Lipoma arborescens with hemarthrosis of the knee. A case report

Arthroscopic Synovectomy in Bilateral Lipoma Arborescens

Introduction:

Lipoma arborescens (LA) is an uncommon condition that consists of a villous lipomatous proliferation of the synovial membrane. Open synovectomy has been previously selected as a curative treatment option. In recent years, some authors have published good results with arthroscopic interventions. We describe a well-documented case of bilateral LA of the knees treated with staged arthroscopic synovectomy.

Case Report:

A 48-year-old North American woman without a history of trauma presented with recurrent effusions and mild pain in both knee joints for many years. Magnetic resonance imaging examinations confirmed the diagnosis of bilateral LA with multiple villous lipomatous synovial proliferations pattern. Degenerative changes of the medial meniscus were detected bilaterally. The patient underwent bilateral arthroscopic anterior synovectomy and partial medial meniscectomy of the knee with three portal techniques. Arthroscopic the knee joint contained a large number or finger-shaped synovial proliferations with yellowish good vascularized diffuse villous masses in the suprapatellar bursa and intercondylar fossa. The cartilage showed degenerative changes with Outerbridge Grade II to III, which was particularly severe in the femoropatellar compartment. Histopathological examination of the villous masses demonstrated papillary hypertrophy, slight hyperplasia, vascular hyperplasia with a slight degree of stromal fibrosis, and interstitial lymphoplasmacytic inflammation. The adipose cells were reduced in number in relation to a normal finding but had a normal aspect without any pathological changes. 25 months after the first operation, the patient reported pain relief with the preserved function. Magnetic resonance examination of both knee joints at the last follow-up showed no relapse of the disease. The Knee injury and Osteoarthritis Outcome Score improved on the right knee joint from 39.3 preoperatively to 85.1 at the last follow-up, and on the left knee joint from 54.2 preoperatively to 86.3 at the last follow-up.

Conclusion:

Arthroscopic anterior synovectomy is an efficient method of achieving good results in LA with multiple villous lipomatous synovial proliferations pattern.

A Rare Intra-articular Pathology of Knee Lipoma Arborescens: A Report of Two Cases Managed by Arthroscopic Synovectomy

Lipoma arborescens is a rare intra-articular condition of unknown exact aetiology. Lipoma arborescens is one of the differential diagnoses of diffuse chronic swelling of the knee and its magnetic resonance imaging (MRI) appearance is diagnostic. We present two cases of patients with recurrent knee effusion. MRI showed a frond-like fatty synovial mass and joint effusion that suggested the likelihood of lipoma arborescens. Arthroscopic synovectomy was performed and pathology confirmed the diagnosis. There was no recurrence of symptoms after synovectomy.

Lipoma arborescens of the knee: report of a case managed by arthroscopic synovectomy

We report a case of lipoma arborescens treated with an arthroscopic procedure. Lipoma arborescens is an uncommon pseudo-tumoral synovial lesion usually located in the suprapatellar pouch of the knee. This diagnosis should be considered, particularly in patients with chronic joint effusion. Magnetic resonance imaging confirms the lipomatous nature of the synovial proliferation. When limited to the anterior compartment of the knee, lipoma arborescens can be treated by arthroscopic synovectomy.

Lipoma arborescens of the elbow: a case report

A 76-year-old woman with a longstanding history of right elbow swelling and recurrent joint effusion presented for consultation. There was no history of trauma and conventional radiographs were negative. Computed tomography (CT) and magnetic resonance imaging were performed and showed a frond-like fatty synovial mass and joint effusion. Arthrotomy disclosed a lipoma arborescens of the right elbow.

Lipoma arborescens in bilateral knee joints

We report a case of lipoma arborescens of both knee joints. In the face of chronic joint hydrops, it is important to consider lipoma arborescens in the differential diagnosis and to try to make early diagnosis, using magnetic resonance imaging or another means of examination.

Evolving stages of lipohemarthrosis of the knee. Sequential magnetic resonance imaging findings in cadavers with clinical correlation

RATIONALE AND OBJECTIVES

Lipohemarthrosis, the presence of fat and blood in a joint cavity, exhibits several complex layers related to differences in specific component relaxation on magnetic resonance (MR) images. The authors investigated sequential changes in the appearance of lipohemarthrosis of the knee as demonstrated by MR imaging.

METHODS

Sequential MR imaging over a 4-day period was performed on two cadaveric knees after intraarticular injection of blood from a volunteer and fat from a cadaveric tibia (50 mL of blood and 25 mL of fat in one knee and 15 mL of blood and 5 mL of fat in the other knee). The authors determined components in the joint based on MR signal behavior. Magnetic resonance imaging examinations of four patients with intracapsular fractures and lipohemarthroses of the knee were reviewed retrospectively.

RESULTS

Sequential MR images of cadaveric knees showed serial changes representing progressive formation and lysis of blood clot. Several fluid-fluid levels (globules of fat at the interface between fat and blood) and entrapment of fat were early findings of lipohemarthrosis. Three different fluid levels appeared approximately 3 hours after injection of fresh blood and marrow fat. The 96-hour study demonstrated three distinct levels.

CONCLUSIONS

Lipohemarthrosis demonstrates temporal changes on MR imaging related to stages of formation and lysis of blood clot.

An unusual case of extraarticular lipoma of the knee joint

Lipoma of the knee joint is a rare disease and most cases are lipoma arborescens within the joint. Here we report a case of true extraarticular lipoma of the knee.

The arthroscopic appearance of lipoma arborescens of the knee

Lipoma arborescens is a rare intra-articular lesion consisting of a villous lipomatous proliferation of the synovial lining. This case report draws attention to the history, physical findings, and arthroscopic appearance of lipoma arborescens, a rare lesion of the synovial lining of the knee. Arthroscopically, the lesion appears as a synovial lesion with numerous fatty-appearing globules and villous projections. In addition, magnetic resonance imaging is a valuable tool to differentiate the lesion from rheumatoid arthritis, pigmented villonodular synovitis, and synovial chondromatosis in those patients who present with a chronic, swollen, and painful joint.