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Yamauchi I, Nakashima H, Inoue T, Nojima T, Imagama S. Neurologic recovery following laminectomy and tumor resection of a pediatric cervical synovial osteochondromatosis causing paralysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08304-8. [PMID: 38801434 DOI: 10.1007/s00586-024-08304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy. METHODS A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5 cm mass within the spinal canal at the C4-6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4-5 and C5-6 facet joints. RESULTS After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3 months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4-5 and C5-6 intervertebral foramen 2 years postoperatively. CONCLUSIONS Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.
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Affiliation(s)
- Ippei Yamauchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Taro Inoue
- Department of Orthopedic Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takayuki Nojima
- Department of Pathology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Braun S, Flevas DA, Sokrab R, Ricotti RG, Rojas Marcos C, Pearle AD, Sculco PK. De Novo Synovial Chondromatosis following Primary Total Knee Arthroplasty: A Case Report. Life (Basel) 2023; 13:1366. [PMID: 37374148 DOI: 10.3390/life13061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
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.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60323 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Dimitrios A Flevas
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Ruba Sokrab
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Robert G Ricotti
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Carolena Rojas Marcos
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, NY 10021, USA
| | - Peter K Sculco
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
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Recurrence of Primary Synovial Chondromatosis (Reichel's Syndrome) in the Ankle Joint following Surgical Excision. Case Rep Orthop 2021; 2021:9922684. [PMID: 34527383 PMCID: PMC8437642 DOI: 10.1155/2021/9922684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Primary synovial chondromatosis, or Reichel's syndrome, is a rare benign tumour arising from the synovial lining of a joint. We present the case of a 25-year-old male with Reichel's syndrome of the ankle, with subsequent recurrence following open retrieval of loose bodies. The initial presentation was of lateral malleolus discomfort which limited moderately strenuous exercise. Clinical examination showed a mild effusion and pain on extremes of movement. Imaging confirmed the presence of multiple loose bodies within the anterior and anterolateral recesses of the ankle. Open removal of 27 loose bodies from the joint was performed, with good postoperative recovery. He represented with pain 9 months later, with imaging of the ankle showing reaccumulation of loose bodies to a lesser extent. A trial of conservative management was opted for. Reichel's syndrome confined to the ankle is an exceedingly rare diagnosis, with few cases reported in the literature. This case saw the recurrence of the disease in a short time period despite successful surgery in the first instance. Management options to treat recurrence include repeat retrieval of foreign bodies, synovectomy, radiotherapy, or arthrodesis. While the prognosis is favourable, a low risk of malignant potential warrants adequate patient follow-up.
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Systematic Arthroscopic Treatment of Synovial Chondromatosis of the Knee. Arthrosc Tech 2021; 10:e2265-e2270. [PMID: 34754733 PMCID: PMC8556586 DOI: 10.1016/j.eats.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023] Open
Abstract
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 while providing adequate control of local disease. The purpose of this Technical Note is to describe our techniques and technical pearls that allow for adequate excision of disease while minimizing complications and disease recurrence. The combination of patient positioning, the establishment of multiple arthroscopic portals to ensure optimal visualization and freedom of instruments, the use of a leg holder, and the use of a variety of surgical instruments to facilitate loose body removal and synovectomy is critical to optimize clinical outcomes and minimize complications. Although technically demanding, our described technique can help facilitate extensive loose body removal and complete synovectomy.
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Abstract
Synovial chondromatosis of the finger is a rare metaplasia affecting either the finger joint or the tendon sheath. It is a benign extraosseus cartilage tumor that often occurs in numbers and is not solitary in nature. This accumulation of masses within the finger can lead the patient to seek medical care. Symptoms are often painful and functionally disabling. Although rare, synovial chondromatosis must be considered in the differential diagnosis for patients with multiple lesions or masses within the hand and finger. Patient workup involves advanced imaging, including magnetic resonance imaging, ultrasonography, and computerized tomography. However, the results of these studies may be inconclusive. Conservative management can be discussed with the patient but has proven to be ineffective. Surgical excision is the recommended first-line treatment. Whether the surgery is arthroscopic or open, with or without synovectomy, is at the surgeon's discretion. Mass recurrence after surgery is an unfortunate complication, and subsequent treatment strategies are undefined. Recurrence may not occur at the same anatomical site. This condition can be intra-articular (within the figure joint) or extra-articular (within the tendon sheath or bursa). Revision surgery in the form of open excision with synovectomy is the mainstay of treatment. There have been only a few case reports of synovial chondromatosis involving the finger. This case series and up-to-date review of the literature presents a discussion of current surgical care. [Orthopedics. 2021;44(3):e454-e457.].
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Intra-articular giant synovial osteochondroma: case reports of the ankle and knee joint. Case Rep Orthop 2015; 2015:320139. [PMID: 25785214 PMCID: PMC4345263 DOI: 10.1155/2015/320139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 11/24/2022] Open
Abstract
Two cases of giant intra-articular osteochondromas (knee and ankle joint) are reported; pathologically they are rare representations of synovial chondromatosis. A 17-year-old man presented with a tumorous mass which had been localized in his left ankle for many years, increasing in volume during the last months. The lesion was removed by posteromedial ankle arthrotomy. The second case was observed in a 39-year-old woman with a slow-growing mass in her right knee joint. The lesion was removed from the Hoffa fat pad by open anteromedial arthrotomy.
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Crawford MD, Kim HT. New-onset synovial chondromatosis after total knee arthroplasty. J Arthroplasty 2013; 28:375.e1-4. [PMID: 22704224 DOI: 10.1016/j.arth.2012.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/13/2012] [Indexed: 02/01/2023] Open
Abstract
Total joint arthroplasty is commonly recommended as a definitive treatment for synovial chondromatosis refractory to other treatment. We describe a unique case of synovial chondromatosis developing after total joint arthroplasty in a patient presenting 5 years after total knee arthroplasty for osteoarthritis. This case illustrates that the diagnosis of synovial chondromatosis cannot be excluded in a patient with chronic, painful swelling of a joint, even after total joint arthroplasty.
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Affiliation(s)
- Matthew D Crawford
- Department of Orthopaedic Surgery, University of California, San Francisco, California, USA
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Arthroscopic treatment of synovial chondromatosis at the knee posterior septum using a trans-septal approach: report of two cases. Knee 2012; 19:732-5. [PMID: 22104391 DOI: 10.1016/j.knee.2011.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 09/28/2011] [Accepted: 10/24/2011] [Indexed: 02/02/2023]
Abstract
Synovial chondromatosis of the knee joint rarely develops in the posterior septum. Such cases are difficult to treat arthroscopically since the posterior septum is not readily accessible via standard portals. We report two cases of localized synovial chondromatosis in the posterior septum. We used a posterior trans-septal portal to arthroscopically remove the loose bodies and perform a concomitant synovectomy. The two cases were followed-up for 24 and 16 months after surgery, respectively, and the patients were found to be pain-free, have a full range of knee motion and showed no evidence of recurrence. A posterior trans-septal portal may be essential in some cases for treatment of synovial chondromatosis at the posterior septum.
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Han JS, Lee SH, Kim ES, Eoh W. Regrowing synovial chondromatosis in a cervical facet joint with radiculopathy. KOREAN JOURNAL OF SPINE 2012; 9:253-6. [PMID: 25983825 PMCID: PMC4431012 DOI: 10.14245/kjs.2012.9.3.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/04/2012] [Accepted: 09/26/2012] [Indexed: 12/02/2022]
Abstract
Synovial chondromatosis (SC) in the spine is rare. There are few reports of associated cervical radiculopathy and there has not been a case reported of regrowing cervical SC. Here we report a 21-year-old man with a SC of a cervical facet joint that extended into the intervertebral foramen and compressed the cervical nerve root. The same symptom developed three years following the first operation. Computed tomography (CT) scans and Magnetic resonance imaging (MRI) showed multiple calcified nodules anterior to the right facet joint of C6-7 that extended into the intervertebral foramen. A mass removal was performed just as in the previous operation with a subtotal facetectomy. When vertebral SC is suspected, complete removal involving the bone and synovium should be considered as the standard treatment option.
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Affiliation(s)
- Jae-Suk Han
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Osti L, Papalia R, Del Buono A, Denaro V, Maffulli N. Recurrence of synovial chondromatosis of the Hoffa's body. Knee Surg Sports Traumatol Arthrosc 2009; 17:1421-4. [PMID: 19590854 DOI: 10.1007/s00167-009-0859-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 06/16/2009] [Indexed: 11/24/2022]
Abstract
Synovial chondromatosis of Hoffa's body is uncommon. Recurrences usually result from incomplete removal of the loose bodies or diseased synovium at the initial surgery. We report a patient with synovial chondromatosis localized into the Hoffa's body who presented with anterior knee pain and mechanical symptoms. At the first arthroscopy, all pathological tissue was removed. At 1-year follow-up, clinical and radiographic examinations were normal. Symptoms recurred at 3 years, when a bony mass in the Hoffa's body was evident on MRI. The mass was removed through a mini-arthrotomy. Histology excluded malignancy. At 10-year follow-up, the patient remained free of symptoms. Synovial chondromatosis can occur with unusual patterns of recurrence. The growth of a large size mass confined to fat pad without intra-articular involvement does not allow to exclude the diagnosis of recurrent synovial chondromatosis.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopy and Sports Trauma Surgery, Hesperia Hospital, Via Arquà 80/b, Modena, Italy
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Kim CH, Kim SH, Kim MS, Chang CH. Cubital tunnel syndrome, associated with synovial chondromatosis. J Korean Neurosurg Soc 2008; 43:109-10. [PMID: 19096614 DOI: 10.3340/jkns.2008.43.2.109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 02/11/2008] [Indexed: 11/27/2022] Open
Abstract
A 62-year-old female patient suffered from numbness and resting pain in the right ring and little fingers for 3 years. We confirmed cubital tunnel syndrome with electrodiagnostic study and performed the operation. We found seven firm consistent nodules, compressing the overlying the ulnar nerve, proximal to the medial epicondyle in the operation field. Histological finding showed synovial chondromatosis. We report a rare case of a patient with cubital tunnel syndrome caused by synovial chondromatosis.
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Affiliation(s)
- Chang-Hwan Kim
- Department of Neurosurgery, College of Medicine, Yeungnam University, Daegu, Korea
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Abstract
Synovial disorders often affect the knee joint and are a common cause of morbidity. Before MR imaging, radiologists were limited in their ability to provide information about the presence or absence of synovial disease. With the advent of MR imaging, useful information can now be provided to referring clinicians, often at a time when the initiation of therapy may mitigate significantly the long-term sequelae of synovial disorders. MR imaging, owing to its superior soft-tissue contrast, is the imaging modality of choice for demonstrating and quantifying pathologic changes of the synovium. MR imaging provides invaluable information to the clinician regarding the need to either initiate or modify therapy in those patients suffering from diseases of, or affecting, the synovium.
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Frick MA, Wenger DE, Adkins M. MR Imaging of Synovial Disorders of the Knee: An Update. Magn Reson Imaging Clin N Am 2007; 15:87-101. [PMID: 17499183 DOI: 10.1016/j.mric.2007.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Synovial disorders often affect the knee joint and are a common cause of morbidity. Before MR imaging, radiologists were limited in their ability to provide information about the presence or absence of synovial disease. With the advent of MR imaging, useful information can now be provided to referring clinicians, often at a time when the initiation of therapy may mitigate significantly the long-term sequelae of synovial disorders. MR imaging, owing to its superior soft-tissue contrast, is the imaging modality of choice for demonstrating and quantifying pathologic changes of the synovium. MR imaging provides invaluable information to the clinician regarding the need to either initiate or modify therapy in those patients suffering from diseases of, or affecting, the synovium.
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Affiliation(s)
- Matthew A Frick
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
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