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Surface anatomy and portal placement in right knee. The patient is positioned supine with the use of a leg holder. Views from both the lateral and medial aspects of the right knee are shown. (AL, anterolateral; AM, anteromedial; APL, accessory posterolateral; APM, accessory posteromedial; BF, biceps femoris; CPN, common peroneal nerve; F, fibula; PL, posterolateral; PM, posteromedial; SL, superolateral; SM, superomedial; SN, saphenous nerve; TT, tibial tuberosity).
Source publication
Synovial chondromatosis is a benign metaplastic disease of the synovial joints, characterized by the development of cartilaginous nodules in the synovium. Treatment generally includes open or arthroscopic loose body removal combined with a synovectomy. An all-arthroscopic approach has been described to minimize complications and reduce morbidity wh...
Context in source publication
Context 1
... often become blocked, which impacts surgical efficiency if only 1 shaver is used. marked accordingly (Fig 1). In addition to standard anteromedial and anterolateral portals, superomedial, superolateral, posteromedial, posterolateral, accessory posteromedial, and accessory posterolateral portals are identified and marked. ...
Citations
... Historically, anterior compartment TCGT was debrided arthroscopically, and posterior compartment TCGT was debrided through open surgery. However, the algorithm shifted to open surgery anterior and arthroscopy posteriorly, or completely arthroscopic management in some cases as joint preservation surgeons improved using a 70°arthroscope posteriorly [29][30][31]. Similar advances occurred with the treatment of other intraarticular pathology, such as hemophilia-induced synovitis and synovial osteochondromatosis. ...
Heterotopic ossification is ectopic lamellar bone formation within soft tissue and can result in significant functional limitations. There are multiple underlying etiologies of HO including musculoskeletal trauma and traumatic brain injury. Intra-articular HO of the knee is rare and is typically located within the cruciate ligaments. We report a case of a 24-year-old female who presented with worsening right knee pain and limited knee extension two and a half years after a motor vehicle crash with multiple lower extremity fractures. Physical examination of the knee revealed anterior pain, limited extension, and a palpable infrapatellar prominence. Imaging showed a retropatellar tendon, intra-articular excrescence of bone proximal to the anterior tibial plateau. Diagnostic arthroscopy with a 70° arthroscope identified HO at the proximal anterior tibial plateau, which was excised with a high-speed burr under direct visualization. At the three-month follow-up, the patient remained asymptomatic and returned to sport. Retropatellar tendon, intra-articular anterior knee HO is a rare but debilitating clinical entity that can be successfully and safely managed with excision under direct visualization using a 70° arthroscope.
... However, once loose bodies are detected, surgical intervention is generally necessary to prevent the restriction of joint movement and persistent swelling [6]. The condition is most commonly managed with arthroscopic loose body removal with synovectomy to remove any of the affected synovium [7]. Depending on the extent of the condition, open radical synovectomy may be recommended for management to prevent recurrence in extensive involvement [8]. ...
Synovial osteochondromatosis or synovial chondromatosis is a benign joint pathology characterized by the development of multiple cartilaginous nodules or loose bodies in the synovial membrane that typically arise in the larger joints of the body. It usually presents as joint pain and, as seen in the present case, can occasionally be missed. Diagnosis involves a combination of clinical evaluation, imaging studies, and histopathological evaluation (which is confirmatory). Treatment depends on the severity of the disease, symptoms, and the patient’s social situation, and may include monitoring for asymptomatic cases, non-surgical management (pain medications and physical therapy), or surgical intervention. Surgical intervention may include arthroscopic removal of loose bodies, synovectomy, or reconstruction/replacement in severe situations. Prognosis has a direct relationship to how early the disease is diagnosed. Early intervention with appropriate management can help alleviate symptoms; however, if left unmanaged, it can lead to joint damage and osteoarthritis or very rarely, malignant transformation into chondrosarcoma. This report describes the case of a 62-year-old female with complaints of bilateral knee pain who was originally diagnosed with osteoarthritis based on clinical exam and X-rays. Two magnetic resonance imaging (MRI) scans were done three years apart, with synovial osteochondromatosis being on the differential after the second scan. A left knee major synovectomy was conducted after the second MRI reading, where rubbery masses of tissue along with loose fragments were removed. Fluid from the tissue masses was sent to culture and pathology for interpretation. Two weeks post the surgery, the patient’s pain improved tremendously, with adequate ambulation independently. Histopathology came back positive for synovial osteochondromatosis. This case report highlights the importance of keeping this joint pathology on the differential when treating patients with joint pain and interpreting imaging.
... When it involves the knee joint, SC is usually restricted to the anterior compartment of the knee and includes the anterior fat pad and suprapatellar pouch [8]. Regarding symptoms, SC in the knee joint is characterized by non-specific symptoms that include pain, swelling, restricted range of motion, locking, giving away, and crepitus [9]. ...
In this case report, we present a rare case of a female patient who developed pain and swelling after a total knee arthroplasty. An extensive diagnostic workup including serum and synovial testing to rule out infection was performed in addition to advanced imaging including an MRI of the knee, but it was only after an arthroscopic synovectomy that the diagnosis of secondary synovial chondromatosis was confirmed. The purpose of this case report is to highlight the occurrence of secondary synovial chondromatosis as a rare cause of pain and swelling after total knee arthroplasty, thereby assisting clinicians in providing prompt diagnosis, surgical treatment, and efficient recovery in the setting of secondary synovial chondromatosis after total knee arthroplasty.
... [1][2][3][4] It usually involves the anterior compartment, including infrapatellar fat pad, suprapatellar pouch, and anterior interval, and it rarely involves the posterior compartment of the knee. 1,[3][4][5][6] Primary synovial chondromatosis can occur in 3 phases. Phase I includes active intrasynovial disease with no free bodies, phase II involves transitional lesions with active intrasynovial proliferation plus loose bodies, and phase III occurs when there are multiple loose bodies with no intrasynovial disease. ...
... Phase I includes active intrasynovial disease with no free bodies, phase II involves transitional lesions with active intrasynovial proliferation plus loose bodies, and phase III occurs when there are multiple loose bodies with no intrasynovial disease. 6,7 Owing to the metaplastic nature of the disease, there is a small risk of transformation to chondrosarcoma. 4 Diagnosis and treatment of synovial osteochondromatosis at its early phase are crucial to prevent the occurrence of secondary osteoarthritis and malignant transformation. ...
... 4 In the literature, different arthroscopic posterior portal approaches have been reported for the management of synovial osteochondromatosis of posterior compartment of the knee. [4][5][6][9][10][11][12] The purpose of this Technical Note is to describe the details of arthroscopic synovectomy and removal of loose bodies in synovial osteochondromatosis of the knee. It is indicated for diffuse type of synovial osteochondromatosis, involving both the anterior and posterior compartment of the knee joint. ...
Synovial osteochondromatosis is a benign process that most commonly affects the knee joint (70%). It is characterized by proliferative metaplasia of synovial membrane into chondrocytes, resulting in the formation of multiple cartilaginous nodules, which can detach from the synovium to become multiple intra-articular loose bodies. It usually involves the anterior compartment, including infrapatellar fat pad, suprapatellar pouch, and anterior interval, and rarely involves the posterior compartment of the knee. Treatment for synovial osteochondromatosis usually involves surgery, especially in the presence of locking symptoms or decreased range of motion. Arthroscopy has gradually replaced a traditional open approach, resulting in low morbidity, low postoperative pain, better cosmetic results, early recovery of range of motion, short rehabilitation course, and an early return to previous function. In case of involvement of the posterior compartment of the knee joint, arthroscopic access may be difficult. In this Technical Note, the technical details of arthroscopic synovectomy and removal of loose bodies in synovial osteochondromatosis of the knee is described. This arthroscopic technique can deal with the disease, involving both the anterior and posterior compartments of the knee joint.
... The addition of synovectomy has been recommended because it reduces the recurrence rate of loose body removal alone. 31 In the WHO 2020 classification of synovial chondromatosis was moved from the benign to the intermediate group to reflect the locally aggressive growth pattern and the high risk for local recurrence. 4 This change highlights the importance of an early radiological diagnosis and treatment to decrease the risk of recurrence and degenerative changes. ...
... 4 This change highlights the importance of an early radiological diagnosis and treatment to decrease the risk of recurrence and degenerative changes. 31 ...
Chondrogenic tumors are typically well recognized on radiographs, but differentiation between benign and malignant cartilaginous lesions can be difficult both for the radiologist and for the pathologist. Diagnosis is based on a combination of clinical, radiological and histological findings. While treatment of benign lesions does not require surgery, the only curative treatment for chondrosarcoma is resection. This article (1) emphasizes the update of the WHO classification and its diagnostic and clinical effects; (2) describes the imaging features of the various types of cartilaginous tumors, highlighting findings that can help differentiate benign from malignant lesions; (3) presents differential diagnoses; and (4) provides pathologic correlation. We attempt to offer valuable clues in the approach to this vast entity.
... In literature, controversy remains over the optimal treatment when comparing the open approach with the arthroscopic procedure [12,17]. Loose bodies are usually located at the posterior compartment owing to the gravity effect, and in many reports are found in the posteromedial compartment of the knee [18]. Some authors reported different ways for posteromedial visualization of the loose bodies [18][19][20], but no one challenged with a knee with osteoarthritis and anterior osteophytes made the trans-notch passage complex. ...
... Loose bodies are usually located at the posterior compartment owing to the gravity effect, and in many reports are found in the posteromedial compartment of the knee [18]. Some authors reported different ways for posteromedial visualization of the loose bodies [18][19][20], but no one challenged with a knee with osteoarthritis and anterior osteophytes made the trans-notch passage complex. In our experience, preoperative planning with MRI and CT scans was essential to predict the difficulties we might have found during the procedure. ...
... Avoiding the traditional open synovectomy, with extensive posterior approach and often combined with an arthroscopic anterior loose body removal, prevents complications such as persistent joint stiffness and prolonged rehabilitation [17]. An all-arthroscopic approach minimizes complications and reduces postoperative morbidity, providing adequate control of local disease, although it is technically demanding [18]. However, the effectiveness of synovectomy for SC remains controversial. ...
Background
The synovial chondromatosis is an uncommon proliferative metaplastic process of the synovial cells that can develop in any synovial joint. An isolated primary chondromatosis of the posterior compartment of the knee is uncommon and few cases are reported in literature. Our purpose is to describe a rare case of primary chondromatosis of the knee posterior compartment and report the arthroscopic loose bodies excision through a difficult posteromedial portal, avoiding the use of the accessory posterior portal, most commonly reported for approaching this disease.
Case presentation
We report a rare case of a 35-year-old Caucasian male patient with diagnosis of chondromatosis of the posterior knee compartment. The radiographs showed multiple loose bodies of the posterior compartment. The MRI revealed minimal synovial hypertrophy areas, multiple osteophytes in the intercondylar notch, and loose bodies in the posteromedial compartment. The CT allowed us to assess the bony structures, the morphology of the intercondylar notch, and the presence osteophytes of the medial and lateral femoral condyles. The CT images were crucial to plan how to reach the posterior compartments of the knee through a trans-notch passage. The patient underwent arthroscopic surgery using anteromedial, anterolateral, and posteromedial portals. The tunneling through the intercondylar osteophytes was performed to allow the arthroscope to pass trans-notch. To avoid additional accessory posterior portals, we used a 70° arthroscope to better explore the posterior knee compartment. The cartilage-like bodies were removed and synovectomy of the inflamed areas was performed. The clinical and radiological follow-up was 12 months and the patient showed excellent clinical outcomes, returning to his activities of daily living and sport activity.
Conclusion
Our case report highlights the importance of the arthroscopic approach to treat synovial chondromatosis, despite the involvement of the posterior compartment of the knee. An optimal preoperative imaging allows to plan for the proper surgical procedure even in patients with severe osteoarthritis. Moreover, the adoption of an intercondylar notch tunneling and a 70° arthroscope can help surgeons to better explore the posterior knee compartment, avoiding an accessory posterior trans-septal portal. Therefore, a synovectomy of the inflamed foci may be useful to prevent recurrence.
... restricted range of motion, locking, giving away and crepitus. 5 As the symptoms are non-specific and insidious in onset, the diagnosis is usually delayed. Synovial chondromatosis is diagnosed clinic-radiologically and confirmed after histopathological examination. ...
Background
Synovial chondromatosis of the knee is an unusual, rare, benign metaplastic neoplasm of the synovium, characterized by formation of focal cartilaginous nodules in the synovium. It predominantly involves the anterior compartment of knee and extensive, disseminated involvement is rarely reported. Diagnosis is usually established with clinico-radiological imaging and confirmed by histology. The paucity of literature on the management of synovial chondromtosis, puts an orthopaedician in dilemma regarding the optimal surgical intervention.
Case Report
We report a case of 50-year-old male who presented with severe pain and swelling in his left knee associated with functional incapacitation. Magnetic Resonance Imaging (MRI) demonstrated diffuse proliferation of synovium with mild effusion displaying multiple, disseminated calcific nodules. We managed the case by open removal of loose bodies and radical synovectomy through combined anterior and posterior approach. At four years follow-up, there are no clinical or radiological signs of recurrence.
Conclusion
Extensive involvement of the knee with calcific nodules is extremely rare. Treatment is controversial which usually includes removal of loose bodies combined with an open or arthroscopic synovectomy. Our case report recommends single stage, open retrieval of loose bodies combined with radical synovectomy to decrease the incidence of recurrence in extensive synovial chondromatosis. To our knowledge, disseminated synovial chondromatosis of the knee, managed by open, combined approach has been reported only once in the literature.
... 5 Mainly, the traditional open synovectomy requires an extensive posterior approach that could lead to persistent joint stiffness and prolonged rehabilitation. 6 According to Authors that recommended the loose body removal combined with the synovectomy to decrease the recurrence rate, 7 we performed the excision of the bodies combined with localized synovectomy to completely eliminate abnormal synovial tissue and prevent recurrence. An allarthroscopic approach to treat the SC of the posterior knee is technically demanding and the surgical pearls and pitfalls described in this article may help to facilitate the procedure ( Table 1). ...
... described in the literature. The disease is characterized by nonspecific symptoms of pain, swelling, restricted range of motion, locking, giving away, and crepitus [5]. As the symptoms are non-specific and insidious in onset, the diagnosis is usually ...
Introduction:
Synovial chondromatosis of the knee is an unusual, rare, benign metaplastic neoplasm of the synovium, characterized by the formation of focal cartilaginous nodules in the synovium. It predominantly involves the anterior compartment of knee and extensive, disseminated involvement is rarely reported. Diagnosis is usually established with clinicoradiological imaging and confirmed by histology. The paucity of literature on the management of synovial chondromatosis puts an orthopedician in dilemma regarding the optimal surgical intervention.
Case report:
We report a case of 50-year-old male who presented with severe pain and swelling in his left knee associated with functional incapacitation. Magnetic resonance imaging demonstrated diffuse proliferation of synovium with mild effusion displaying multiple, disseminated calcific nodules. We managed the case by open removal of loose bodies and radical synovectomy through combined anterior and posterior approach. At 4 years follow-up, there are no clinical or radiological signs of recurrence.
Conclusion:
Extensive involvement of the knee with calcific nodules is extremely rare. Treatment is controversial which usually includes removal of loose bodies combined with an open or arthroscopic synovectomy. Our case report recommends single stage, open retrieval of loose bodies combined with radical synovectomy to decrease the incidence of recurrence in extensive synovial chondromatosis. To the best of our knowledge, disseminated synovial chondromatosis of the knee, managed by open, combined approach, has been reported only once in the literature.
... Es istjedochdenkbar, dass arthroskopische Zugänge a priori eher bei limitierter Erkrankung und seltener bei disseminierter SC mit sekundären Pathologien gewählt worden waren. Eine detaillierte Beschreibung der arthroskopischen Behandlung der SC des Knies findet sich bei Wengle et al. [64]. ...
Zusammenfassung
Hintergrund
Die primäre synoviale Chondromatose (SC) ist eine seltene Erkrankung der Synovialmembran unklarer Ätiologie. Der aktuelle Wissensstand zu dieser Erkrankung soll in einer kurzen Übersicht dargestellt werden.
Methoden
Übersichtsarbeiten und rezente Fallberichte zur SC wurden systematisch ausgewertet und mit Daten eigener Fälle in Kontext gesetzt.
Ergebnisse
Auf Grund neuer genomischer Daten wird die SC als benigne Neoplasie eingestuft. In 60 % der Fälle liegen Mutationen im Fibronektin-1-Gen (FN1) und/oder im Gen für den Activin-A-Typ-II-Rezeptor (ACVR2A) vor. Diagnoseweisend ist die Magnetresonanztomographie (MRT) und die meist arthroskopische Biopsie der Synovia. An einem Fallbeispiel soll gezeigt werden, dass die Knorpelaggregate der SC radiologisch nicht immer schattengebend sein müssen. Differenzialdiagnostisch kommen Monarthritiden anderer Ursachen, andere Gelenk- und Muskelerkrankungen mit Mineralisierung sowie weitere von der Synovialmembran ausgehende Erkrankungen in Betracht. Die Entartungsrate liegt bei 2–4 %. Therapeutisch hat sich in den letzten Jahren das arthroskopische Vorgehen durchgesetzt, das an die Ausdehnung der Erkrankung adaptiert wird.
Schlussfolgerung
Genomische Untersuchungen sowie Fallserien und Fallberichte aus jüngerer Zeit werfen ein neues Licht auf die SC. Therapeutisch wird in jüngeren Arbeiten überwiegend arthroskopisch vorgegangen.
