Synovial Chondromatosis in a Young Athlete: A Report of a Rare Case

Synovial chondromatosis is a rare and benign disorder that involves the synovial lining of joints, synovial sheaths and bursae. The synovial layer of the joint is affected by a metaplastic process which in turn converts it into cartilagenous tissue. Eventually, it gets dislodged and transformed into a loose body in the large joints. We report the case of a 24-year-old young athlete who presented with complaints of painful movements and restriction of joint movements associated with a growing deformity in the right knee joint. This case report aims to describe a rare synovial pathology that necessitated arthroscopic synovectomy and diagnostic arthroscopy to treat, particularly in younger individuals. The atypical feature, in this case, was metaplastic development from the peripheral joint capsule attached to the surrounding cartilage, which, to the extent that the authors are aware, has only been documented in one instance in the record. Magnetic resonance imaging (MRI) was performed which demonstrated evidence of the joint effusion, synovial hypertrophy and a loose calcific body just anterior of the distal femoral condyle causing pressure over the patellar tendon anteriorly as well as a hyper-dense cyst in the popliteal region. Treatment often requires partial or complete synovectomy with either an arthroscopic or open approach.

Sacroiliac joint involvement in osteochondromatosis: identifying its prevalence and characteristics from cross-sectional imaging

PURPOSE

Apart from a few case reports, sacroiliac joint (SIJ) involvement in osteochondromatosis has not been studied. We aimed to determine the prevalence and characteristics of such involvement using cross-sectional imaging.

METHODS

In this retrospective study, three observers (one junior radiologist and two musculoskeletal radiologists) independently reviewed computed tomography (CT) or magnetic resonance imaging (MRI) of patients in our database who had osteochondromatosis (≥2 osteochondromas across the skeleton) for SIJ involvement. The final decision was reached by the consensus of the two musculoskeletal radiologists in a later joint session.

RESULTS

Of the 36 patients with osteochondromatosis in our database, 22 (61%) had cross-sectional imaging covering SIJs (14 females, 8 males; age range 7-66 years; mean age 23 years; 13 MRI, 9 CT). Of these, 16 (73%) had intra-articular osteochondromas. For identifying SIJ osteochondromas on cross-sectional imaging, interobserver agreement was substantial [κ = 0.67; 95% confidence interval (CI): 0.34, 1.00] between the musculoskeletal radiologists and moderate (κ = 0.59; 95% CI: 0.23, 0.94) between the junior radiologist and the final consensus decision of the two musculoskeletal radiologists. In the cohort with cross-sectional imaging, the anatomical variations of the accessory SIJ (n = 6, 27%) and iliosacral complex (n = 2, 9%) were identified in six different patients with (n = 2) and without (n = 4) sacroiliac osteochondromas.

CONCLUSION

Cross-sectional imaging shows frequent (73%) SIJ involvement in osteochondromatosis, which, although a rare disorder, nevertheless needs to be considered in the differential diagnosis of such SIJ anatomical variants as the accessory SIJ and iliosacral complex. Differentiating these variants from osteochondromas is challenging in patients with osteochondromatosis.

Lumbar Myelopathy Caused by Multiple Cartilaginous Exostoses in a Dog

A 6-months-old male mixed-breed dog was admitted to the veterinary hospital with lameness in the right pelvic limb, proprioceptive ataxia, and suspected spinal cord injury in the lumbosacral segment. Upon palpation, firm nodules were noted on the bony surface of the thoracic and pelvic limbs, ribs, vertebrae, and tail. The radiographic study showed nodules of low radiopacity with well-defined limits and smooth contours, one of which was overlapping the fifth lumbar vertebra. Given the clinical presentation indicative of spinal cord injury, the animal was subjected to hemilaminectomy for nodular resection. Histopathological examination of the biopsy enabled the diagnosis of osteochondroma. The clinical follow up after surgery showed improvement in walking, despite persistent monoparesis in the right pelvic limb. The radiographic study in association with clinical and histopathological exams allowed the diagnosis and monitoring of the lesions.

Single-Bone Forearm as a Salvage Procedure in Recalcitrant Pediatric Forearm Pathologies

PURPOSE

To report on the outcome of single-bone forearm reconstruction (SBFR) as a salvage procedure in pediatric forearm pathologies.

METHODS

Twenty-eight forearms in 27 patients (median age, 9.6 years; range, 3.4-29.7 years) treated with SBFR at a pediatric referral center were included in the study. Records and radiographs were retrospectively analyzed. Median follow-up was 84 months (range, 24-261 months). The most common underlying condition was multiple hereditary exostoses (MHEs) (17 of 28), followed by brachial plexus birth injury (5 of 28), Ollier disease (2 of 28), congenital radial head dislocation (2 of 28), and others (2 of 28).

RESULTS

By 4 months (range, 2-10 months) after surgery, 21 of 28 forearms had united. Median resting postoperative forearm rotation was 10° pronation (range, neutral to 25° pronation). Before surgery, pain was present in 23 of 28 forearms. At the latest follow-up, pain was present in 5 of 28 forearms. In three of the 5 forearms with residual pain, this was attributed to ulnohumeral degenerative changes that existed prior to SBFR. Following SBFR, elbow flexion-extension range was maintained. In the subgroup with MHEs, radial articular angle was maintained (median, 37°-30°) and carpal slip percentage improved significantly (median, 40%-12%). Complications occurred in 8 forearms: 3 cases of nonunion in older patients (age, 30, 20, and 14 years), 2 cases of traumatic juxtaimplant fractures following successful union, 1 case of infection, 1 case of compartment syndrome, and 1 case of persistent radiocapitellar impingement. All complications were successfully treated. When stratified by age, none of the patients in the younger group (16 forearms, age < 12 years) had nonunions or pain at latest follow-up.

CONCLUSIONS

The SBFR is an old, but generally reliable, option as a single-stage salvage procedure for a number of recalcitrant pediatric forearm pathologies. Success rate may be higher in younger patients.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Rare radiculopathy from an osteochondral loose body: a case report and literature review

Lumbar radiculopathy is usually caused by nerve compression due to herniated disc material or compression by degenerative pathology such as enlarged facet joints, thickened ligamentum flavum or synovial cysts. We report the case of a 48-year-old female with L5 sciatica due to an osteochondral loose body in the foramen. This is only the third reported case of a single osteochondral loose body in the lumbar spine and the first reported case found in the foramen.

Primary Synovial Osteochondromatosis Discovered After Ankle Sprain

A 23-year-old military cadet presented to a direct-access physical therapy clinic for an ankle sprain 1 day after inverting his left ankle. Following examination, the physical therapist ordered lower-leg radiographs, which showed no fracture; however, small, rounded, partially calcified bodies were noted in the ankle. Additional ankle imaging was ordered under radiologist guidance. Preoperative computed tomography of the cadet's left ankle, ordered by orthopaedics, demonstrated chondral and osteochondral bodies. J Orthop Sports Phys Ther 2019;49(4):284. doi:10.2519/jospt.2019.8383.

Left Knee Synovial Osteochondromatosis

A 28-year-old male military service member reported to a physical therapist with progressively worsening left knee pain during impact activity and with work duties. Following examination, he physical therapist ordered radiographs of the knee, which revealed severe osteochondromatosis and tricompartmental arthritis. J Orthop Sports Phys Ther 2017;47(4):294. doi:10.2519/jospt.2017.7016.

Osteochondromatosis and osteochondroma involving bilateral patella and patellar tendon: a case report

We present a 22-year-old man with osteochondromatosis and osteochondroma involving bilateral patella and patellar tendon with restriction of joint movement and severe arthritis.

[Synovial osteochondromatosis of the carpometacarpal joint of the thumb in a patient with systemic lupus erythematosus]

L'ostéchondromatose synoviale est une métaplasie du tissu synovial. Elle engendre de petites masses cartilagineuses qui font saillie à la face interne de la synoviale, puis, se pédiculisent et enfin s'en détachent en développant des chondromes libres. On en distingue deux formes d'ostéchondromatose, la forme primitive, qui est rare, et la forme secondaire plus fréquente dont l'origine est généralement l'arthrose. Nous rapportons un cas d'ostéchondromatose synoviale de l'articulation carpo-métacarpienne du pouce chez une patiente atteinte d'un lupus érythémateux systémique.

A unique case of multiple osteochondroma: Mandibular symphysis and femur

Osteochondroma is a common benign tumor of the axial skeleton rarely seen in the facial bones. When encountered in the facial skeleton, it is commonly found in the mandible, usually in the condyle or coronoid processes. There are only two earlier reported cases of the tumor in the mandibular symphysis. We report an unusual case of osteochondroma of the mandibular symphysis found in conjunction with osteochondroma of the distal femur and, stress the need for long-term follow-up in patients with multiple lesions.