefringence if this ancillary technique is available.[5,6] FNAC offers a simple, cost effective tool in elucidating the nature of periarticular nodule.[1,3,4] In case of gouty tophus, it also has an added advantage of excellent preservation of crystals. Thus, if a pathologist is aware of its morphology, further unnecessary investigations can be avoided. Patient was subsequently puts on the antiuric acid drugs. After a period of 3 months, swelling reduced remarkably in size and uric acid level decreased to 4.6 mg/dl.

Synovial Osteochondromatosis of the Hip with Femoroacetabular Impingement and Osteoarthritis: A Case Report

Synovial osteochondromatosis is a rare, benign condition characterised by synovial metaplasia and the formation of cartilaginous and osteocartilaginous bodies in the capsule. We report one such case in a 30-year-old woman with synovial osteochondromatosis of the hip and progressive osteoarthritis caused by femoroacetabular impingement with joint-space narrowing. She underwent surgical removal of 32 loose bodies and osteochondroplasty. A coronal osteophyte at the junction of the femoral head and neck was also excised. At 2-year follow-up, her Harris Hip Score had improved from 62 to 90.

Giant Extra-articular Synovial Osteochondromatosis of the Sinus Tarsi: A Case Report

A 32-year-old male presented with painful swelling of the sinus tarsi that occurred during daily activities. Diagnostic imaging suggested the presence of a large synovial osteochondromatosis that blocked subtalar motion with deformity of the adjacent bone. The large bony mass was excised, and normal subtalar motion was achieved.

Synovial osteochondromatosis and sclerosing osteosarcoma in a cat

The clinical, radiographic and histological features of synovial osteochondromatosis in multiple joints and an unrelated sclerosing osteosarcoma of the left tibia in a cat are reported. Radiographic evaluation showed signs of several nodular radiopacities in both stifles and both shoulders. Pathologic transverse fractures of the left tibia and fibula were also present. A midfemoral amputation of the left hindlimb was performed and treatment consisted of lifelong administration of nonsteroidal anti-inflammatory drugs. Histological evaluation confirmed synovial osteochondromatosis of the left stifle and sclerosing osteosarcoma of the left tibia. This is the first report of a feline patient with bilateral synovial osteochondromatosis that describes the clinical, radiographic and histological aspects of this disease.