Patello-femoral joint pain due to unusual location of localised pigmented villonodular synovitis-a case report

Pigmented villonodular synovitis in pediatric population: review of literature and a case report

BACKGROUND

Pigmented villonodular synovitis (PVNS) is a rare proliferative process in children that mostly affects the knee joint.

CASE PRESENTATION

The study follows the case of a 3-year-old boy presenting recurrent patellar dislocation and PVNS. Due to symptoms such as chronic arthritis, he had been taking prednisolone and methotrexate for 6 months before receiving a definitive diagnosis. After a period of showing no improvements from his treatment, he was referred to our center and was diagnosed with local PVNS using magnetic resonance imaging (MRI). The patient was treated for his patellar dislocation by way of open synovectomy, lateral retinacular release, and a proximal realignment procedure, with no recurrence after a 24-month follow-up.

CONCLUSION

PVNS may appear with symptoms resembling juvenile idiopathic arthritis, thus the disease should be considered in differential diagnosis of any inflammatory arthritis in children. PVNS may also cause mechanical symptoms such as patellar dislocation. In addition to synovectomy, a realignment procedure can be a useful method of treatment.

Giant Cell Tumor of the Patella Tendon Sheath Presenting as a Painful Locked Knee

Patient: Male, 26

Final Diagnosis: Giant cell tumor of the patella tendon seath

Symptoms: Efusion • locking knee • pain

Medication: None

Clinical Procedure: Arthroscopy and open resection of the tumor

Specialty: Orthopedics and Traumatology

Localized pigmented villonodular synovitis in the knee associated with locking symptoms

Pigmented villonodular synovitis (PVNS) occurs in the knee more frequently than other joints. Most cases involve diffuse PVNS while the localized type is relatively rare. This report describes a patient who had PVNS and a lateral meniscus injury which induced locking symptoms in the knee. A closed reduction of the meniscus tear was performed under local anesthesia. However, complete extension of the knee was not achieved and the locking symptoms persisted. MRI examination showed a neoplastic lesion measuring approximately 2 x 2 cm in the intercondylar space together with a lateral meniscus tear. The lesion was resected using arthroscopy. Histology of the resected lesion demonstrated localized PVNS. There has not been any recurrence of locking symptoms or PVNS two years after surgery. The findings in this case suggest that localized PVNS may contribute to locking symptoms in a patient with meniscal pathology.

Outcome of 17 pigmented villonodular synovitis (PVNS) of the knee at 6 years mean follow-up

Between January 1950 and December 2000, 16 patients were identified from Scottish Bone Tumour Registry with 17 histologically proven pigmented villonodular synovitis (PVNS) of the knee. The mean follow-up was 6 years (range, 1-14 years). A knee swelling of chronic duration with dull ache was the common presenting symptom. The mean duration of symptoms prior to presentation was 25 months (1-108 months), however it was much less (mean, 7 months) in four patients with a history of trauma. The mean age was 33 years (range, 16-58 years) with a slight male predominance. The lesion was predominantly anterior in nine patients, posterior in four, anterolateral in two, and medial and lateral in one each. Three patients (four knees) had localised disease and 13 diffuse. Anteroposterior and lateral radiographs of the knee revealed normal findings in 11 patients, features of gonarthrosis in four and a large suprapatellar loose body in one patient (both knees). Open (incisional-eight, excisional-eight) biopsy was carried out in all and all were histologically confirmed as PVNS. Removal of a localised synovial mass or loose body with surrounding partial synovectomy (four) was carried out for the localised variety, whilst open partial (three) or total (radical) synovectomy (10) was performed in all cases of diffuse PVNS. Three of seventeen knees had a recurrence, noted at 4, 6 and 8 years postoperatively (0% - localised, 23% - diffuse variety). A total (radical) synovectomy should be considered in diffuse PVNS in order to obtain optimal outcome.