1
|
Zanna L, Secci G, Innocenti M, Giabbani N, Civinini R, Matassi F. The use of posteromedial portal for arthroscopic treatment of synovial chondromatosis of the knee: a case report. J Med Case Rep 2022; 16:457. [PMID: 36494697 PMCID: PMC9737985 DOI: 10.1186/s13256-022-03667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Luigi Zanna
- grid.8404.80000 0004 1757 2304Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Gregorio Secci
- grid.8404.80000 0004 1757 2304Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Matteo Innocenti
- grid.8404.80000 0004 1757 2304Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Niccolò Giabbani
- grid.8404.80000 0004 1757 2304Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Roberto Civinini
- grid.8404.80000 0004 1757 2304Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| | - Fabrizio Matassi
- grid.8404.80000 0004 1757 2304Orthopaedic Clinic CTO, University of Florence, Largo Palagi 1, 50139 Florence, Italy
| |
Collapse
|
2
|
Tomar L, Arya RC, Govil G, Dhawan P. Synovial Chondromatosis-Induced Monoarticular Knee Arthritis: Challenges With Arthroscopic Synovectomy on Late Presentation. Cureus 2022; 14:e30332. [PMID: 36407207 PMCID: PMC9663268 DOI: 10.7759/cureus.30332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Unilateral painful swelling of the knee is one of the most common orthopedic presentations. Monoarticular synovitis of the knee may be present due to inflammation, trauma, age-related degeneration, or tumor pathology. Primary synovial chondromatosis (PSC) is an uncommon cause. A 40-year-old female presented with painful swelling of her left knee for around nine months. She had a flexion deformity of her left knee with minimal hydrops. The radiograph showed speckled calcifications and osteopenia with a reduction of medial joint space. MRI imaging confirmed synovitis with calcifications. She underwent an arthroscopic synovectomy for her management. Her biopsy was consistent with synovial chondromatosis. The initial progression was favorable to allowing independent, unsupported, pain-free activities of daily routine. At three months, however, there was disease progression, causing limitation of knee movements and the need for a walker for support. An uncommon cause of synovitis presents at a late stage with a delay in the early diagnosis and early recognition. PSC is considered a benign lesion with good functional outcomes after arthroscopic surgery. Recurrence and poor functional outcome possibly suggest aggressive disease. A delayed diagnosis and late presentation may be susceptible to recurrence and poor functional outcome, even after an adequate arthroscopic debridement and rigorous post-operative rehabilitation program.
Collapse
|
3
|
Auran RL, Martin JR, Duran MD, de Comas AM, Jacofsky DJ. Evaluation and Management of Intra-Articular Tumors of the Knee. J Knee Surg 2022; 35:597-606. [PMID: 35189664 DOI: 10.1055/s-0042-1743223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intra-articular tumors of the knee are most commonly benign. Overall, this is a relatively rare clinical presentation. The differential diagnosis includes pigmented villonodular synovitis, synovial chondromatosis, lipoma arborescens, synovial hemangioma, and very rarely primary sarcoma (synovial sarcoma being the most common). The clinical presentation for these conditions is usually non-specific, but radiographic and advanced imaging findings are able to differentiate some of these tumors. It is essential to obtain and send tissue specimens to pathology for histologic analysis to rule out a primary malignancy as a missed diagnosis can have grave implications on patient outcomes. This review summarized key aspects of diagnosis and treatment for these conditions.
Collapse
Affiliation(s)
- Richard L Auran
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - John R Martin
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona
| | - Michael D Duran
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - Amalia M de Comas
- Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, Arizona.,The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| | - David J Jacofsky
- The Center for Orthopedic Research and Eduction (CORE) Institute, Phoenix, Arizona
| |
Collapse
|
4
|
Zhou N, Fang K, Arthur V DT, Yi R, Xiang F, Wen J, Xiao S. Synovial chondromatosis combine with synovial tuberculosis of knee joint: a case report. BMC Pediatr 2022; 22:8. [PMID: 34980042 PMCID: PMC8722140 DOI: 10.1186/s12887-021-03085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
Backgroud Synovial chondromatosis is a rare synovial-derived metaplasia disease that comes from the formation of cartilage nodules within the synovial connective tissue of the joint. Knee tuberculosis is a disease caused mostly by the pulmonary tuberculosis and a few by tuberculosis of the digestive tract and lymphatic. tube. Case presentation Herein we report a 3-year-old child admitted by intermittent swelling of left knee joint with lameness for half a year, the patient received surgical treatment. The loose bodies filled in the joint cavity was taken out and the degenerative synovium was excised. Biopsy confirmed as synovial chondromatosis combined with synovial tuberculosis of knee joint. After 6 months follow-ups, knee swelling and claudication get totally recovered and the gait of patient recover back to normal. Conclusion Careful investigation of children with knee pain is recommended to avoid misdiagnosis, Synovial chondromatosis combine with tuberculosis should be considered a differential diagnosis in a child with knee pain.
Collapse
Affiliation(s)
- Nan Zhou
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Ke Fang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Djandan Tadum Arthur V
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Runbin Yi
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Feng Xiang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China.
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| |
Collapse
|
5
|
Zmerly H, Moscato M, Akkawi I. Assessment and Management of Loose Bodies in the Knee Joint and Related Disease: A Narrative Review. Curr Rheumatol Rev 2021; 18:12-19. [PMID: 34674623 DOI: 10.2174/1573397117666211021165807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/09/2021] [Accepted: 08/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Loose bodies are frequently encountered during clinical activity and a common finding during knee arthroscopy. Usually, treatment consists of the removal of the loose bodies, which can be challenging even for experienced surgeons. The excision alone is not always the complete treatment, because loose bodies are generally secondary to other diseases that can cause persistent symptoms with the risk of new loose body formation. The aim of this narrative review is to show the clinical, imaging and arthroscopic evaluation of loose bodies in order to plan optimal treatment. METHODS A comprehensive search of PubMed was conducted to find the most recent and relevant studies investigating the aetiopathogenesis, the assessment tools and the therapeutic strategies for knee loose bodies and their related diseases. RESULTS When dealing with a loose body, the first issue is the evaluation of the intra-articular fragment (location, size, number, symptoms) and its aetiopathogenesis by identifying the underlying pathology (e.g., osteochondritis dissecans, osteoarthritis, chondral defect, tumour-like lesions, rheumatoid arthritis, etc.). In the case of symptomatic intra-articular loose bodies, treatment consists of fragment removal and the management of related diseases (e.g., lifestyle modification, physiotherapy, pharmacological and surgical treatment). CONCLUSION Loose bodies are not separate entities and in addition to their pathological aspect, must be evaluated within the context of the underlying disease. Correct assessment and comprehensive management allow for relief of symptomatology and prevention of loose body formation by removal and treatment of the associated diseases.
Collapse
Affiliation(s)
- Hassan Zmerly
- Orthopaedic Department, Villa Erbosa Hospital, Via Dell'Arcoveggio 50/2, 40129, Bologna. Italy
| | - Manuela Moscato
- Orthopaedic Department, Villa Erbosa Hospital, Via Dell'Arcoveggio 50/2, 40129, Bologna. Italy
| | - Ibrahim Akkawi
- Orthopaedic Department, Villa Erbosa Hospital, Via Dell'Arcoveggio 50/2, 40129, Bologna. Italy
| |
Collapse
|
6
|
An Unusual Cause of Limping in a 2-Year-Old Girl: Synovial Chondromatosis of the Knee. Am J Phys Med Rehabil 2021; 100:e37. [PMID: 32541346 DOI: 10.1097/phm.0000000000001494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Junaid S, Gnanananthan V, Malhotra K, Saifuddin A. Tumours and tumour-like lesions of joints: Differential diagnoses in a paediatric population compared to adults. Br J Radiol 2021; 94:20201389. [PMID: 33617297 DOI: 10.1259/bjr.20201389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the differential diagnosis of intra-articular tumours and tumour-like lesions in a paediatric population compared to adults. METHODS Retrospective review of children up to the age of 18 years with suspected intra-articular tumours and tumour-like lesions referred to a specialist musculoskeletal oncology service from January 2019 to August 2020. Data recorded included patient age and gender, lesion location and morphology (based on the classification system of Adams et al.), and the final diagnosis made either by image-guided biopsy/resection or by clinical and imaging features. Comparison was then made with a group of adults presenting during the same period. RESULTS 28 paediatric patients were included (12 males and 16 females with mean age 11.2 years, range 3-18 years). Joints involved were the knee (n = 22; 78.6%), ankle (n = 4; 14.3%), hip (n = 1; 3.6%) and elbow (n = 1; 3.6%). Lesion morphology was Type 1 (n = 18; 64.3%), Type 2 (n = 3; 10.7%), Type 3 (n = 1; 3.6%) and Type 4 (n = 5; 17.9%). Final diagnosis was made by image-guided biopsy/resection in 18 (64.3%) patients. The commonest neoplastic lesion was tenosynovial giant cell tumour (n = 11; 39.3%), followed by synovial haemangioma (n = 5; 17.9%). There was only a single malignant lesion, a case of synovial sarcoma. Of eight (28.6%) non-neoplastic lesions, three were diagnosed as juvenile idiopathic arthritis and three as non-specific synovitis. There was no difference compared to adults regarding gender, joint involved or lesion morphology, but there was a significant difference in final diagnoses (p < 0.001). The range of intra-articular tumours and tumour-like lesions in children differs from that in adults, although tenosynovial giant cell tumour is the commonest diagnosis in both groups and malignant lesions are rare. ADVANCES IN KNOWLEDGEART In our series, ~16% of tumours and tumour-like lesions of joints occur in the paediatric population. Tenosynovial giant cell tumour remains the commonest diagnosis in children as in adults. Synovial haemangioma and juvenile idiopathic arthritis were the next commonest diagnoses in children, while primary synovial chondromatosis and reactive synovitis were the next commonest diagnoses in adults. Malignant lesions are rare in both groups.
Collapse
Affiliation(s)
- Syed Junaid
- Department of Radiology, Princess of Wales Hospital, CTM University Health Board, Bridgend, UK
| | | | - Karan Malhotra
- Foot and Ankle Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
8
|
Hashimoto K, Nishimura S, Yamagishi K, Tsukamoto I, Nakagawa K, Inoue S, Asada S, Kakinoki R, Akagi M. Extra-articular synovial osteochondroma of the Hoffa's fat pad involving the patellar tendon: A case report and literature review. Mol Clin Oncol 2020; 12:355-357. [PMID: 32190319 PMCID: PMC7057915 DOI: 10.3892/mco.2020.1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/04/2020] [Indexed: 11/08/2022] Open
Abstract
Synovial osteochondroma (SO) is a relatively uncommon tumor affecting the synovial joints that is characterized by the development of hyaline cartilage from the synovial membrane. The basic pathophysiology of SO is thought to be the metaplastic change of the synovium to hyaline cartilage. Large extra- or para-articular lesions in the Hoffa's fat pad are relatively uncommon. A 56-year-old woman complained of knee pain associated with a large lesion on the anterior of the right knee. She also had restricted range of motion in the knee. Examination revealed an elastic hard 8x9-cm lesion involving the patellar tendon. Computed tomography and magnetic resonance imaging demonstrated a mosaic-intensity mass lesion in the inferior side of the Hoffa's fat pad as well as the patellar tendon. The patient underwent needle biopsy. Histological analysis revealed a solitary SO. There were no atypical features suggestive of malignancy and the mass was resected marginally. The patient had no recurrence or knee functional disorder 3 years postoperatively. There are no reports of SO involving the patellar tendon with restriction of range of motion. Removal of the mass lesion for management for SO, as in the present case, is unusual. To the best of our knowledge, this is the first case of extra-articular SO in the Hoffa's fat pad involving the patellar tendon causing a restriction of range of motion of the knee. Marginal surgical resection improved knee function.
Collapse
Affiliation(s)
- Kazuhiko Hashimoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Shunji Nishimura
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Koutaro Yamagishi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Ichiro Tsukamoto
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Koichi Nakagawa
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Shinji Inoue
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Shigeki Asada
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Ryosuke Kakinoki
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| | - Masao Akagi
- Department of Orthopedic Surgery, Kindai University Hospital, Osaka-Sayama, Osaka 589-8511, Japan
| |
Collapse
|