Long-term results after arthroscopic treatment of synovial chondromatosis of the shoulder

PURPOSE

The purpose of this study was to document the results of arthroscopic treatment for synovial chondromatosis of the shoulder with loose body removal and partial synovectomy.

METHODS

Five cases of shoulder arthroscopy performed for synovial chondromatosis were reviewed. Removal of loose bodies and partial synovectomy was performed in all cases. Follow-up of 4 to 9 years was obtained on these 5 patients.

RESULTS

The clinical result was very good for all patients. Radiologic signs of chondroma were observed in two patients. Revision surgery was not necessary in either case.

CONCLUSIONS

The clinical results referring to the Constant and Murley score and subjective assessment were very good at 4 to 9 years following surgery. However, in two out of five subjects, radiographs revealed evidence of persisting or recurrent synovial chondroma at follow-up.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Arthroscopic treatment of synovial chondromatosis that possibly developed after open capsular shift for shoulder instability

Synovial chondromatosis is a rare disease with an unknown etiology, and can be defined as a synovial process characterized by the formation of metaplastic cartilaginous foci inside the connective tissue of articular surfaces. The disease is classified as primary or secondary. The cause of primary disease is unknown, but its pathogenesis involves the development of chondroid foci in synovial membranes. Secondary disease is caused by synovial tissue pathophysiologies, such as, trauma or infection, adjacent to an involved joint. Plain radiographs reveal multiple calcific nodules in glenohumeral joints. However, X-ray diagnosis is often delayed and extremely difficult when the disease is not calcified. Magnetic resonance imaging (MRI) and computed tomography are helpful. For treatment, open or arthroscopic synovectomy and loose body removal are recommended. The authors experienced a rare case of radiologically non-visible synovial chondromatosis, which was viewed as the cause of postoperative residual pain and limitation of motion in a young male with open capsular shift. This case report is presented to emphasize the role of arthroscopy and MRI in the early diagnosis and treatment of synovial chondromatosis.

Synovial chondromatosis of the pisotriquetral joint with secondary osteoarthritis: case report

There are only a few reported cases of synovial chondromatosis affecting pisotriquetral joint (PT). Osteoarthritis of the PT is also rare and can be as disabling as osteoarthritis of any other joint. We report this to be the unique case of synovial chondromatosis of the PT joint with secondary osteoarthritis.

A case of recurrence of synovial chondromatosis of the temporomandibular joint

This is a case study of a patient with recurrent synovial chondromatosis. It shows some relevant images. It also provides possibilities for why this patient may have had a recurrence and how this was managed.

Arthroscopic treatment for synovial chondromatosis of the subacromial bursa: a case report

Synovial chondromatosis of the subacromial bursa has been reported rarely. To the best of our knowledge, there was no case report of arthroscopic treatment for synovial chondromatosis of the subacromial bursa in English literature. The authors present a case of synovial chondromatosis of the subacromial space in a 45-year-old male, which was managed by arthroscopy. This rare condition can be well managed on similar lines as the other joints through arthroscopic surgery.

Diagnosis and arthroscopic treatment of primary synovial chondromatosis of the shoulder

Primary synovial chondromatosis of the shoulder is a rare condition. We present the case of a 24-year-old man with a 6-month history of right shoulder pain and decreased range of motion. Computed tomography and magnetic resonance imaging findings led us to the diagnosis of synovial chondromatosis of the shoulder. Arthroscopy revealed loose bodies in the glenohumeral joint, the biceps tendon sheath, and the subscapularis recess. Active intrasynovial proliferation of the axillary pouch was noted. All loose bodies were removed arthroscopically, and partial synovectomy was performed. Histologic examination confirmed the diagnosis of primary synovial chondromatosis. We recommend arthroscopic treatment for synovial chondromatosis of the shoulder because of low morbidity and early functional return.

Synovial chondromatosis of the posterior cruciate ligament managed by a posterior-posterior triangulation technique

Various causes have been reported for cystic lesions arising from the cruciate ligaments. We present a case of synovial chondromatosis that involved the posterior cruciate ligament and was treated by an arthroscopic posterior-posterior triangulation method. We recommend that synovial chondromatosis be considered in the differential diagnosis of cystic lesions of the cruciate ligaments. Lesions involving the posterior aspect of the posterior cruciate ligament, as in the presented case, can be accessed via the standard anterior arthroscopic portals. However, scattered synovial chondromatosis masses located in the posterolateral compartment are difficult to access via anterior portals. We suggest that the arthroscopic posterior-posterior triangulation technique may be useful for the management of such cases.

Synovial chondromatosis of four compartments of the knee: medial and lateral tibiofemoral spaces, patellofemoral joint and proximal tibiofibular joint

A case of synovial chondromatosis of the proximal tibiofibular joint in addition to lateral and medial tibiofemoral spaces and patellofemoral joint has been presented.

Synovial chondromatosis presented as knocking sensation of the knee in a 14-year-old girl

Knee joint is the most common site of synovial chondromatosis with the prevalence in middle-aged male. The following is the description of a 14-year-old girl presented with a knocking sensation during the motion of her joint, which is a less common occurrence at her age. Loose bodies in the left knee joint were excised as much as possible with arthroscopy. The patient was asymptomatic when moving her knee after arthroscopic synovialectomy and removal of the loose bodies. In spite of the less possibility of malignant transformation of synovial chondromatosis, long-term follow-up is still recommended in this 14-year-old girl due to the supposed genetic abnormalities.

[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.

Radiotherapy in the management of recurrent synovial chondromatosis

Synovial chondromatosis is a rare, benign condition characterized by the formation of multiple cartilaginous nodules that are generally intra-articular and can lead to chronic pain and limit the function of involved joints. We report on the novel use of radiotherapy that was used to treat a 42-year-old man with rapid recurrences of extensive synovial chondromatosis in the knee refractory to multiple operations. Based on follow-up MRI scans and clinical findings, the disease process was halted with no progression seen over 5 years.

Synovial chondromatosis of the temporomandibular joint

Synovial Chondromatosis (SC) is a disease whose etiology is unknown, can be defined as a benign synovial process characterized by the formation of metaplastic cartilaginous nodes inside connective tissue of articular surfaces, is considered an active metaplastic phenomenon better than a neoplastic process; it presents a greater preference to affect women who constitute almost 70% of reported cases, the age range is wide and oscillates between 18-75 years (average 44.6 years). Between the main clinical findings are: pain, crackle, volume augmentation and a limited buccal opening. SC is an unusual state and the reports in the English literature are no more than 75 cases, only 66 of those where histologically verified, most of those were affecting great joints like hip, knee and shoulder, but if SC is not frequent in this sites, is even more infrequent on temporomandibular joint. The aim of this paper is to report a clinical case and at the same time to realize a brief review of the literature.

Synovial Chondromatosis of the Temporomandibular Joint With Skull Base Extension

Synovial chondromatosis is a benign pathologic lesion that is considered to be a metaplastic process. This disease is rarely encountered in the temporomandibular joint (TMJ). In this article, a 72-year-old patient with synovial chondromatosis of the TMJ extending to the infratemporal fossa is presented and the literature is reviewed.

Operative treatment of primary synovial osteochondromatosis of the hip

BACKGROUND

Primary synovial osteochondromatosis of the hip, a rare benign condition characterized by multiple intra-articular osteochondral loose bodies and synovial hyperplasia, may result in mechanical symptoms and degenerative arthritis if untreated. The purpose of this study was to report the results of arthrotomy alone or combined with anterior dislocation of the hip to perform synovectomy and removal of loose bodies in patients with this condition.

METHODS

We retrospectively reviewed a consecutive series of twenty-one patients (twenty-one hips) with primary synovial osteochondromatosis of the hip treated with open surgical débridement. On the basis of the extent of extra-articular involvement as seen on preoperative magnetic resonance imaging, eight of the twenty-one patients underwent synovectomy and removal of loose bodies following anterior dislocation of the hip and thirteen underwent the same procedure with arthrotomy alone. At a mean of 4.4 years postoperatively, the patients were assessed clinically and radiographically with special attention to disease recurrence, osteoarthritis progression, and surgical complications.

RESULTS

The mean Harris hip score for the entire series of patients improved from 58 points preoperatively to 91 points at the time of the latest follow-up. Eighteen of the twenty-one patients had a good or excellent clinical result, and seventeen patients were satisfied with the result of the surgery. The clinical scores, patient satisfaction scores, and radiographic grades of osteoarthritis at the time of the latest follow-up did not differ significantly between the group treated with dislocation and the group treated without dislocation. Symptomatic disease recurred in two of the thirteen hips treated with arthrotomy alone and in none of the hips that had undergone dislocation. However, the surgical complication rate was higher in the group treated with dislocation than it was in the group treated without dislocation (p = 0.042). While patients with some signs of mild osteoarthritis at the initial procedure had a higher rate of osteoarthritis progression, severe osteoarthritis requiring arthroplasty had developed in only one patient at the time of follow-up.

CONCLUSIONS

At a mean of 4.4 years postoperatively, we found that open synovectomy and removal of loose bodies for the treatment of primary synovial osteochondromatosis of the hip is a reliable procedure that can effectively relieve symptoms. Our results also indicated that synovial osteochondromatosis may recur in patients with extensive involvement who are treated with synovectomy alone without dislocation of the hip; however, surgical complications are more likely to occur in patients managed with anterior dislocation of the hip and synovectomy.

Modified complete synovectomy prevents recurrence in synovial chondromatosis of the hip

Synovial chondromatosis of the hip is a rare disorder with few published reports regarding treatment and outcomes, and therefore, selecting the optimal surgical treatment is difficult. We reviewed eight patients with monoarticular synovial chondromatosis of the hip who had joint débridement and a modified total synovectomy performed through a surgical hip dislocation with a trochanteric flip osteotomy. Patients were evaluated for recurrence of disease, progression of osteoarthritis, clinical outcomes, and subsequent reoperations. The minimum followup was 4 years (mean, 6.5 years). At final review, no patient had recurrence of disease. Two patients had progression of osteoarthritis requiring total hip arthroplasties at 5 and 10 years after the initial surgical intervention. These patients did not show recurrent disease on histologic examination of the synovial membrane at the time of the arthroplasty. The six patients with preserved joints were followed up for a mean of 6.2 years. The mean Merle d'Aubigné and Postel score in this group was 16.5 points (range, 15-18 points) at the latest followup. There were no major or minor complications related to this treatment. Our midterm results suggest that open débridement with modified total synovectomy is an effective treatment that prevents recurrence of disease and provides substantial pain relief. Surgical hip dislocation allows safe and complete access to the joint for débridement and synovectomy with no added morbidity.

[Diagnostic image (280). A female dancer with a painful shoulder]

A 17-year-old woman, attending a ballet school, presented with left shoulder pain due to synovial osteochondromatosis.