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Correia Cardoso R, Malheiro F, Pereira B. Management of Primary Synovial Osteochondromatosis in the Ankle Joint With a Combined Posterior-Anterior Arthroscopic Procedure: A Case Report. Cureus 2024; 16:e60843. [PMID: 38910686 PMCID: PMC11191673 DOI: 10.7759/cureus.60843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/25/2024] Open
Abstract
Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the ankle joint. Controversy exists regarding whether a combined posterior-anterior approach with total synovectomy is necessary to avert recurrence or malignancy. An 18-year-old Caucasian male presented to the outpatient clinic with clinical and imaging findings indicative of a stage III PSO. The surgical intervention involved a combined posterior-anterior arthroscopic approach with the removal of multiple loose bodies and complete synovectomy, resulting in complete relief of symptoms without recurrence at the 12-month follow-up. Pathological examination confirmed the diagnosis. The management of PSO in the ankle joint using a combined posterior-anterior arthroscopic approach with complete synovectomy demonstrated effectiveness in this case. Regular follow-ups are essential for monitoring long-term outcomes and detecting potential recurrence or malignant transformation.
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Affiliation(s)
- Rui Correia Cardoso
- Orthopaedics and Traumatology Surgery, Centro Hospitalar Baixo Vouga, Aveiro, PRT
| | | | - Bruno Pereira
- Foot and Ankle, Clinica Espregueira Mendes, Porto, PRT
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2
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Afzal S, Kazemian G, Baroutkoub M, Amouzadeh Omrani F, Ahmadi A, Tavakoli Darestani R. Arthroscopic management of ankle primary synovial chondromatosis (Reichel's syndrome): A case report with literature review. Int J Surg Case Rep 2023; 111:108832. [PMID: 37738829 PMCID: PMC10518486 DOI: 10.1016/j.ijscr.2023.108832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary Synovial chondromatosis is a rare disease characterized by metaplastic cartilaginous nodules originating from the synovium, which rarely involves the ankle joint. To date, there has been a limited number of reported cases regarding the arthroscopic treatment of this disease, which can be attributed to its rare incidence. This article aims to illuminate the advantages and challenges of this technique by presenting a case study. Furthermore, we delve into the existing literature to assess the different treatments used for this disease and their outcomes. CASE PRESENTATION A 59-year-old male patient presented with ankle pain, swelling and limited dorsiflexion. Subsequent imaging findings led to the diagnosis of anterior ankle primary synovial chondromatosis. Following this, the patient underwent arthroscopic assisted loose body removal and partial anterior synovectomy, conducted via anteromedial and anterolateral portals. During the five-year follow-up period, no recurrence was observed, and the American Orthopedic Foot and Ankle Score (AOFAS) was assessed as 88. CLINICAL DISCUSSION Given the uncommon occurrence of this disease, no standardized treatment approach has been established in the literature. While many researchers advocate for surgical intervention to alleviate symptoms and prevent potential complications like osteoarthritis and malignancy, there exists a diversity of perspectives concerning the specific strategies and techniques to employ. CONCLUSION Partial anterior synovectomy and loose body removal using arthroscopy via anteromedial and anterolateral portals demonstrate a notably efficacious and low-risk technique for addressing primary synovial chondromatosis affecting the anterior chamber of the ankle.
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Affiliation(s)
- Sina Afzal
- Department of Orthopedic Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gholamhossein Kazemian
- Department of Orthopedic Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Baroutkoub
- Department of Orthopedic Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Amouzadeh Omrani
- Department of Orthopedic Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Ahmadi
- Department of Orthopedic Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Tavakoli Darestani
- Department of Orthopedic Surgery, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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3
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Braun S, Flevas DA, Sokrab R, Ricotti RG, Rojas Marcos C, Pearle AD, Sculco PK. De Novo Synovial Chondromatosis following Primary Total Knee Arthroplasty: A Case Report. Life (Basel) 2023; 13:1366. [PMID: 37374148 DOI: 10.3390/life13061366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
In this case report, we present a rare case of a female patient who developed pain and swelling after a total knee arthroplasty. An extensive diagnostic workup including serum and synovial testing to rule out infection was performed in addition to advanced imaging including an MRI of the knee, but it was only after an arthroscopic synovectomy that the diagnosis of secondary synovial chondromatosis was confirmed. The purpose of this case report is to highlight the occurrence of secondary synovial chondromatosis as a rare cause of pain and swelling after total knee arthroplasty, thereby assisting clinicians in providing prompt diagnosis, surgical treatment, and efficient recovery in the setting of secondary synovial chondromatosis after total knee arthroplasty.
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Affiliation(s)
- Sebastian Braun
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University, 60323 Frankfurt am Main, Germany
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Dimitrios A Flevas
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Ruba Sokrab
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Robert G Ricotti
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Carolena Rojas Marcos
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
| | - Andrew D Pearle
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, NY 10021, USA
| | - Peter K Sculco
- Stavros Niarchos Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY 10021, USA
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Yadav SK, Rajnish RK, Kumar D, Khera S, Elhence A, Choudhary A. Primary Synovial Chondromatosis of the Ankle in a Child: A Rare Case Presentation and Review of Literature. J Orthop Case Rep 2023; 13:5-10. [PMID: 37193376 PMCID: PMC10182579 DOI: 10.13107/jocr.2023.v13.i04.3594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/18/2023] [Indexed: 05/18/2023] Open
Abstract
Introduction Synovial chondromatosis is not a common condition and involvement of the ankle joint is quite rare. We found only one case of synovial chondromatosis of the ankle joint among the pediatric population. We present a case of a 9-year-old boy with synovial chondromatosis of the left ankle. Case Report A 9-year-old boy had synovial osteochondromatosis in the left ankle joint, which caused pain, swelling, and restriction of movement of the left ankle. Radiological examinations showed variable size calcific foci adjacent to the medial malleolus and medial ankle joint space with mild soft-tissue swelling. The ankle mortise space was well-maintained. The magnetic resonance imaging of the ankle joint revealed a benign synovial neoplastic process and a few focal marrows containing loose bodies. The synovium was thick, and there was no articular erosion. The patient was planned and underwent an en bloc resection. A lobulated pearly white mass arising from the ankle joint was observed intraoperatively. Histological examination also showed attenuated synovium with osteocartilaginous nodule with binucleated and multinucleated forms of chondrocyte typical of osteochondroma were appreciated. Endochondral ossification, mature bony trabeculae with intervening fibro adipose tissue, was noted. The patient had remarkable relief of clinical complaints and was almost asymptomatic at the time of the first follow-up. Conclusion Synovial chondromatosis may present with diverse clinical manifestations according to the different stages of the disease as described by Milgram; like joint pain, limitation of movements, swelling due to the close proximity of important structures including joints, tendons, and neurovascular bundles. A simple radiograph with a characteristic appearance is usually sufficient in confirming the diagnosis. In pediatric patients, overlooking these conditions may result in growth abnormality, skeletal deformities, and several mechanical problems. We suggest that when dealing with the case of swelling in or around the ankle, the differential diagnosis should include synovial chondromatosis.
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Affiliation(s)
- Sandeep K Yadav
- Department of Orthopedics, AIIMS, Jodhpur, Rajasthan, India
- Address of Correspondence: Dr. Sandeep K Yadav, Department of Orthopedics, AIIMS, Jodhpur, Rajasthan, India. E-mail:
| | | | | | - Sudeep Khera
- Department of Pathology, AIIMS Jodhpur, Rajasthan, India
| | - Abhay Elhence
- Department of Orthopedics, AIIMS, Jodhpur, Rajasthan, India
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McEneaney PA, Rundell JD, Nordquist T, Pacaccio D. Synovial chondromatosis of the ankle joint: 2 cases treated by open arthrotomy and synovectomy. Foot (Edinb) 2021; 49:101804. [PMID: 34016505 DOI: 10.1016/j.foot.2021.101804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 02/27/2021] [Accepted: 04/11/2021] [Indexed: 02/05/2023]
Abstract
Synovial chondromatosis is a rare condition consisting of metaplasia of the synovial tissue that usually presents in large joints such as the knee and hip. The reported occurrence of synovial chondromatosis in the foot and ankle joints is rare in the literature. In this case report, the successful surgical management of two patients presenting with this condition using open ankle arthrotomy & synovectomy is described. These two cases are presented to provide added depth to the current literature, as well as presenting a review of published literature to further guide clinicians in the management of this rare condition. LEVEL OF EVIDENCE: 4 (case study).
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Botros D, Ford K, Holderread B, Mollabashy A, Rizkalla J. Synovial chondromatosis of the distal radio-ulnar joint. Proc (Bayl Univ Med Cent) 2021; 34:701-702. [PMID: 34732993 DOI: 10.1080/08998280.2021.1953877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Synovial chondromatosis (SC) is a benign metaplastic proliferation of cartilaginous nodules within the synovial membrane. Primary SC, though a rare monoarticular disease, significantly impacts patients' functional and pain-related outcomes. We outline the case of a 52-year-old man who presented with a large mass on the volar-ulnar aspect of his left wrist. Biopsy and workup revealed SC of the distal radio-ulnar joint. Though most cases of SC can be managed with arthroscopic or intralesional resection of the mass, a subset of extremely aggressive cases of SC may ultimately fail intralesional resection. Patients must be counseled about the possibility of amputation as an ultimate treatment option for the resolution of their pain and symptoms.
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Affiliation(s)
- David Botros
- Department of Neurological Surgery, The Johns Hopkins University School of Medicine , Baltimore , Maryland.,Department of Orthopedic Surgery, Coptic Medical Association of North America Research Institute , Dallas , Texas
| | - Ken Ford
- Department of Orthopedic Surgery, Baylor University Medical Center , Dallas , Texas
| | - Brendan Holderread
- Department of Orthopedic Surgery, Baylor University Medical Center , Dallas , Texas
| | - Al Mollabashy
- Department of Orthopedic Surgery, Baylor University Medical Center , Dallas , Texas
| | - James Rizkalla
- Department of Orthopedic Surgery, Coptic Medical Association of North America Research Institute , Dallas , Texas.,Department of Orthopedic Surgery, Baylor University Medical Center , Dallas , Texas
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7
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Bojanić I, Plečko M, Mataić A, Dimnjaković D. Anterior and Posterior Arthroscopic Treatment of Primary Synovial Chondromatosis of the Ankle. Foot Ankle Int 2021; 42:440-447. [PMID: 33203258 DOI: 10.1177/1071100720970961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary synovial chondromatosis (PSC) is a progressive disorder of unknown etiology resulting in formation of multiple loose bodies. If left untreated, it may lead to degenerative changes or malignant transformation to chondrosarcoma. METHODS Seventeen patients who underwent combined posterior and anterior ankle arthroscopy within the same operative session and had histologically confirmed PSC were included in this retrospective study. American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score was used to evaluate ankle function preoperatively and at a final follow-up. A 3-question survey was used to evaluate patient's satisfaction at the final follow-up. RESULTS In 14 patients, loose bodies were found in both compartments of the ankle, in 2 only in the anterior compartment, and in 1 only in the posterior compartment. All patients had evident signs of synovial inflammation in both compartments. The AOFAS Ankle-Hindfoot score increased from the preoperative median score of 65 (range, 29-90) to 95 (range, 65-100) at the final follow-up. Fourteen patients reported they were extremely satisfied with the outcome, 1 was moderately satisfied, and 2 were dissatisfied. No cases of recurrence of synovitis or loose body formation were noted, nor any signs of malignant transformation during the follow-up period. CONCLUSION We believe the risk of recurrence of PSC, which is in close relation to malignant transformation, can be minimized by performing a complete synovectomy of the ankle. Our experience and review of literature makes us believe that ankle PSC should be regarded as a whole joint disorder. Performing a combined posterior and anterior arthroscopic procedure within the same operative session should always be considered in patients with ankle PSC. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ivan Bojanić
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.,Department of Orthopedic Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mihovil Plečko
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Mataić
- Clinical Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Damjan Dimnjaković
- Department of Orthopedic Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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8
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Al Farii H, Doyle-Kelly C, Marwan Y, Volesky M, Turcotte R. Arthroscopic Management of Synovial Chondromatosis of the Ankle Joint: A Systematic Review of the Literature. JBJS Rev 2020; 8:e2000045. [PMID: 33151646 DOI: 10.2106/jbjs.rvw.20.00045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Synovial chondromatosis (SC) of the ankle is a rare disorder in which metaplastic proliferation of synovia, tendon sheaths, and/or bursae leads to the formation of loose cartilaginous bodies within the joint space. While SC itself is a benign condition, its sequelae can be chronic and debilitating if left untreated, or if there is postoperative recurrence. Arthritic degeneration and malignant transformation to chondrosarcoma are among the more serious complications in the natural history of the disease; the latter occurs in approximately 5% of cases. We performed a systematic review of the literature on the arthroscopic management of ankle SC in order to better understand recurrence patterns and suggest an alternative approach to open arthrotomy. METHODS Using predetermined inclusion and exclusion criteria, the PubMed and Embase databases were searched for relevant articles related to arthroscopic surgical management of patients with confirmed SC of the ankle. Article selection and data abstraction were performed in 3 steps by 3 independent reviewers. RESULTS The initial search retrieved 116 articles, of which 15 were included. Those studies included 22 patients (14 to 63 years of age; 77% male) who were followed for a mean of 27 months (range, 8 weeks to 12 years) postoperatively. The cases represented a mix of primary and secondary SC etiologies, and almost entirely stage-III disease. Arthroscopic synovectomy with excision of loose bodies was a consistent feature of treatment, and bursectomy, debridement of osteochondral lesions or involved tendons, and osteophyte resection were performed as indicated. All but 1 case employed an anterior approach including anteromedial and anterolateral portals, and in several cases a 4-portal technique was used, which was subsequently proposed as a necessary approach for the definitive treatment of ankle SC. On the basis of the available data, complication and recurrence rates following arthroscopic management were very low. CONCLUSIONS A growing pool of evidence is emerging to suggest favorable outcomes for arthroscopic treatment of SC of the ankle joint. However, more data on patient and surgical variables, as well as comparative studies with longer follow-up, are needed in order to draw definitive conclusions. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Humaid Al Farii
- 1Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
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9
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Zmerly H, Mauela M, Akkawi I. Ankle synovial chondromatosis in anterior and posterior compartments. A Case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:267-270. [PMID: 32555108 PMCID: PMC7944820 DOI: 10.23750/abm.v91i4-s.9528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/22/2020] [Indexed: 11/23/2022]
Abstract
Synovial chondromatosis is a rare benign disease, the aetiology of which is not clear. It can arise in the synovial membrane of joints, tendon sheaths, or bursae. Synovial chondromatosis is characterized by multiple loose bodies that can grow and cause symptoms such as pain, swelling and a limited range of motion. It can also result in joint damage. We describe the case of a 48-year-old male dancer with ankle synovial chondromatosis. Diagnosis by radiograph and MRI showed multiple lesions in anterior and posterior ankle compartments. The patient was successfully treated with arthroscopic removal of all loose bodies and partial synoviectomy. Clinical follow-ups at one, four and 12 months and again at 10 years, showed the ankle had a full range of motion without pain or swelling. Post-operative radiographs at one month and at 10 years showed no lesions. Synovial chondromatosis is a benign condition with several loose bodies that must be removed to relieve symptoms and avoid future joint damage. The ankle is a rare location for chondromatosis and arthroscopic removal is the treatment of choice with good results.
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Affiliation(s)
- Hassan Zmerly
- Orthopaedics and Traumatology Unit, San Pier Damiano Hospital , Faenza, Italy and UCM Malta - Ludes Lugano Campus, Switzerland;.
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10
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Monestier L, Riva G, Stissi P, Latiff M, Surace MF. Synovial chondromatosis of the foot: Two case reports and literature review. World J Orthop 2019; 10:404-415. [PMID: 31840021 PMCID: PMC6908443 DOI: 10.5312/wjo.v10.i11.404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/17/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary synovial chondromatosis (PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.
CASE SUMMARY We report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.
CONCLUSION Synovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC, choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot, particularly the subtalar joint, due to the high risk of arthritic evolution.
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Affiliation(s)
- Luca Monestier
- Orthopedic and Trauma Unit, ASST Settle Laghi, Varese 21100, Italy
| | - Giacomo Riva
- Orthopedic and Trauma Unit, ASST Settle Laghi, Varese 21100, Italy
| | - Placido Stissi
- Residency Program in Orthopedics and Trauma, University of Insubria, Varese 21100, Italy
| | - Mahfuz Latiff
- Residency Program in Orthopedics and Trauma, University of Insubria, Varese 21100, Italy
| | - Michele Francesco Surace
- Orthopedic and Trauma Unit, ASST Settle Laghi, Varese 21100, Italy
- Interdisciplinary Research Centre for Pathology and Surgery of the Musculoskeletal System, Department of Biotechnology and Life Sciences, University of Insubria, Varese 21100, Italy
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Wen J, Liu H, Xiao S, Li X, Fang K, Tang Z, Cao S, Li F, Cai G, Hu C. Synovial chondromatosis of the hip joint in childhood: A case report and literature review. Medicine (Baltimore) 2018; 97:e13199. [PMID: 30572428 PMCID: PMC6320087 DOI: 10.1097/md.0000000000013199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Pain in the hip joint is a common symptom in children. The common diseases leading to pain in the hip joint in children include transient synovitis of the hip, septic arthritis of the hip, and Legg-Calve-Perthes disease. PATIENT CONCERNS A 7-year-old boy was admitted due to pain in the right hip joint and limping for more than 1 month. DIAGNOSIS Synovial chondromatosis. INTERVENTIONS The patient underwent a hip open surgery, all the loose bodies in articular capsule were removed. OUTCOMES At the 6-month follow-up, pain and limping disappeared, and the range of activity of the hip joint was restored to a normal level. CONCLUSIONS Synovial chondromatosis is an uncommon disease which can cause pain of hip joint in children. LESSONS When the pediatric orthopedic surgeon treats the children suffered with hip pain the surgeon should be aware of this rare disease.
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Abstract
Synovial chondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Patients may be asymptomatic or may present with pain, swelling, and limited range of motion. Plain radiographs can be diagnostic and mineralized nodules are pathognomonic. Recommended treatment involves arthroscopic or open removal of loose bodies with or without a synovectomy to prevent further articular and periarticular destruction and to relieve symptoms.
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Affiliation(s)
- Julie A Neumann
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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13
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Kunzler DR, Shazadeh Safavi P, Warren BJ, Janney CF, Panchbhavi V. Arthroscopic Treatment of Synovial Chondromatosis in the Ankle Joint. Cureus 2017; 9:e1983. [PMID: 29503777 PMCID: PMC5825044 DOI: 10.7759/cureus.1983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Synovial chondromatosis of the ankle is rare and sparsely documented. Traditional surgical intervention is open loose body excision and synovectomy. Upon literature review, only two other cases were found to be managed arthroscopically. We report a case of synovial chondromatosis in a 54-year-old man leading to pain and limited range of motion of his ankle. This unique case of extensive nodule formation was treated via a three-port arthroscopic approach. Removal of loose bodies and synovectomy were successfully performed arthroscopically. A total of 76 loose bodies were removed and synovectomy performed using a 3.5 mm diameter full radius shaver. This case demonstrates that a three-port arthroscopic approach can provide adequate treatment while maintaining the superior risk profile inherent to arthroscopic intervention.
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Affiliation(s)
- Daniel R Kunzler
- School of Medicine, University of Texas Medical Branch at Galveston
| | | | - Brittney J Warren
- Department of Orthopedics, University of Texas Medical Branch at Galveston
| | - Cory F Janney
- Department of Orthopedics, United States Navy, University of Texas Medical Branch at Galveston
| | - Vinod Panchbhavi
- Department of Orthopedics, University of Texas Medical Branch at Galveston
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14
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Li J, Li Z, Su X, Liu C, Wang K, Zhang H, Yang Y. [Effectiveness of arthroscopy for synovial chondromatosis of hip joint]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:897-901. [PMID: 29806421 DOI: 10.7507/1002-1892.201704006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of arthroscopy for synovial chondromatosis of hip joint. Methods Between April 2012 and September 2015, 32 patients with synovial chondromatosis of hip joint were treated by arthroscopy. There were 19 males and 13 females, with an average age of 42.1 years (range, 22-64 years). The synovial chondromatosis located at right hip in 15 cases and left hip in 17 cases. The main clinical symptoms were pain and swelling of hip joint. Of all patients, 6 cases were hip hinge, 2 cases were lower limb weakness, and 1 case was snapping hip. The "4" sign was positive in 9 cases, Thomas' sign positive in 4 cases, and rolling test positive in 2 cases. Results All incisions healed by first intention, and no complication occurred. All patients were followed up 16-48 months (mean, 33.8 months). The visual analogue scale (VAS) was 1.4±0.8 at last follow-up, which was significantly lower than that before operation (4.8±1.2) ( t=6.382, P=0.013). The hip Harris score was 92.6±6.7 at last follow-up, which was significantly higher than that before operation (63.2±8.3) ( t=9.761, P=0.006). At last follow-up, the "4" sign and Thomas' sign were positive in 3 cases and 1 case, respectively. The others had no positive sign. X-ray film showed no recrudescence in all cases. Conclusion Treating synovial chondromatosis of hip joint under arthroscopy has advantages of less trauma, complete debridement, quick postoperative recovery, and the satisfactory short-term effectiveness.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853,
| | - Xiangzheng Su
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Chunhui Liu
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Hao Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
| | - Yimeng Yang
- Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China
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Saxena A, St Louis M. Synovial Chondromatosis of the Ankle: Report of Two Cases With 23 and 126 Loose Bodies. J Foot Ankle Surg 2016; 56:182-186. [PMID: 27066867 DOI: 10.1053/j.jfas.2016.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Indexed: 02/03/2023]
Abstract
Synovial chondromatosis is rare joint disorder that has no clear etiology. Classification of the disorder was first reported by Milgram in 1977. One possible cause is a change in the level of fibroblast growth receptor factor receptor-3, which leads to a possible feedback loop that results in the formation of loose bodies. Genetics is another possible cause for the disorder. Synovial chondromatosis is considered benign but does the have the potential for malignant transformation. We report the case of 2 patients with 23 and 126 loose bodies of the ankle, respectively, who had successful outcomes without malignancy, after excision of the lesions. Also presented is a review of the published data for the possible causes of synovial chondromatosis and the symptoms leading up to the transformation from benign to malignant.
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Affiliation(s)
- Amol Saxena
- Podiatrist, Department of Sports Medicine, Palo Alto Foundation Medication Group, Palo Alto, CA.
| | - Marie St Louis
- Podiatrist, Kaiser Permanente, West Los Angeles Facility, Los Angeles, CA
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Duan XJ, Yang L. Removal of osteoblastoma of the talar neck using standard anterior ankle Arthroscopy:A case report. Int J Surg Case Rep 2016; 23:52-5. [PMID: 27100951 PMCID: PMC4855791 DOI: 10.1016/j.ijscr.2016.03.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/09/2016] [Accepted: 03/09/2016] [Indexed: 11/27/2022] Open
Abstract
We present the first, to our knowledge, case of osteoblastoma of the talar that was excised using standard anterior ankle arthroscopy. Osteoblastoma of the talar is rare. We present the first case, to our knowledge, that was excised using standard anterior ankle arthroscopy.
Introduction Osteoblastoma of the talus, a benign tumor, is rare in orthopedics. The choice of treatment is usually open surgery for excision of tumor. Limited data is available concerning arthroscopic approaches. Presentation of case A 36-year-old male patient was evaluated for pain and swelling of the left ankle joint. Based on the findings of physical examination, X-rays and MRI investigations, the tumor was isolated. Standard anterior arthroscopic surgery was performed due to ankle pain. A diagnosis of osteoblastoma of the talar neck was made following the pathological survey. He had no recurrent pain and normal joint mobility 5 years postoperatively during he was regularly followed up. Discussion Osteoblastoma of the talar neck is slowly progressive and it is a palpable painful mass. Open or arthroscopic surgery can be performed. Treatment strategies are decided on according to the tumor's location, extent and size. Some advantages of arthroscopic surgery are wide visualization areas, minimally invasion, low morbidity, no necessity for casting and immobilization, early rehabilitation and quick recovery. Conclusion In conclusion, arthroscopic management can be successful in selected patients with small benign tumor localized to the ankle joint.
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Affiliation(s)
- Xiao-Jun Duan
- Center of Joint Surgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
| | - Liu Yang
- Center of Joint Surgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
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Abstract
ABSTRACT
Synovial chondromatosis is a condition where the synovial lining of joints, tendons, or bursa undergoes metaplasia into cartilaginous loose bodies. Primary synovial chondromatosis of the ankle joint is very rare and less commonly reported in literature. We report a case of primary synovial chondromatosis of the ankle that we encountered in our clinic. A 33-year-old male patient presented with a history of multiple swellings around his right ankle joint, along with dull aching pain. Both the clinical examination and X-rays were suggestive of primary synovial chondromatosis of the ankle. We performed an open loose body removal and synovectomy of the ankle. Histopathology confirmed the diagnosis of primary synovial chondromatosis. We report this case owing to its rarity of presentation.
How to cite this article
Chathoth V, Sankaranarayanan S. A Rare Case of Primary Synovial Chondromatosis of the Ankle. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):53-55.
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