Osteochondritis dissecans of the temporomandibular joint: a scoping review

PURPOSE

To perform a scoping review to identify the available evidence regarding osteochondritis dissecans (OCD) of the temporomandibular joint (TMJ).

METHODS

An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: 'Temporomandibular Joint Disorders', 'Osteochondritis Dissecans', 'Joint Loose Bodies' and 'Temporomandibular Joint'. Full-text articles were obtained from the records after applying the inclusion/exclusion criteria.

RESULTS

Ten articles were included in the analysis - six case reports, one case series, one retrospective study, one comparative study and one correlational study - with a total of 39 patients. The most frequently reported clinical presentation involved TMJ pain, locked jaw and articular noises (clicking and crepitus). The imaging methods used to identify OCD were radiographs, tomography, arthrography and magnetic resonance imaging. The reported imaging findings varied widely, but the most frequent were (single or multiple) calcified intra-articular loose bodies, signs of degenerative osseous changes, disc displacements, widening of the joint space and alterations in condylar morphology. Seven articles reported treatments (surgical or conservative), but the treatment outcome was not reported in all of the articles, which makes it difficult to make comparisons.

CONCLUSION

OCD of the TMJ may present various non-specific clinical characteristics, and given the heterogeneous imaging findings, multiplanar images are required for an accurate diagnosis. Finally, the results do not allow recommending a standard treatment for OCD of the TMJ.

Intercruciate trans-septal arthroscopic approach to the posterior compartment of the knee joint

Approach to the posterior compartment of the knee joint and working within it has been made assessable since the trans-septal approach was established. Herein, the authors describe a simple intercruciate trans-septal approach to the posterior compartment of the knee joint. This technique allows a direct visualization to the posterior septum (septum), creating a safer trans-septal portal and easier separation of the septum. The authors have used this approach in conditions such as the posterior cruciate ligament (PCL) reconstruction, PCL avulsion repairs, popliteus tendon reconstruction, posterior compartment synovectomy, hardware removal, loose bodies removal, meniscus ramp lesion repair, and others. No complications such as femoral condyle damage, meniscus damage, or neurovascular bundle injuries has occurred with this approach.

Rice bodies in a shoulder bursa: a cadaveric and histologic case report

INTRODUCTION

The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature.

METHODS

A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa. This bursa, along with the biceps brachii tendon sheath, and the subscapularis muscle bursa, were filled with numerous rice-like bodies. The bursal wall was well developed and thickened. Tissue specimens were obtained of the suspected rice bodies, the subacromial/subdeltoid bursal wall, and the biceps brachii tendon sheath. The tissue was embedded, sectioned, and processed with hematoxylin and eosin or Masson's Trichrome staining for blinded histologic assessment.

RESULTS

The tissue samples from within the bursa were identified as tissue similar to that in prior descriptions of rice bodies. Tissue samples from the bursal wall and tendon sheath were identified as similar to synovial membranes.

CONCLUSIONS

Rice bodies found within the cadaveric body were similar histologically to those described in rheumatology, radiology, and orthopedic literature. Anatomists teaching future health-care providers and practicing physical therapists should be familiar with rice bodies as a potential finding in cadavers, and patients.

Temporomandibular joint synovial chondromatosis: An analysis of 7 cases and literature review

OBJECTIVE

To investigate the diagnosis and treatment procedure of synovial chondromatosis (SC) of the temporomandibular joint (TMJ).

METHODS

Clinical features, imaging features, surgical methods, and prognosis of 7 patients with SC of the TMJ were analyzed. We also reviewed and analyzed surgery-relevant literature included in the Pubmed database in the past decade using the search terms "synovial chondromatosis" and "temporomandibular joint", and found 181 cases.

RESULTS

There was no specific difference in the symptoms of SC in the TMJ in different Milgram's stages in our cases and the cases mentioned in the literature. The main symptoms of SC in the TMJ were pain (100%, 7/7; 64.64%, 117/181), limited mouth opening (57.14%, 4/7; 53.59%, 97/181), swelling (14.29%, 1/7; 28.18%, 51/181), crepitus (28.57%, 2/7; 19.34%, 35/181), and clicking (14.29%, 1/7; 9.94%, 18/181) in our cases and cases from literature separately. The imaging features of SC were occupying lesions (including loose bodies or masses) (71.42%, 5/7; 37.57%, 68/181), bone change in condyle or glenoid fossa (1/7, 14.29%; 34.81%, 63/181), effusion (42.86%, 3/7; 20.99%, 38/181), joint space changes (42.86%, 3/7; 11.05%, 20/181) in our cases and cases from literature separately. The surgical procedures seem to depend mainly on the involved structures and the extension of the lesion rather than the Milgram's stage.

CONCLUSIONS

The clinical features of SC in the TMJ are nonspecific and easy to be misdiagnosed. MRI is helpful in the diagnosis of SC in the TMJ. The surgical procedures mainly depend on the involved structures and the extension of the lesion.

Extra and Intra-articular Synovial Chondromatosis

Synovial chondromatosis is not so rare intra-articular condition secondary to synovial metaplasia, that affects the knee joint. Extra-articular synovial chondromatosis however is an extremely rare condition that usually involves the synovial sheath or bursa of the foot or hand. We present two cases of synovial chondromatosis, one intra and one extra-articular. The first case was a 25 year old lady who presented with pain, swelling and restricted range of motion of left knee and was found to have an intra-articular synovial chondromatosis which was treated successfully by joint debridement. The second case was that of a 22 year old man who presented with right knee pain and was diagnosed to have an extra-articular synovial chondromatosis of his right medial hamstring tendon sheath, excision of which resulted in complete relief of symptoms.

Synovial chondromatosis of the shoulder: open synovectomy and insertion of osteoarticular allogaft with internal fixation to repair intraoperative glenohumeral joint instability

Synovial chondromatosis is a rare benign disorder characterized by chondroid metaplasia with multinodular proliferation of the synovial lining of a diarthroidal joint, bursa, or tendon sheath. These cartilaginous nodules may become embedded within the proliferating synovium and may extend into the surrounding soft tissues. They also can detach from the synovium, where they can calcify and may present as intra-articular loose bodies. Presence of these nodules leads to joint pain, dysfunction, and ultimately, destruction. Clinically, patients often present with a chronic monoarthropathy. In this article, we report a case of extensive synovial chondromatosis of the right shoulder and surrounding soft tissues with extensive erosion of the humeral head, discuss combined anterior and posterior surgical excision of the cartilaginous fragments, and describe insertion of an osteoarticular allograft to repair the humeral head defect and secondary anterior glenohumeral joint instability.

Synovial chondromatosis of the elbow causing a mechanical block to range of motion: a case report and review of the literature

We report a unique case of elbow synovial chondromatosis with sudden onset of severe loss of elbow extension and flexion range of motion caused by mechanical block from deposition of chondral fragments in the olecranon and coronoid fossae, respectively. We performed successful arthroscopic surgical treatment of synovial chondromatosis of the elbow. Arthroscopy examination revealed an acutely evolving synovial chondromatosis. Three-year follow-up indicated that arthroscopic removal of loose bodies and partial synovectomy can yield lasting improvement in motion without disease recurrence.

Capitellar cartilage injuries concomitant with radial head fractures

PURPOSE

To evaluate the incidence and types of capitellar cartilage injuries associated with higher-grade radial head fractures.

METHODS

Fifty-one consecutive patients with operatively treated, unstable, displaced Mason type II to III radial head fractures were identified. Ten of 51 patients had capitellar cartilage injuries concomitant with these fractures. All cartilage injuries were identified at the time of surgery except in 1 patient whose injury was determined via computed tomography. There were 8 men and 2 women with an average age of 33 years (range, 24-39 years). Lesions were seen with direct inspection and recorded by location, size, and thickness.

RESULTS

The incidence of capitellar chondral lesions concomitant with operatively treated Mason type II to III radial head fractures appeared in 10 of 51 patients. The average size was 5 x 5 mm (range, 2 x 2 mm to 10 x 10 mm). Four patients had Mason type II and 6 had Mason type III radial head fractures. The average surface of the cartilage injury was 6 x 7 mm (range, 3 x 6 mm to 10 x 10 mm) for Mason type II fractures and 4 x 4 mm (range, 2 x 2 mm to 5 x 10 mm) for Mason type III fractures. Two Mason type III fractures had full-thickness cartilage lesions, and 4 Mason type III fractures had partial-thickness cartilage lesions. Two Mason type II fractures had full-thickness cartilage lesions and the other 2 had partial-thickness cartilage lesions.

CONCLUSIONS

Capitellar cartilage lesions frequently occurred concomitantly with higher-grade radial head fractures. The incidence of these lesions increased with greater severity of radial head fractures. Low-grade radial head fractures created higher-grade cartilage lesions as the intact radial head can cause more damage to the capitellum. Careful evaluation of the joint should be performed for these subtle injuries.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic IV.

The mobile Condylus tertius occipitalis and fractures of the hypochordal clasp

The Condylus tertius is defined as a small bony hunch on the anterior surface of the clivus. Its presence means an enormous functional impairment of the upper head joint, looking at the 3-point-contact between the skull base and the upper cervical vertebrae. In 10 of the 2000 forensic examined bodies, analyses of neck vertebra + skull base revealed this feature. The origin of these findings is discussed, as stated in the literature of embryology, to be a suboccipital hypochordal plate. So in one of the cases the condylus was found at the hypochordal plate itself whereas the so-called socket was lying at the margin of the clivus. In three cases there was found a free body between the apex of the Dens and the Clivus forming a mobile Condylus tertius. In our opinion its position varies over the anterior arch of the atlas and the apex of the dens as a result of rotatory forces between the atlas and axis and physiological strain. Examples are given to elucidate this. There is a difference in the differentiation of the deposited material according to functional demand. A pressure bed (i.e. a Condylus tertius) is formed when a bony structure is deposited on the clivus. This functional prospect relativises the hypothesis of a purely constitutional genesis of the Condylus tertius. A fracture of the hypochordal clasp being joined with a bony connection to the anterior atlantic arch is described for the first time.

[Giant bursitis with rice bodies of the shoulder/neck region in a patient with rheumatoid arthritis without joint-connection]

Giant bursitis with rice bodies is an important clinical entity recognized in rheumatoid arthritis. Usually the bursitis is connected to a joint space. In this unusual case of a giant bursitis of the shoulder/neck region, no connection to a joint could be found. The bursitis lays directly on a rib. The clinical and radiological findings are presented and this special case is discussed in comparison to the literature.

Ultrasonographic and arthrographic diagnoses of synovial chondromatosis

Synovial chondromatosis (SC) is rare in the temporomandibular joint (TMJ). Plain radiographs, CT, MRI and arthrography of the TMJ have been used for the diagnosis of SC. The purpose of this paper is to present ultrasonographic and arthrographic diagnoses of a case of SC of the TMJ.

Histologic evaluation of osteochondral loose bodies and repaired tissues after fixation

PURPOSE

The purpose of this study was to evaluate histologic changes in osteochondral loose bodies in the rabbit knee joint and histologic changes in repaired tissue after fixation of osteochondral loose bodies following isolation periods of varying length.

METHODS

We harvested osteochondral fragments from the patellar groove in rabbit knee joints and left them in the lateral gutters of the joints for periods of varying duration to create osteochondral loose bodies. We then evaluated histologic and immunohistochemical changes within these loose bodies. Next, we fixed osteochondral loose bodies that had been isolated for various periods within the joints to the osteochondral defect in the patellar groove. Twelve weeks after fixation, repaired tissues were evaluated histologically and immunohistochemically, and results were analyzed according to the varying isolation periods of fragments.

RESULTS

Extracellular matrix and type II collagen expression of osteochondral loose bodies deteriorated with increased duration of fragment isolation periods. A significantly negative correlation was noted between length of isolation periods and histologic grading scores. After osteochondral loose bodies had been fixed, repaired tissues deteriorated significantly in accordance with duration of fragment isolation periods. However, in some cases, even when osteochondral fragments had been isolated for 12 weeks, repaired tissues showed dense extracellular matrix stained by safranin O and abundant type II collagen expression, which indicated regeneration of the cartilage layer.

CONCLUSIONS

Osteochondral loose bodies and repaired tissues deteriorated after they were fixed to osteochondral defects. Although a direct correlation was noted between isolation periods of fragments and time to their deterioration, some osteochondral loose bodies showed regeneration of cartilage after fixation.

CLINICAL RELEVANCE

Clinically, reduction of osteochondral loose bodies should be performed as early as possible, if these can be found. However, even if the fragment seems to be old, fragment fixation is worthy of consideration.

Histologic classification of loose bodies in osteoarthrosis

BACKGROUND

Histologically based analyses of the nature and origin of loose bodies occurring in osteoarthrosis have been few, and further study is warranted.

METHODS

We histologically examined 84 loose bodies and 9 related lesions (synovial membrane nodules) surgically removed from 24 joints of 24 patients with osteoarthrosis.

RESULTS

The 84 loose bodies included 48 chondral loose bodies (type I), 26 osteochondral loose bodies (type II), and 10 osseous loose bodies (type III). The 26 osteochondral loose bodies (type II) could be subdivided into 8 composed of cartilage with enchondral ossification (type IIa), 11 consisting of mature bone covered by cartilage without enchondral ossification (type IIb), and 7 made up of mature bone and partially articular cartilage or hyaline cartilage (type IIc). Synovial membrane nodules could be also divided into three types in the same manner as loose bodies. Many type IIa, type IIc and type III loose bodies and all synovial membrane nodules showed blood vessels containing red blood cells, as well as osteoclasts. The type I and type IIb loose bodies, however, did not show them.

CONCLUSIONS

It is well known that loose bodies grow from proliferation of cartilage without blood supply in the joint cavity, and that enchondral ossification is able to develop only under the condition of having a blood supply. As synovial membrane nodules were also classified to the same types as loose bodies and more than half of osteochondral and osseous loose bodies contained blood vessels with red blood cells, the loose bodies were thought to be caught in the synovial membrane and to be modified as the result of a blood supply. Considering the results of this study, the various histologic characteristics of loose bodies in osteoarthrosis resulted from modifications including cartilage proliferation in the joint cavity and enchondral ossification in the synovial membrane.

Histology of two rice bodies isolated from the stifle of an adult draught horse stallion

In the human and equine species, different kinds of free floating intra-articular particles are related to certain disorders. Osteochondral fragments formed during osteochondrosis dissecans are the most common finding in the equine species, whereas in humans rice bodies due to rheumatoid arthritis are more frequent. Herein we report a third type of floating body inside the stifle of an adult draught horse stallion, in macroscopic appearance similar to articular rice bodies known in humans. As revealed by histologic examination, the two particles consist of polypoid degenerated structures derived from synovial villi. Their formation was probably induced by ischemia.

[Isolated synovial chondromatosis of the subacromial bursa: report of a new case and review of the literature]

Synovial chondromatosis is a rare metaplasia of the synovium of unknown etiology that may involve occasionally the subacromial bursa. We report a new case diagnosed by ultrasound in a 30-year-old man and we present pathogenetic, diagnostic and therapeutic features of this disease with a literature review.

[Arthroscopic treatment of symptomatic loose bodies in osteoarthritic elbows]

OBJECTIVES

We evaluated functional and clinical results of patients who underwent arthroscopic surgery for symptomatic loose bodies in osteoarthritic elbow joint.

METHODS

Arthroscopic surgery was performed in 10 patients (6 males, 4 females; mean age 47 years; range 30 to 59 years) for symptomatic loose bodies in osteoarthritic elbow joint. Eight patients had a history of trauma. Involvement was on the right in seven patients, and on the left in three patients. Preoperatively, six patients had limited joint movements and locking, and five patients had pain. The presence and the number of loose bodies were investigated by standard radiographs and computed tomography preoperatively, and by radiographs and magnetic resonance imaging postoperatively. The range of motion was measured with a goniometer. Functional assessment was made with the use of the Broberg and Morrey's scoring system, and pain was assessed with a visual analog scale. The mean follow-up was 31 months (range 7-59 months).

RESULTS

The mean range of motion of the elbows increased from 100 degrees (range 55 degrees to 160 degrees) preoperatively to 115 degrees (range 70 degrees to 160 degrees) at the end of the follow-up (p=0.05). None of the patients developed valgus or varus instability. The mean preoperative and postoperative Broberg and Morrey's scores were 59 (range 45 to 80) and 86 (range 59 to 100), respectively (p<0.01). The results were excellent in five patients, good in three patients, and poor in two patients. The mean visual analog score decreased from 7 (range 5 to 10) preoperatively to 1 (range 0-4) postoperatively (p<0.01). Eight patients were satisfied with surgery and returned to normal activities after a mean of 16 days (range 1 to 60 days).

CONCLUSION

Arthroscopic surgery is effective in reducing pain in selected patients with symptomatic loose bodies in osteoarthritic elbows, with the advantages of low morbidity and rapid functional recovery.

[Synovial disorders and loose bodies in the hip joint. Arthroscopic diagnostics and treatment]

Synovial disorders and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for loose bodies, synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis. One major advantage in comparison to radiologic imaging is the ability to inspect, biopsy, and treat within one procedure. In contrast to an arthrotomy, hip arthroscopy avoids the potential risks of extensive surgical exposure and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with loose bodies, synovial plicae, initial septic arthritis and, to a certain extent, PVNS curative therapy and "restitutio ad integrum" can be achieved. In contrast, in patients with synovial chondromatosis and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis and to provide symptomatic relief and maintain or improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.

[Preliminary observation of biological characters of chondrocytes in articular loose body]

OBJECTIVE

To observe the biological characters of chondrocytes in articular loose body and to find out seeding cells for cartilage tissue engineering.

METHODS

Samples from 5 loose body cartilages, 2 normal articular cartilages and 6 osteoarthritis articular cartilages were collected. Part of each sample's cartilage was histologically studied to observe the chondrocytes distribution the morphologic changes by toluidine-blue staining, chondrocytes' apoptosis by terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate-biotin nick end-labeling (TUNEL). The rest of each cartilage was digested and isolated by 0.25% trypsin and 0. 2% collagenase II, and then were cultivated in 10%DMEM. Their morphologic changes were observed 24h later. Comparison was made between three cartilages.

RESULTS

Compared with normal cartilage and osteoarthritis articular cartilage, the cells density was higher, their lacunary were larger, cells distribution was irregular, and apoptosis was more apparent in loose body cartilage.

CONCLUSION

The characters of chondrocytes from loose body is more like fibroblasts so they can not serve as seeding cells directly for cartilage tissue engineering.

Malocclusion associated with osteocartilaginous loose bodies of the temporomandibular joint

BACKGROUND

The authors review the literature regarding osteocartilaginous loose bodies (that is, secondary synovial chondrometaplasia or secondary synovial chondromatosis) in the temporomandibular joint (TMJ), present a case report and stress the importance of early diagnosis.

CASE DESCRIPTION

A 57-year-old woman was referred to an orthodontist with a chief complaint of bite changes that took place over several years as the patient intermittently experienced TMJ problems. The authors noted radiopacities around the right TMJ space on a panoramic radiograph. They referred the patient to an oral and maxillofacial surgeon for treatment.

CLINICAL IMPLICATIONS

Asymmetrical occlusal changes in a nongrowing adult with progressive shifts from Class I to Class III malocclusion unilaterally may indicate a space-occupying lesion in the TMJ space on the affected side.

Synovial chondromatosis of the temporomandibular joint: a clinical, radiological and histological study

Synovial chondromatosis (SC) is a cartilaginous metaplasy of the mesenchymal remnants of the synovial tissue of the joints. It is characterized by the formation of cartilaginous nodules in the synovium and inside the articular space (loose bodies). SC mainly affects to big synovial joints such as the knee and the elbow, being uncommon the onset within the TMJ, where 75 cases have been published. The main symptoms are pain, inflammation, limitation of the movements of the jaw and crepitation. Different methods of diagnosis include panoramic radiograph, CT, MR and arthroscopy of the TMJ. We report a new case of unilateral SC of the TMJ, including diagnostic images, treatment performed and histological analysis.

Secondary osteochondromatosis in the subacromial bursa: a report of two cases and review of the literature

Osteochondromatosis is classified into primary and secondary lesions; primary osteochondromatosis is a tumor-like lesion, whereas secondary lesions are due to such joint or bursal disorders as osteoarthritis and osteochondral fractures. There is no clinical distinction between these two conditions. Only the pathological findings of loose bodies and synovium can clearly distinguish between them. In this report, we present two patients with secondary osteochondromatosis in the subacromial bursa. Both had shoulder pain and were treated surgically. We discuss methods of differentiating between primary and secondary lesions and elucidate the pathogenesis of osteochondromatosis in the subacromial bursa by analyzing findings for 17 shoulders with this condition reported in the literature. We also present two more cases. We reviewed the 12 cases of osteochondromatosis in the literature for histopathological findings of loose bodies and the presence or absence of acromial osteophytes. Our findings suggest that osteochondromatosis of the subacromial bursa is secondary in most cases, and that osteocartilaginous fragments from acromial osteophytes can be shed into the subacromial bursa and grow into loose bodies.

Multiple rice body formation in the subacromial-subdeltoid bursa and knee joint

Multiple rice body formation is an uncommon disorder which resembles synovial chondromatosis both radiologically and clinically. The clinical symptoms are usually non-specific. We report on a pathologically proven multiple rice body formation in both the left subacromial-subdeltoid bursa and knee joint in a 4-year-old girl.

Synovial chondromatosis of the temporomandibular joint: clinical and immunohistopathological considerations

A histopathological study of 30 cases of synovial osteochondromatosis found that the process followed a temporal sequence characterised by three phases: (I) active intrasynovial disease only; (II) transitional lesions with both active intrasynovial proliferation and free loose bodies; and (III) many free osteochondral bodies with no demonstrable intrasynovial disease [J. Bone Joint Surg. 59 (1977) 792]. We present five cases of synovial chondromatosis of the temporpmandibular joint (TMJ) which we studied by immunohistochemical methods of for transforming growth factor beta (TGFbeta) and tenascin.

[Joint loose bodies in the mandible. Diagnostic criteria and pathways for therapy planning]

Osteochondrosis dissecans (OD) and synovial chondromatosis (SC) are two rare causes for loose bodies in the temporomandibular joint. It is assumed that OD is a reaction of some type of joint trauma. Gene mutations similar to what is known in chondrosarcomas can be found in metaplastic SC. The reasons for mutations are still unknown. Both diseases have very similar symptoms. Patients suffer from preauricular swelling, facial or temporomandibular joint pain, and occasional joint locking. In addition, radiological imaging (MRI) is difficult in evaluating the differential diagnosis of presented intra- or periarticular pathology. To overcome diagnostic problems, we strongly support temporomandibular joint arthroscopy as a diagnostic and therapeutic tool. The decision whether or not total synovectomy is needed or if simple removal of fragments is adequate can be evaluated in vivo including the option of histopathological examination.

Ochronotic arthropathy: arthroscopic findings in the shoulder and the knee

Ochronotic arthropathy is a disorder resulting from the deposition of homogentisic acid derivatives in the articular cartilage and the menisci. Large joints of the appendicular skeleton are preferentially affected. The clinical picture resembles that of degenerative joint disease. We present the arthroscopic findings in the shoulder and the knee in a 40-year-old man with ochronotic arthropathy and discuss the role of arthroscopy in the diagnosis and management of this rare metabolic disorder.

Synovial chondromatosis of the temporomandibular joint: clinical, surgical and histological aspects

Nine patients with histologically confirmed unilateral synovial chondromatosis of the temporomandibular joint were treated surgically with extirpation of loose bodies and partial synovectomy. In six of them the histological material was available for a systematic examination. The results of treatment were evaluated clinically and with MRI after a follow-up ranging between 1 and 17 years. Our findings suggest that synovial chondromatosis of the temporomandibular affects only the synovial lining of the upper compartment. The histological appearance is that of a benign chronic inflammation varying in severity and with metaplastic activity. The most specific clinical sign of synovial chondromatosis is swelling over the joint. Distension of the lateral capsule and fluid in the joint on the MRI are very suggestive of this diagnosis. Loose bodies also indicate synovial chondromatosis, but they are not always detected on the preoperative MRI. The surgical treatment should be conservative and include thorough removal of the loose bodies and partial synovectomy in areas with marked inflammation.

Acute anterior cruciate ligament stump entrapment in anterior cruciate ligament tears: MR imaging appearance

PURPOSE

To describe the magnetic resonance (MR) imaging appearance of anterior cruciate ligament (ACL) stump entrapment in patients who presented with decreased knee extension after rupturing the ACL.

MATERIALS AND METHODS

MR images in 15 patients who had presented with a block to terminal knee extension after sustaining an ACL tear were retrospectively reviewed. The MR imaging appearances of entrapped ACL stumps were defined and correlated with arthroscopic and histologic findings.

RESULTS

The entrapped ACL stumps had two distinct appearances. Type 1 stumps (n = 11) were characterized by a nodular mass located at the anterior aspect of the intercondylar notch, interposed between the lateral femoral condyle and tibia. Type 2 stumps (n = 4) were characterized by a tonguelike free end and angulation of the stump. Histologic evaluation of the resected specimens showed distorted ACL fibers intermixed with variable fibrosis and inflammation.

CONCLUSION

Entrapment of an ACL stump can limit knee extension. The two observed appearances of entrapped ACL stumps likely represent two points along a spectrum of appearances, which possibly includes the cyclops lesion.

The expression of fibroblast growth factor-2 and fibroblast growth factor receptor-1 in chondrocytes in synovial chondromatosis of the temporomandibular joint. report of two cases

Synovial chondromatosis (SC) is a rare, benign condition characterized by the formation of metaplastic cartilaginous nodules. The expression of fibroblast growth factor-2 (FGF-2) and fibroblast growth factor receptor-1 (FGFR-1) in two cases of SC of the temporomandibular joint (TMJ) were immunohistochemically studied. The possible roles of FGF-2 and FGFR-1 in SC of the TMJ are discussed.

Observations on the growth of loose bodies in joints

The categorization, origin, natural history, and histopathology of loose bodies in joints are well described in the literature. Clinical and basic science data have indirectly concluded that loose bodies grow over time; however, to date, there is no clearly documented published clinical example. This case report demonstrates the dramatic enlargement of 2 osteochondral loose bodies in a patient's knee over the course of a decade. The loose bodies possess a large number of viable cells; and growth appears to have occurred through encapsulation of the niduses by multiple layers of fibrocartilagenous tissue, thus confirming the findings of earlier studies.

Magnetic resonance imaging characteristics of synovial chondromatosis of the temporomandibular joint

AIMS

To determine the characteristic magnetic resonance imaging (MRI) findings of synovial chondromatosis of the temporomandibular joint (TMJ).

METHODS

MRI was carried out in 11 cases of synovial chondromatosis of the TMJ, which had been confirmed surgically and histologically.

RESULTS

Severe bony changes were not apparent. One or more hypointensive loose bodies were seen in 7 of the 11 cases. A considerable amount of synovial fluid, often with capsular expansion, was a common finding.

CONCLUSION

A diagnosis of synovial chondromatosis of the TMJ must be considered when the amount of synovial fluid is abnormally large and the disc position is fairly normal, as seen on closed- and open-mouth MRI of the TMJ, without any associated severe changes in disc shape or bony structure.

[Primary synovial chondromatosis of the shoulder]

AIM

To demonstrate the various patterns of primary synovial chondromatosis (PSC) around the shoulder and to discuss a therapeutic algorithm.

METHOD

In this retrospective study, 6 patients with histologically proven PSC were operated on. The diagnosis was based on clinical examination, plain X-rays, ultrasonography and MRI in 5/6 patients. Also, a histological examination was done in all cases. According to the localisation of the disease, surgery was done by endoscopy alone, endoscopy together with open surgery or direct open surgery.

RESULTS

In one case each, we saw an isolated disease of the subacromial bursa or the gleno-humeral joint. In two cases, we found an intraarticular affection together with the biceps tendon sheath. The other two patients showed a massive periarticular deposition of loose bodies together with a defect of the rotator cuff. All patients with intraarticular disease (5/6) showed different stages of chondromalacia. In 5 of 6 patients all bodies could be removed at surgery. At follow-up after 36 months the patients subjectively rated the result as satisfactory to excellent. In the patients with total removal of the bodies, no recurrences were seen on plain X-ray or ultrasonography.

CONCLUSION

PSC around the shoulder appears with a variable pattern. According to the possible late complications described in the literature (i. e., secondary osteoarthritis, involvement of the rotator cuff and secondary malignant transformation), we find operative treatment justified. Surgery addressing removal of loose bodies and partial synovectomy allows good results. The operative approach (endoscopy or open surgery) is related to the localisation and severity of the condition.

Synovial chondromatosis of the temporomandibular joint: clinical, diagnostic, and histomorphologic findings

Objective. The primary diagnosis of synovial chondromatosis of the temporomandibular joint is extremely rare. Often many months, or even years pass before the diagnosis is confirmed. Study Design. Eight patients with synovial chondromatosis were treated by arthrotomy. In addition to the definitive diagnosis, histologic classification according to the stages proposed by Milgram was undertaken and confirmed with the literature. Results. The predominant symptoms of synovial chondromatosis, including pain, swelling, restricted movement of the mandible, and crepitation, were evaluated. Nevertheless, more than 80% of the patients were previously primarily treated on the basis of other tentative diagnoses. Conclusion. Synovial chondromatosis of the temporomandibular joint should be included in the differential diagnosis of chronic swelling and pain in the preauricular region, and the patient should be sent for appropriate diagnostics and therapy at an early stage.

Histology of Kashin-Beck lesions

There are few papers in existence describing the histopathology of Kashin-Beck disease. The few existing papers mention chondronecrosis within the epiphyseal primodium and metaphyseal cartilage. In the present study, two series of samples were available for histology: supernumerary fingers removed from young subjects and intra-articular bodies collected in more advanced cases of the disease. The prevailing characteristic of the samples is the absence of vascularisation within the proximal cartilage end plate of the phalanx associated with an alteration of the epiphyseal bone formation. These observations suggest that Kashin-Beck disease could develop from an alteration of the angiogenesis of the metaphyseal cartilage resulting in degeneration with consequent joint dysplasia, which may be associated with a decrease in growth of the diaphyseal bones.

Condylar hyperplasia associated to synovial chondromatosis of the temporomandibular joint: a case report

Condylar hyperplasia is a slowly developing malformation of the mandible, with elongation of the mandibular neck, that generally results in facial asymmetry. Synovial chondromatosis is a benign chronic disorder characterized by the formation of multiple small nodules of hyaline cartilage as a result of metaplasia of the synovial connective tissue. It affects mostly the large joints, particularly the knee, hip, elbow and ankle. The temporomandibular joint (TMJ) is rarely affected. The case of a 42-year-old male with a history of left preauricular pain and swelling and deviation of the mandible to the left upon opening the mouth is presented. Computed tomography disclosed hyperplasia of the left condyle with loose radiopaque bodies within the joint cavity. The left TMJ was subject to open surgery, which included resection of four loose bodies and a remodeling condylectomy. The histopathological study confirmed the diagnosis of condylar hyperplasia and chondromatosis of the left TMJ.

Pseudotumoral osteochondromatosis of the hip in a soccer player

The authors present a case of pseudotumoral osteochondromatosis of the hip, interesting for its clinical and radiological features. They discuss the incidence of the sport in the pathogenesis of the loose bodies and the magnetic resonance findings.

Expression of collagen type I, II and III in loose body of osteoarthritis

The expression of collagen type I, II, and III was investigated to evaluate phenotypic change in chondrocytes in loose bodies related to osteoarthritis. We assessed collagen type I, II, and III production in loose bodies from knee joints of ten osteoarthritic patients, using an immunohistochemical method with monoclonal antibodies. Collagen type III expression was identified in all ten loose bodies and was mainly located in cartilage, including chondrocytes and matrices, as well as in a layer of fibroid tissue on the surface. No positive signal for collagen type III was observed in necrotic osteocytes. There was weakly positive staining for collagen type I in chondrocytes. No positive staining for collagen type II could be seen in the cartilage of loose bodies. Cartilage from the non-osteoarthritic knee joints of four people was negative for the expression of collagen type I and III, and positive for the expression of collagen type II. Collagen type I and III expression suggested the dedifferentiation status of chondrocytes in loose bodies.

Femoral head disintegration in a paraplegic patient: loose bodies in neuropathic joints

A case report of potential loose body formation in a hip joint of a paraplegic patient is presented. The case is used to discuss why loose bodies do not persist in neuropathic joints, although they might be expected to be common when this type of joint pathology exists.

[Ankle arthroscopy--indications, findings and results]

Thirty-six consecutive ankle arthroscopies from 1991 to 1996 were reviewed. Indications for arthroscopy were loose bodies, osteochondritis dissecans, and post traumatic and degenerative ankle joints. Thirty patients were re-examined 5-60 months postoperatively (median follow-up 12 months). Among twelve patients with an ankle fracture, a loose body was arthroscopically removed from eight patients while the remaining four patients were treated with local synovectomy. Of these twelve patients, nine had no symptoms at follow-up. Of eight patients with initial ankle sprain, four had no symptoms after removal of soft tissue lesions. Of five patients with osteochondritis dissecans treated by drilling through the fragment into the subchondral bone or, alternatively, removal of small pieces, two had no symptoms at follow-up. Five patients with degenerative joint disease had no improvement after arthroscopical debridement. Ankle arthroscopy seems to provide an effective treatment of loose bodies and soft tissue impingement, but the results are not convincing in osteochondritis dissecans and are poor in degenerative ankle joint disease.

Growth potential of loose bodies: an immunohistochemical examination of primary and secondary synovial osteochondromatosis

Histologic and immunohistochemical studies of growth potential were performed on 53 surgically removed loose bodies representing 10 cases of primary synovial osteochondromatosis, 37 bodies representing 12 cases of secondary synovial osteochondromatosis, and five bodies representing five cases of osteochondral fracture. Loose bodies in primary synovial osteochondromatosis were nodular, showing plump chondrocytes and irregular calcification, and all contained proliferative cell nuclear antigen-positive chondrocytes (labeling index: 42.5%; range: 36.0-52.0%). Other markers stained less frequently. Loose bodies in secondary synovial osteochondromatosis showed uniform chondrocytes and annular calcification surrounding core tissue. Eighteen of 37 loose bodies showed proliferative cell nuclear antigen-positive chondrocytes, mostly peripherally. Chondrocyte labeling indices were less than 5% for proliferative cell nuclear antigen and other markers, although some connective tissue cells in the outer layer were stained. Loose bodies from osteochondral fractures were composed of articular cartilage, subchondral bone, and connective tissue; cartilage was negative for markers, whereas connective tissue contained positive cells. One specimen showed cartilaginous metaplasia of connective tissue. These results suggest that loose bodies have the potential for slow growth by proliferation of chondrocytes in primary synovial osteochondromatosis and by metaplasia following proliferation of surrounding connective tissue in secondary synovial osteochondromatosis.

Intra-articular tophus presenting as a loose body

In chronic tophaceous gout, tophi may occur in various tissues of the body. The joints are one of the main tissues of the tophaceous deposits. The articular surface may be coated by heavy deposits. We present a case of a patient with chronic tophaceous gout where the tophaceous deposits formed an intra-articular mass causing symptoms of a loose body.

A case report. Chondromatosis of the temporomandibular joint

Synovial chondromatosis is a rare pathological condition that usually affects large joints but can affect the temporomandibular joint. The disease typically manifests itself with signs and symptoms similar to internal derangement. The disease is characterized by free-floating or attached cartilaginous bodies in the joint space. In this article, the authors present a case of synovial chondromatosis and discuss its pathological process. They also discuss diagnostic approaches and current treatment.

Primary synovial chondromatosis: a clinicopathologic review and assessment of malignant potential

This is a clinicopathologic review of 53 cases of primary synovial chondromatosis covering a period of 30 years. The average age at presentation was 41 years (range, 17 to 64 years) with a male/female preponderance of 1.8:1. The condition was always monarticular, the most common site being the knee joint (70%) followed by the hip (20%). Degenerative joint disease was well established in three patients (5%), all occurring in the hip. Nine patients suffered recurrences (15%), including three that became malignant. There was no relationship between the age and site of the lesion, nor between the degree of cellularity of the cartilage and age or site. However, there was an association between cellularity of the cartilage and the extent of calcification and ossification--highly cellular lesions were poorly calcified and ossified, but heavily calcified lesions were usually of relatively low cellularity. There was no relationship between extent of calcification and ossification and the age of the patient. Three patients suffered malignant change representing a relative risk of 5%, much higher than that quoted in other series. This suggests that primary synovial chondromatosis has a significant potential for malignant change.