Bilateral synovial chondromatosis of the elbow in an adolescent: a case report and literature review

Bilateral Knee Synovial Chondromatosis in a 2-Year-Old Girl: First Reported Case and Literature Review

BACKGROUND Synovial chondromatosis (SC) is a rare monoarticular benign condition characterized by the development of intra- or periarticular cartilage-like nodules or loose bodies. Typically affecting middle-aged men, SC is exceptionally rare in female pediatric patients. Symptoms include diffuse pain, swelling, and limited joint movement. The loose bodies are typically numerous, small, rounded, and uniform in size. Histologically, they consist of hyaline cartilage-like nodules containing clusters of chondrocytes. Bilateral SC in the knee of young children is even rarer and has not been previously documented in the medical literature. CASE REPORT A 2-year-old girl presented with recent pain in her right knee without preceding trauma. Physical examination revealed joint effusion, a limping gait, and limited knee flexion, with no signs of local inflammation. Radiographs showed normal joint structures, and laboratory test results, except for an elevated CRP, were normal. Joint aspiration ruled out septic arthritis. The worsening of symptoms within a relatively short period prompted further investigation, leading to the identification of numerous cartilaginous nodules within the joint during exploratory arthrotomy. Microscopic examination revealed unossified cartilage-like nodules containing disorganized chondrocytes. Four months after surgery, she was diagnosed with SC in the contralateral knee. CONCLUSIONS Given the rarity of synovial chondromatosis in young children, and the even rarer bilateral presentation in a large joint, this case report provides an opportunity to explore the challenges in diagnosing and managing such conditions in pediatric patients. To the best of our knowledge, this is the youngest reported case of bilateral SC of the knee in a pediatric patient.

Case Report: Synovial chondromatosis in sport climbers fingers

Introduction

Sport Climbing is a rapidly developing sport with an increasing variety and number of injuries, especially now that it is an Olympic event. The objective of this study is to firstly report the presence of Finger Synovial Chondromatosis (FSC) found in the fingers of climbers. Synovial chondromatosis is a rare condition and particularly rare in the hands and fingers.

Methods

We prospectively evaluated all climbers with finger injuries presenting in 2022 for the presence of FSC in the finger joints. 13 patients in this case series were included with complaints of finger pain for more than 6 weeks. The study was performed in our Sports Medical Centre in Bamberg, Germany. The diagnosis was made based on in person clinical assessment, ultrasound examination and additional radiological findings (e.g., x-ray, CT, MRI) as applicable.

Results

We detected 13 male climbers with FSC with experience ranging from intermediate to elite level. 77% (10/13) of the patients did not complain of any symptoms of the FSC and presented with other diagnoses (e.g.pulley rupture, tenosynovitis) and the finding of FSC was just an additional finding. In 12 subjects FSC was found in the proximal interphalangeal (PIP) joint and one in the metacarpo-pahalangeal (MCP) joint and distributed as follows: right (R) side 69%, left (L) side 38%, considering 15% in both hands. The prevalence corresponded to the digits are as follows: D2 15%, D3 77%, and D4 15%.

Discussion

With the rapid development in sport climbing there has been a rise in the intensity, volume and variety of training, which may be the key factors contributing to the spectrum of injuries associated with climbing. Hand and finger climbing related injuries are well documented, however the incidental discovery of this rare condition warrants its inclusion as another differential diagnosis in the spectrum of climbing related pathologies. At the moment, not enough is understood about FSC and its long-term consequences therefore further analysis is warranted for future studies.

[Synovial chondromatosis : Results from the histopathological arthritis register of the German Society for Orthopedic Rheumatology]

BACKGROUND

Synovial chondromatosis, or osteochondromatosis, is a rare benign disorder that occurs in joints, tendon sheaths, or bursae, characterized by cartilage proliferations of varying sizes and shapes, often with ossifications. In this study the prevalence, sensitivity, gender predominance, differential diagnoses, and primary localization of synovial chondromatosis are analyzed within the Histopathological Arthritis Registry of the German Society for Orthopedic Rheumatology.

METHODS

All cases of patients diagnosed with "synovial chondromatosis" from the Histopathological Arthritis Registry of the German Society for Orthopedic Rheumatology were retrospectively examined, covering the period from 1 January 2018, to 31 December 2022.

RESULTS

Between 1 January 2018, and 31 December 2022, there were 14 cases of synovial chondromatosis out of a total of 13,222 cases in the Histopathological Arthritis Register of the German Society for Orthopedic Rheumatology. The available data include primary localization, and age and gender of the patients. Among the 13,222 cases in the Histopathological Arthritis Register of the German Society for Orthopedic Rheumatology, 14 were histopathologically confirmed as synovial chondromatosis. This resulted in a prevalence of 0.1% or 1.13 per 1,000 cases. The correct clinical presumptive diagnosis was made in 5 cases, yielding a sensitivity of 35.7%, 95% confidence interval (CI) 12.8% to 64.9%.

DISCUSSION

Differential diagnoses for this condition include pigmented villonodular synovitis, tenosynovial giant cell tumor, and chondrosarcoma. Synovial chondromatosis frequently occurs in large joints such as the knee, hip, and the temporomandibular joint. A peak incidence is described in the fifth decade of life. However, the disorder can also occur in children. For the first time, the study was able to provide data for Germany based on a large sample. Additionally, initial statements regarding the prevalence and sensitivity of synovial chondromatosis could be made. The aim of this work is to raise awareness of this very rare disease to enable faster and more efficient diagnosis. The study also highlights the importance of histopathology in the diagnosis of synovial chondromatosis.

Intermediate Outcomes of Shoulder Synovial Chondromatosis in an Adolescent Boy: A Case Report

CASE

Synovial chondromatosis is a rare condition affecting synovial joints. It occurs uncommonly in the shoulder and is rare in the pediatric population. We present a case of a 13-year-old male patient with shoulder pain who was diagnosed with synovial chondromatosis and a posterior labral tear. He was treated with arthroscopic loose body removal, synovectomy, and posterior labral repair and recovered well from the surgery. Four years after the surgery, he developed pain in the same shoulder, but the cause of the pain was not investigated per the patient's decision.

CONCLUSION

Synovial chondromatosis should be considered in pediatric patients presenting with shoulder pain and loss of function with potential for recurrence.

Giant synovial chondromatosis of hip

Synovial chondromatosis is a rare, benign condition occurring due to metaplasia of synovium. A 65-year-old woman presented with pain in her right hip for 6 years. On examination, a swelling was palpable at the base of scarpa's triangle and her right hip movements were restricted. Imaging modalities showed ossified nodules in the antero-inferior aspect of the hip joint, joint effusion and arthritic changes. We diagnosed the patient to have synovial chondromatosis with secondary arthritis of the hip joint. We performed a total hip arthroplasty with simultaneous synovectomy and extraction of the osteochondral loose bodies, 5 of which were about 2×2 cm in size. We found that excessive acetabular reaming was required due to craters, the osteochondral masses formed on the acetabular surface. Histopathological analysis confirmed the diagnosis. The patient had an excellent functional outcome and no recurrence 5 years following the surgery.

Synovial macrophages in cartilage destruction and regeneration-lessons learnt from osteoarthritis and synovial chondromatosis

Inflammation is a critical process in disease pathogenesis and the restoration of tissue structure and function, for example, in joints such as the knee and temporomandibular. Within the innate immunity process, the body's first defense response in joints when physical and chemical barriers are breached is the synovial macrophages, the main innate immune effector cells, which are responsible for triggering the initial inflammatory reaction. Macrophage is broadly divided into three phenotypes of resting M0, pro-inflammatory M1-like (referred to below as M1), and anti-inflammatory M2-like (referred to below as M2). The synovial macrophage M1-to-M2 transition can affect the chondrogenic differentiation of mesenchymal stem cells (MSCs) in joints. On the other hand, MSCs can also influence the transition between M1 and M2. Failure of the chondrogenic differentiation of MSCs can result in persistent cartilage destruction leading to osteoarthritis. However, excessive chondrogenic differentiation of MSCs may cause distorted cartilage formation in the synovium, which is evidenced in the case of synovial chondromatosis. This review summarizes the role of macrophage polarization in the process of both cartilage destruction and regeneration, and postulates that the transition of macrophage phenotype in an inflammatory joint environment may play a key role in determining the fate of joint cartilage.

Diagnosis and Arthroscopic Treatment of Synovial Chondromatosis of Glenohumeral Joint: A Case Report

Introduction:

Synovial chondromatosis is a rare benign entity with the presence of cartilaginous or osseous loose bodies in the synovium. It commonly involves the larger joints such as the knee, hip, ankle and rarely the shoulder joint manifesting with pain, swelling, and restriction of movements. The treatment of choice is surgical intervention in symptomatic patients using either the open or the arthroscopic approach.

Case Report:

Here, we report a rare case of synovial chondromatosis affecting the right shoulder joint in a 23-year-old male with a 5-year disease duration who presented with progressive pain and restriction in movements which were impacting his routine activities. The loose bodies were removed using the arthroscopic approach combined with a partial synovectomy, and intra-articular methylprednisolone post procedure. The patient showed an excellent recovery in joint mobility within 4 weeks post-operatively, and there were no clinical signs of recurrence during a 6-month follow-up period.

Conclusion:

We believe that arthroscopic surgery is effective in the treatment of patients with synovial chondromatosis with advantages such as good visualization, lesser morbidity, and early return of functional activities.