Primary synovial chondromatosis of the subtalar joint presenting as ankle instability

Synovial chondromatosis of the ankle joint: 2 cases treated by open arthrotomy and synovectomy

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).

Feasibility of MRI in diagnosis and characterization of intra-articular synovial masses and mass-like lesions

Background

Classifications of intra-articular masses are infectious granulomatous diseases, non-infectious synovial proliferative processes (synovial chondromatosis, lipoma arborescens, rheumatoid arthritis, pigmented villonodular synovitis [PVNS]), vascular malformations, deposition disorders, neoplastic, and miscellaneous conditions. The aim of this study is to correlate the results of MRI with arthroscopy in characterization of different varieties of intra-articular synovial masses and mass-like lesions. This observational prospective study was conducted between February 2018 and August 2019. We screened 1000 routine musculoskeletal MRI examination during this period, 32 of which showed intra-articular synovial masses/mass-like lesions. The selected 32 patients (20 males and 12 females) have a mean age of 49.20 ± 2.0 years; all presented with joint swelling, pain, or difficulty of movement according to the joint affected. All patients underwent arthroscopy for histopathological correlation.

Results

The final diagnosis was synovial chondromatosis in 14 patients (43.8%), PVNS in ten patients (31.3%), and lipoma arborescens in five patients (15.6%). Synovial chondrosarcoma, synovial hematoma, and synovial ganglion cyst each in one patient (3.1%). The concordance of MRI to arthroscopy was 96.6% accuracy, 91.7% sensitivity, 99% specificity, 52.3% PPV, and 99.9% NPV.

Conclusion

Good correlation was observed between MRI and arthroscopy in diagnosis of intra-articular synovial masses/mass-like lesions.

Synovial chondromatosis of the foot: Two case reports and literature review

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.

Arthroscopic treatment of synovial chondromatosis of the ankle

Synovial chondromatosis is a rare proliferative disease, characterized by the occurrence of metaplasia in the synovium of the joints. These lesions become pedunculated; with the evolution of the disease they become detached, leading to intra-articular loose-bodies. It occurs more frequently in males between the third and fifth decades of life, usually affecting large joints such as the knee and hip. Smaller joints, such as the ankle, are less frequently affected. Patients report articular pain, blockage, and limited range of motion caused by the loose fragments. As the disease progresses, the joint undergoes degenerative changes. This report describes a case of synovial chondromatosis of the ankle, treated by arthroscopy. The patient, a 59 year-old male, complained of pain and swelling of the left ankle. Physical evaluation showed limited tibiotarsal mobility (plantar flexion of 20° and dorsiflexion of 5°). After physical and imaging evaluation, the patient underwent ankle arthroscopy due to impingement of the joint, with limitation of mobility. Arthroscopic treatment allowed easy access to the joint, removal of loose bodies, and partial synovectomy, with low morbidity and early rehabilitation. The final prognosis was excellent.

Primary synovial chondromatosis of the subtalar joint: case report and review of the literature

Primary synovial chondromatosis is a rare benign condition of uncertain etiology manifested by synovial proliferation. In the radiology literature, there is only 1 prior case report of primary synovial chondromatosis involving the subtalar joint with only partial description of the imaging appearance. We present a 28-year-old female with primary synovial chondromatosis of the subtalar joint and conduct a literature review of the imaging features of primary synovial chondromatosis presenting in the feet.

Primary synovial chondromatosis of the talonavicular joint: A case report

Synovial chondromatosis developes by metaplasia of the synovial cells in the synovium of joints, and is a benign synovial tumor with multiple cartilaginous nodules. It is most commonly found in single and large joints, such as the knee, hip, and shoulder. Occurrence in the foot and ankle is uncommon, although there have been previous reports in the orthopedic and radiological literature of primary synovial chondromatosis in the subtalr, calcaneocuboid, naviculocuneiform, and metatarsaophalangeal joints. To our knowledge, occurrence in the talonavicular joint is even rarer, with only one report in the literature to date. Here, we report a case of synovial chondromatosis of the talonavicular joint, alongside a review of the literature.

Synovial Chondromatosis of the Ankle: Report of Two Cases With 23 and 126 Loose Bodies

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.

Synovial Chondromatosis Surrounding the First Metatarsophalangeal Joint: A Case Report

Synovial chondromatosis is a benign synovial tumor that rarely occurs in the foot. We present a case of a 36-year-old male who underwent surgical excision of primary synovial chondromatosis of the first metatarsophalangeal joint. This report also presents a review of the literature related to synovial chondromatosis of the foot. Currently in the literature, this pathology has been described as occurring in multiple locations in the foot and ankle. Synovial chondromatosis can occur primarily or secondarily in diseased joints. Treatment is based on the phase of disease, with a goal to decrease pain and arthritis, and increase mobility. Surgical techniques used for foot and ankle synovial chondromatosis have been adapted from larger joints where the condition is more prevalent. Further case studies are needed to formulate a treatment protocol for foot and ankle synovial chondromatosis, but successful surgical excision was found in this case report.

LEVELS OF EVIDENCE

Therapeutic, Level IV: Case study.

Tenosynovial Osteochondromatosis of the Flexor Hallucis Longus in a Division I Tennis Player

Tenosynovial (extra-articular) chondromatosis (TC) is a condition characterized by the cartilaginous proliferation of synovial cells derived from the synovial lining of bursa and tendon sheaths. These lesions are often multinodular and most commonly present with complaints of swelling or pain. Treatment of TC primarily entails surgical excision. There are no known reports of TC in collegiate athletes. We present a case of TC in a Division I tennis player.

Pediatric Subtalar Joint Synovial Chondromatosis Report of a Case and an Up-to-date Review

Synovial chondromatosis is a rare, usually benign disorder affecting the population predominantly in the third and fourth decades of life and mainly involving the large weightbearing joints of the lower limb-the knees and the hip. In this report, we highlight an unusual pediatric clinical presentation of synovial osteochondromatosis involving the subtalar joint and discuss its surgical management; we also provide a comprehensive up-to-date literature review of the disorder. This patient was successfully treated with en masse surgical excision. He has been doing well, with complete pain relief and improved range of motion at 1-year follow-up. An exceptional involvement of the subtalar joint and an unusual presentation in the pediatric age group makes this case unique.