A pictorial review of primary synovial osteochondromatosis

Arthroscopic management of recurrent synovial chondromatosis of the hip: a case report

Synovial chondromatosis is a rare condition characterized by the chondral proliferation of synovium forming loose bodies which can lead to pain, swelling, and decreased range of movement of the affected joint.

CASE PRESENTATION

Here the authors report a case of eighteen years lady with recurrent hip synovial chondromatosis who was treated previously with hip arthrotomy and loose bodies removal and now she underwent arthroscopic loose bodies removal with partial synovectomy.

CLINICAL DISCUSSION

In comparison to arthrotomy of the hip, arthroscopic management is a minimally invasive surgery that is associated with decreased postoperative pain, earlier improvement in range of motion, a shorter course of rehabilitation, and overall lower morbidity.

CONCLUSION

Thus, the authors recommend arthroscopic removal of the loose bodies and partial synovectomy for the management of synovial chondromatosis of the hip.

Primary synovial osteochondromatosis of the ankle: A case report and review of the literature

Primary synovial osteochondromatosis of the ankle is a rare and benign disease of the young adult. It is characterized by the formation of multiple nodules of hyaline cartilage under the synovium. It is usually asymptomatic but can sometimes be revealed by pain or joint mobility disorders. X-rays and CT scans can easily diagnose calcified osteochondromas, but ultrasound and MRI can provide a quicker diagnosis by visualizing non-calcified foreign bodies. Surgery under arthroscopy remains the best therapeutic choice, however, this pathology still causes recurrence in less than 1/3 of cases.

Synovial Osteochondromatosis: Clinical Characteristics Unique to the Shoulder

Background

Synovial osteochondromatosis (SOC) of the shoulder is a rare condition with unclear characteristics. This study evaluated the clinical features and postoperative functional outcomes of SOC of the shoulder that are distinct from SOC of other joints.

Methods

The characteristics of 28 shoulders with SOC that underwent arthroscopy were retrospectively assessed. Ten shoulders (35.7%) had rotator cuff tears (RCTs) and underwent concomitant arthroscopic rotator cuff repair. The mean follow-up period was 83.6 months (range, 24-154 months). Demographic characteristics and loose bodies localized under arthroscopy were compared between cases with and without concomitant RCTs. Radiography, ultrasonography, or magnetic resonance imaging were performed preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and satisfaction were evaluated for all cases, and functional scores were assessed in shoulders with concomitant RCTs.

Results

The average age was 36.2 ± 15.6 years among patients without RCTs and 58.3 ± 7.2 years among patients with RCTs. Seven shoulders (7%) had osteoarthritis. Arthroscopy revealed loose bodies in multiple spaces, including the glenohumeral joint, subacromial (SA) space, and biceps tendon sheath. Overall, loose bodies were found in multiple spaces in 12 shoulders (42.9%). Loose bodies were found in the SA space only in 4 shoulders (22.2%) without RCTs and in 7 shoulders (70.0%) with RCTs. VAS for pain decreased significantly from 3.9 ± 2.3 to 1.1 ± 1.3 (p < 0.001). The functional scores increased significantly after arthroscopic management for patients with concurrent RCTs (all p < 0.05). Recurrence of SOC occurred in 3 of the 22 shoulders (13.6%) who underwent postoperative imaging, but no patient had a recurrent RCT.

Conclusions

Pain relief and patient satisfaction were achieved via arthroscopic management. Unlike in other joints, loose bodies can occur simultaneously in several spaces in the shoulder, including the glenohumeral joint, SA space, and biceps tendon sheath. Early diagnosis of SOC of the SA space can help prevent osteoarthritis and RCT progression.

Primary synovial chondromatosis of the hip joint (PrSC of the hip): A retrospective cohort analysis and review of the literature

Introduction

Primary synovial osteochondromatosis (SOCM) or Synovial chondromatosis (SC) of the hip is a benign metaplastic condition of the synovium that is rare and may present with a spectrum of clinical features and radiological findings.

Patients and methods

A retrospective search using the keyword 'Synovial chondromatosis' (SC) of the hip was performed at a tertiary care orthopaedic referral centre in the UK and a hospital in India. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS), over 15 years. The patient's data was collated with Electronic Patient Records (EPR), RIS, and correlated with histo-pathology laboratory records where available. The demographic details of the patients, their clinical symptoms, imaging details, and management outcomes were collected.

Results

We found 15 cases, with a mean age of 36.53 years (range: 14-50 years). There were 9 male and 6 female patients. The follow-up ranged from 1 year to 6 years. Predominantly unilateral presentation with insidious onset of symptoms was found. A spectrum of radiological Imaging was undertaken. Management strategies included supervised observation, arthroscopic or open synovectomy, and hip arthroplasty. No malignant transformation was found in the analysed cohort.

Conclusion

Primary 'Synovial chondromatosis' of the hip had a male preponderance in our cohort, presenting with a range of clinical features. Radiologically, Magnetic Resonance Imaging (MRI) was the commonest modality of cross-sectional imaging utilised and crucial for the diagnosis, evaluating underlying articular involvement including guiding appropriate patient management presenting with Primary 'Synovial chondromatosis' of the hip.

Concomitant lipoma arborescens and synovial osteochondromatosis of the knee

Intra-articular masses are not a rare finding in routine imaging. This is particularly true in patients with underlying joint diseases such as degenerative arthritis. Nevertheless, concomitant presentation is rather uncommon in imaging studies. The authors report an unusual concomitant lipoma arborescens and synovial osteochondromatosis (which has not previously been reported in the literature to the best of the authors' knowledge) in a man in his 60 s with a long-standing history of knee osteoarthritis. In this case presentation, we review the differential diagnosis for noninfectious synovial proliferative disorders presenting as intra-articular masses, their potential association with underlying joint pathology, and discuss the key imaging features and appropriate treatment.

Incidental Finding of Synovial Osteochondromatosis: A Case Report

Synovial osteochondromatosis (SOC) is a rare, benign condition of unknown etiology characterized by the formation of cartilaginous loose bodies. This often leads to early osteoarthritis with decreased range of motion and pain. Clinical presentation most often is reported as monoarticular pain affecting the knee or less commonly the hip shoulder or elbow. Diagnosis can be confirmed on x-ray imaging where the characteristic synovial bodies will be identified. Management with early debridement of the synovium will often be curative but more complex cases may require further surgical management.

We present a 33-year-old male presented with localized left knee pain. Given the history of new-onset pain, left knee x-rays were obtained that revealed a displaced patella with multiple ossific densities around the left knee which were suspicious for a new diagnosis of SOC.

Due to its nonspecific symptoms and imaging, the diagnosis of SOC is often delayed or missed. Therefore, prompt diagnosis and treatment are important in order to avoid irreversible cartilage destruction in the joint, prevent the development of chronic pain, and reduce the risk of malignant transformation.

Synovial osteochondromatosis mimicking juvenile idiopathic arthritis in an adolescent: a case-based review

Synovial osteochondromatosis is an extremely rare benign condition in children and adolescents that have joint pain as a presenting manifestation. It is usually monoarticular with the knee as the most common affected joint. In this article, we describe the case of a female adolescent suffering from debilitating chronic right knee pain initially mimicking juvenile idiopathic arthritis, who was subsequently diagnosed with primary synovial osteochondromatosis. We present a review of synovial osteochondromatosis focusing on the clinical manifestations, radiographic features, histopathologic findings, and treatment, with a summarized review of pediatric patients with initial musculoskeletal presentations who were ultimately diagnosed as synovial osteochondromatosis. Although synovial osteochondromatosis is rare in children and adolescents, this condition should be included in the differential diagnosis of joint pain and may mimic juvenile idiopathic arthritis. Appropriate diagnostic radiography, including both plain radiography and magnetic resonance imaging, is necessary to accurately diagnose this condition. We also emphasize the importance of a multidisciplinary team approach to managing patients with synovial osteochondromatosis.

A Systematic Approach to Diagnosing Arthritis Based on Radiological Imaging

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Radiology plays key roles in diagnosis of arthritis. We herein suggest an algorithmic approach to diagnosing arthritis. First, the number of joint involvements is reviewed. Monoarticular arthritis includes septic arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Second, polyarticular arthritis can be categorized by its characteristics: erosive, productive and mixed. Erosive disease includes rheumatoid arthritis, hemophilia, and amyloidosis while productive disease includes osteoarthritis, and hemochromatosis. Third, mixed diseases are subcategorized by symmetricity. Ankylosing spondylitis and inflammatory bowel disease related arthritis affect joints symmetrically while psoriatic arthritis, reactive arthritis, and crystalline arthropathy are asymmetric. Adjacent soft tissue density, periostitis, and bone density are ancillary findings that can be used as additional differential diagnostic clues. The final step in identifying the type of arthritis is to check whether the location is a site frequently affected by one particular disease over another. This systematic approach would be helpful for radiologist to diagnose arthritis.

Recurrence of Primary Synovial Chondromatosis (Reichel's Syndrome) in the Ankle Joint following Surgical Excision

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.

Chondrosarcoma Arising in Synovial Chondromatosis of the Hip: A Case Report

CASE

Synovial chondromatosis (SC) is a rare condition involving the proliferation of cartilage within the synovial membrane secondary to subsynovial connective tissue metaplasia. Malignant transformation to chondrosarcoma is rare. We cite a case of SC of the hip refractory to arthroscopic debridement, found to have secondary chondrosarcoma on aborted total hip arthroplasty, in which curative treatment was ultimately obtained with external hemipelvectomy.

CONCLUSION

SC has the potential to undergo malignant transformation to chondrosarcoma. The consequences of not recognizing such transformation can significantly impact patient outcomes and limit options for local control surgery and limb salvage.

Surgical hip dislocation for treatment of synovial chondromatosis of the hip

PURPOSE

In the present study, we aimed to evaluate the clinical outcomes of surgical hip dislocation in patients with synovial chondromatosis (SC) of the hip.

METHODS

Seven patients with primary SC of the hip treated with open synovectomy and removal of loose bodies by surgical hip dislocation from 2016 to 2019 were retrospectively reviewed. All patients had numerous and widespread loose bodies based on pre-operative images, including routine radiographs, CT, and MRI. The visual analog scale (VAS) score and Harris hip score (HHS) were collected and analyzed before and after surgery. The post-operative radiographs were reviewed to evaluate disease recurrence and osteoarthritis progression.

RESULTS

The mean operative time was 61 minutes (range, 42-75 min). An average of 33 loose bodies in each patient (range, 16-67) was removed, and extra-articular pathology was found in one patient. Patients were followed up for a mean duration of 30 months (range, 18-42 months). The average VAS scores were decreased from 3.7 (range, 2-6) pre-operatively to 0.9 (range, 0-2) at the last follow-up, and the HHS was improved from 60.1 (range, 50-73) to 90.1 (range, 82-95). All results demonstrated significant improvements (P < 0.05). Post-operative radiographs showed no recurrence, osteoarthritis progression, or osteonecrosis of the femoral head in all hips.

CONCLUSIONS

Surgical hip dislocation was a practical approach for managing both intra-articular and extra-articular pathologic lesions around the hip. It was an effective treatment for SC of the hip with short surgical time, good joint functions, a lower recurrence rate, and few complications.

Retrospective analysis of the clinical and radiological profile of few cases of synovial osteochondromatosis with a literature review

Synovial osteochondromatosis (SOC) is a rare benign neoplasm. It is caused by the metaplasia of the synovium into the bone. The knee, hip, elbow, shoulder, and ankle are the common sites. Our objective was to retrospectively assess the clinical and radiological features of a few cases of SOC resembling some rheumatological conditions and describe it along with a literature review. A retrospective analysis of the clinical and radiological features of a few cases of SOC mimicking some rheumatological conditions was performed. There were 4 cases: 3 adult men and a young boy. Three cases presented in the elbow and 1 case in the hip. There was a case mimicking osteoarthritis of the elbow in a young individual, another case presented like myositis ossificans of the elbow, and another case was similar to neuropathic arthritis of the elbow. The case in the hip presented as painful limping in the child. SOC can sometimes mimic various conditions affecting the synovial joints. A careful evaluation of the clinical and radiological features can be helpful in the correct diagnosis.

Synovial chondromatosis of the hip, a case report and literature review

A case of giant synovial chondromatosis of the hip with extra-articular localisation in the ileopectineal bursa is presented and the literature concerning this condition is reviewed. Synovial chondromatosis is a rare condition of unknown aetiology. A literature search was performed to identify studies describing outcome after surgical treatment of synovial chondromatosis of the hip. Thirteen studies including two hundred-ninety patients could be included. Mean follow-up was fifty-six months. Seven out of two hundred-ninety developed a complication after surgical resection of the lesion. Recurrence rate of synovial chondromatosis is about 19%. Malignant transformation of synovial chondromatosis to chondrosarcoma is extremely rare. No wound infections were reported and avascular necrosis of the femoral head occurred in one patient who was treated with dislocation of the hip during surgery. After resection of synovial chondromatosis excellent functional outcome can be expected.

Synovial Chondromatosis in the First Metatarsophalangeal Joint: A Case Report of this Uncommon Condition and Review of Current Literature

Introduction

Synovial osteochondromatosis is a rare condition characterized by the formation of multiple cartilaginous nodules, which involves metaplastic changes of the synovium and is commonly found in larger joints. Occurrence in foot and ankle is uncommon, even less in metatarsophalangeal joints.

Case Report

A 54-year-old woman with primary synovial osteochondromatosis in the first metatarsophalangeal joint was treated by complete excision plus synovectomy. After 8years of follow-up, the patient remains symptom free with no recurrence observed. A summary of the case and review of all published cases found in the current literature around this location is discussed.

Conclusion

Though rare, synovial chondromatosis should be considered as a differential diagnosis in a refractory synovitis and tumor mass in the metatarsophalangeal joint of the hallux.

Carpal tunnel syndrome caused by synovial osteochondromatosis of the finger flexor tendon: A case report

RATIONALE

Carpal tunnel syndrome (CTS) is the most common peripheral nerve neuropathy resulting from compression of the median nerve as it traverses the carpal tunnel. The pathophysiology of this condition is multifactorial, and majority of cases of CTS are idiopathic. We report cases of CTS caused by synovial osteochondromatosis (SOC), which has rarely been reported.

PATIENT CONCERNS

A 45-year-old female was admitted to the clinic due to right hand tingling sensation for 4 months. On physical examination, the patient's symptoms and signs corresponded to the median nerve entrapment at wrist. However, there is mild swelling and tenderness around the second metacarpal bone. Pain was aggravated during wrist and finger flexion.

DIAGNOSES

An electrodiagnostic study revealed CTS. She was advised to begin splinting the hand using a wrist brace and to undergo physiotherapy. After 2 weeks, the tingling sensation decreased slightly. However mild swelling and tenderness around the second metacarpal bone did not improve. Ultrasonography showed multiple echogenic foci. Magnetic resonance imaging (MRI) revealed a nodule at the proximal metacarpal level with synovial thickening, enhancement, and a calcified shadow close to the flexor tendon. After confirming the presence of an osseous nodule with synovial thickening, the patient underwent surgery INTERVENTIONS:: Carpal tunnel release and mass excision with synovectomy of the adjacent structures were performed. Histologically, the lesion was compatible with a diagnosis of SOC.

OUTCOME

The symptoms have improved.

LESSONS

CTS due to SOC on finger flexor tendon is rare but should be considered for possible etiology. Appropriate clinical examination, plain radiography, ultrasonography, and MRI will help physicians to diagnose this condition. In this paper, we report the successful diagnosis and treatment of CTS caused by SOC within the finger flexor tendon.

Primary Synovial Osteochondromatosis of the Hip Joint Treated with Arthroscopic-assisted Mini-open Surgery-Two Case Reports

Introduction:

Primary synovial osteochondromatosis of the hip joint is a rare condition. It is characterized by the presence of multiple intra-articular loose bodies and can result in mechanical symptoms, even causing degenerative change. Surgical treatment is indicated for synovial osteochondromatosis of the hip joint. However, the optimal approaches for successful surgical management are still controversial.

Case Report:

We report two cases with primary synovial osteochondromatosis of the hip joint where arthroscopic-assisted mini-open surgical treatmentwas performed. The posterior approach was used, and a minimal arthrotomy was performed with preservation of bloody supplement of thefemoral head. With the assistance of an arthroscope, synovectomy, debridement, and loose body removal were completed without dislocating the femoral head. The follow-up duration was 5years and 2.5 years, respectively. There were no perioperative or post-operative complications. At the latest follow-up, the patients remain symptom free with no radiographic evidence of recurrence.

Conclusions:

Our arthroscopic-assisted mini-open method could achieve the goals of extensive synovectomy, debridement, and loose body removal, thus reducing the recurrence rate. This method avoids dislocation of the femoral head, thus reducing the occurrence of surgical complications.

Shoulder joint synovial chondromatosis presenting as multiple axillary masses: A case report

Synovial chondromatosis is a rare, benign, proliferative cartilaginous lesion arising from the synovial tissue, tenosynovium, or bursal lining. We describe the case of a patient who initially presented with multiple axillary masses. Breast ultrasound (US) was requested due to the concern of a breast tumor with axillary lymph node metastases. US study was helpful and provided adequate information to suggest the diagnosis.

Primary synovial osteochondromatosis of the stifle in an English Mastiff

A two-year-old, 97 kg, male neutered English Mastiff was evaluated for left pelvic limb lameness of five months duration localized to the stifle joint. Following radiographic, computed tomographic and arthroscopic examination, the lameness was subsequently diagnosed as being caused by primary synovial osteochondromatosis. In total, 194 osteochondral bodies were removed using arthroscopy in combination with a mini-arthrotomy. Histology and immunohistochemistry of the loose osteochondral fragments confirmed the diagnosis with a moderately high degree of differentiation and low cellularity. Nuclear staining for Ki-67 revealed decreasing differentiation and increasing cellularity in the fragments. At the 13 months telephone follow-up the owner reported that the dog was free from lameness and had a vastly improved function compared with preoperative levels, although mild lameness did occasionally occur. This is the first report of computed tomography, arthroscopy and immunohistochemistry confirming a case of primary synovial osteochondromatosis in a dog.

Isolated acetabular osteochondroma of the hip

We present a case of isolated intra-acetabular osteochondroma in a 21 year-old male who presented with history of right hip pain for 5 years and difficulty in walking. Patient was managed with excision of intra-articular exostoses through surgical hip dislocation. Intra-articular hip osteochondromas can be a rare cause of hip pain in patients with unexplained etiology, and their diagnosis and management can be challenging.

Extra-articular chondromatosis of flexor and extensor compartments of the hand: Case report and review of literature

Objectives:

Tenosynovial chondromatosis is an uncommon type of chondro-dysplasia of synovial and connective tissue. We report a case of a patient with a primary right wrist extra-articular chondromatosis extending to the flexor and the extensor compartments.

Methods:

Until now, there has been no study describing double surgical access for such a case.

Results:

Due to the extension, two surgical accesses are required to completely remove the neoformation.

Conclusions:

At 2 years of follow-up, the good functional-clinical results and absence of recurrence confirm the validity of our surgical strategy.

Synovial osteochondromatosis in a 14-year-old boy with a history of Legg-Calve-Perthes disease

We describe a case of a 14-year-old boy with a history of Legg–Calve–Perthes disease diagnosed at the age of 6 years and development of synovial osteochondromatosis of the same hip joint 7 years later. Synovial osteochondromatosis is very rare in children, and to the best of our knowledge, only a single case of Legg–Calve–Perthes disease and secondary synovial osteochondromatosis was described in the literature in a 35-year-old male, making this the first reported case of Legg–Calve–Perthes disease with development of synovial osteochondromatosis in a pediatric patient.

A diagnostic approach to popliteal fossa masses

There is a myriad of potential mass lesions that occur in the popliteal fossa, which present as palpable masses or are found incidentally on imaging. With a thorough knowledge and understanding of the appearances and locations of these different entities, one can narrow the differential diagnoses in the majority of cases. This will eliminate unnecessary additional investigations and enable a more rapid management. We present a review of frequently encountered and less common entities using an anatomical sieve, with the aim of providing a diagnostic approach to popliteal fossa masses.

Total Knee Arthroplasty in Severe Synovial Osteochondromatosis in an Osteoarthritic Knee

Synovial osteochondromatosis (SO) can occur idiopathic or secondary to osteoarthritis. SO can be easily diagnosed with plain film radiography and clinical findings. In case of disabling osteoarthritis, total knee arthroplasty and removal of all corpora libra are indicated. We present a 71-year-old woman with significant osteoarthritis and severe SO intra-articular and in the suprapatellar bursa of the right knee. Total knee arthroplasty, extraction of the loose bodies, and partial synovectomy were performed. During a 2.5-year follow-up, the patient regained full function of her affected knee and there was no recurrence of SO. We choose to present this case to show the extensiveness SO can occur in. Our advice is to remove all the loose bodies carefully to prevent damage to the prosthesis. During follow-up, special attention should be paid to prevent recurrence of SO. When recurrence is associated with rapid growth or destruction of joints, malignant reoccurrence must be considered.

Synovial osteochondromatosis of the wrist joint: A case report

Synovial osteochondromatosis is a rare condition in which multiple cartilaginous nodules proliferate within the synovial membranes of joints, tendon sheaths or bursae. In general, a complete synovectomy is an effective method to treat this disease. Commonly involved joints are the knee, glenohumeral joint, elbow, hip and ankle, although any articulation may be affected. However, synovial osteochondromatosis occurs rarely in the wrist, and there have been a lack of reports of this occurrence in the literature. The current study presents a case of synovial osteochondromatosis in a 33-year-old man, who was admitted in 2014 with the symptom of swelling of the left wrist joint for 2 years. The swelling had become increasingly painful over the previous 2 months. Physical examination revealed local tenderness and a soft pliable mass, with no involvement of the skin and with moderate pain. X-ray, computed tomography and magnetic resonance imaging of the left wrist revealed a lump at the volar radial side of the left wrist joint without any bone erosion. The lesion was subsequently excised. Histological examination resulted in a diagnosis of osteochondromatosis, which was not considered prior to the surgery. The present case was reported with the aim of analyzing the clinical, imaging characteristic and therapeutic modalities of synovial osteochondromatosis of the wrist. While there was no evidence of recurrence for the subsequent 4 months of post-operative follow-up in the present case, the long-term efficacy of surgical excision requires extended observation.

Basic radiological assessment of synovial diseases: a pictorial essay

The synovium is a specialized tissue lining the synovial joints, bursae, and tendon sheaths of the body. It is affected by various localized or systemic disorders. Synovial diseases can be classified as inflammatory, infectious, degenerative, traumatic, hemorrhagic, and neoplastic. Damage in other intraarticular structures, particularly cartilages, generally occurs as a part of pathologic processes involving the synovium, leading to irreversible joint destruction. Imaging has an essential role in the early detection of synovial diseases prior to irreversible joint damage. Obtaining and understanding characteristic imaging findings of synovial diseases enables a proper diagnosis for early treatment. This article focuses on the recent literature that is related with the role of imaging in synovial disease.

Extra-articular Synovial Chondromatosis Eroding and Penetrating the Acromion

Synovial chondromatosis of the shoulder is an uncommon disorder. It usually affects the glenohumeral joint and is characterized by metaplasia of the synovium leading to the formation of osteochondral loose bodies. Few cases of extra-articular subacromial synovial chondromatosis involving the rotator cuff tendon have been reported in the literature. The treatment of previously reported cases consisted of open bursectomy and removal of loose bodies. We report a case of subacromial synovial chondromatosis without rotator cuff involvement but with severe erosion and fracture of the acromion. Treatment consisted of shoulder arthroscopy to remove all loose bodies, total bursectomy, and debridement of the acromion. Potential benefits of arthroscopy were also evaluated.

Intra-articular giant synovial osteochondroma: case reports of the ankle and knee joint

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.

Osteochondroma of the hip with adjacent bursal chondromatosis

It is well established that irregular bursae can form adjacent to an osteochondroma (bursa exostotica) as a result of mechanical irritation and that these bursae can be complicated by inflammation, hemorrhage, or infection. Bursal chondromatosis is a rare complication, with only seven published cases in the literature according to our searches. We present the case of a 53-year-old female who presented with slowly progressive left hip/thigh pain and was found to have an osteochondroma arising from the lesser trochanter with numerous ossified bodies in the adjacent soft tissues. MRI demonstrated osteochondral bodies in a fluid-filled bursa adjacent to the osteochondroma, with several of the bodies noted to be fairly displaced from the osteochondroma cartilaginous cap. At surgery, the osteochondroma was removed and numerous bodies of varying sizes were excised, some of which were noted to be adherent to the bursal lining and others that were separated/distant from the cartilage cap. The question arises as to whether this process represents bursal chondromatosis resulting from benign neoplasia of cells lining the abnormal bursa, "cartilage shedding" from the osteochondromatous cap, or both. The purpose in presenting this case is to introduce a rare complication of an osteochondroma, demonstrate that soft tissue calcification and osteochondral densities displaced from an underlying osteochondroma are not always the result of sarcomatous degeneration, and provide support for the theory that cells lining a bursa in a nonphysiologic location can undergo benign neoplasia with subsequent formation of osteochondral bodies.

Rare Case of Extra-articular Synovial Chondromatosis of Biceps Tendon Sheath in 8 years Male Child

Introduction:

Primary synovial osteo chondromatosis (PSOC) is chondroid metaplasia with multi¬nodular proliferation of the synovial lining of a diarthrodial joint, bursa, or tendon sheath. It usually occurs in third-fifth decade and shoulder joint involvement is infrequent. It is very rare in children and primary extraarticular PSOC of the shoulder has been reported very rarely in children.

Case Report:

We present a case of primary PSOC of the long head of biceps in 8year child. It presented as painful swelling in proximal arm. The pain radiograph was showing multiple calcified loose bodies on anteromedial aspect of humerus. MRI scan showed fluid filled cysts with calcified wall. The lesion was excised through deltopectoral approach. He had complete resolution of symptoms without recurrence at 1 year.The diagnosis was confirmed on histopathological examination.

Conclusion:

We want to emphasize that one should keep a differential diagnosis of this rare condition in patients presenting with cystic swelling with calcified wall. We further emphasize the need to follow these patients to detect recurrence or malignant transformation.

Normal anatomical variants of the menisci and cruciate ligaments that may mimic disease

There are many normal anatomical variants of the knee joint. Some are common and others are rare. With continuing improvements in the spatial resolution of MRI, smaller variants are more clearly demonstrated and can be mistaken for disease. They can all be differentiated from pathological conditions by understanding their anatomy and key differentiating features. This review compares normal variants of the menisci and cruciate ligaments with the pathological disorders that can mimic them.

Bursal synovial chondromatosis formation following osteochondroma resection

Osteochondroma is a common tumor of the bone and can be complicated by adventitial bursa formation and malignant transformation of the cartilaginous cap. Synovial chondromatosis formation within these bursae is extremely rare and can be confused with malignant transformation of the osteochondroma cap to a chondrosarcoma. We describe a case of extra-articular synovial chondromatosis formation several years following osteochondroma resection. Cartilage nodule formation within the bursal synovial lining and proliferation of cartilage debris shed from the cartilaginous cap during surgery or biopsy are potential etiologies of this rare complication of osteochondromas.

Pathology of Articular Cartilage and Synovial Membrane From Elbow Joints With and Without Degenerative Joint Disease in Domestic Cats

The elbow joint is one of the feline appendicular joints most commonly and severely affected by degenerative joint disease. The macroscopic and histopathological lesions of the elbow joints of 30 adult cats were evaluated immediately after euthanasia. Macroscopic evidence of degenerative joint disease was found in 22 of 30 cats (39 elbow joints) (73.33% cats; 65% elbow joints), and macroscopic cartilage erosion ranged from mild fibrillation to complete ulceration of the hyaline cartilage with exposure of the subchondral bone. Distribution of the lesions in the cartilage indicated the presence of medial compartment joint disease (most severe lesions located in the medial coronoid process of the ulna and medial humeral epicondyle). Synovitis scores were mild overall and correlated only weakly with macroscopic cartilage damage. Intra-articular osteochondral fragments either free or attached to the synovium were found in 10 joints. Macroscopic or histologic evidence of a fragmented coronoid process was not found even in those cases with intra-articular osteochondral fragments. Lesions observed in these animals are most consistent with synovial osteochondromatosis secondary to degenerative joint disease. The pathogenesis for the medial compartmentalization of these lesions has not been established, but a fragmented medial coronoid process or osteochondritis dissecans does not appear to play a role.

Management of synovial osteochondromatosis of the distal radioulnar joint with imaging features consistent with malignancy

Synovial osteochondromatosis of the distal radioulnar joint is a rare entity with only 14 cases reported in the literature. Malignant transformation of synovial osteochondromatosis is the most worrisome complication of the disease. It has been described in joints such as the hip and knee but never for the distal radioulnar joint. We report a case of synovial osteochondromatosis of the distal radioulnar joint which presented with radiographic features which were worrisome for malignant transformation and required a comprehensive preoperative workup. Discussed are the preoperative management, surgical treatment, and a literature review of this rare disease.

Synovial Osteochondromatosis With Malignant Transformation to Chondrosarcoma in a Dog

A 4.5-year-old intact male Labrador Retriever dog had a 1-month history of right forelimb lameness with painful swelling of the elbow. The radiographic findings of increased synovial mass with mineralized opacities and the gross and histologic findings in the synovial biopsy specimens were consistent with a diagnosis of primary (idiopathic) synovial osteochondromatosis. Twenty months after initial presentation, based on progression of clinical signs and radiographic evidence of marked bone lysis in the distal aspect of the humerus and proximal aspects of the radius and ulna, the affected leg was amputated. The histologic diagnosis was chondrosarcoma with fibroblastic differentiation and bone lysis. The chondrosarcoma was interpreted as malignant transformation of primary synovial osteochondromatosis.