BackgroundPrimary lipoma arborescens (LA) is a rare, benign intra-articular hyperplastic tumor that has been associated with osteoarthritis (OA). The aim of this study was to determine whether prompt synovectomy could avoid progressive joint degeneration in cases of primary LA of the knee.Materials and methodsA review of currently available literature about the disease was carried out. The clinical, histological and radiological records of a series of nine knees with primary LA diagnosed and treated between 2002 and 2012 were retrospectively reviewed. Eight of the knees had histological confirmation of LA and none had evidence of condropathy on the initial magnetic resonance image or degenerative changes at the initial radiographic examination.ResultsAt the final follow-up no evidence of OA was found in the three knees that underwent synovectomy when symptoms did not last more than 1 year. The five knees in which synovectomy was delayed developed progressive joint degeneration.ConclusionIn this series, primary LA of the knee involved the development of early osteoarthritis when prompt synovectomy was not performed. Timely synovectomy is strongly recommended, if not mandatory.Level of evidenceIV.
The acromioclavicular joint represents the link between the clavicle and the scapula, which is responsible for the synchronized dynamic of the shoulder girdle. Chronic acromioclavicular joint instability involves changes in the orientation of the scapula, which provokes cinematic alterations that might result in chronic pain. Several surgical strategies for the management of patients with chronic and symptomatic acromioclavicular joint instability have been described. The range of possibilities includes anatomical and non-anatomical techniques, open and arthroscopy-assisted procedures, and biological and synthetic grafts. Surgical management of chronic acromioclavicular joint instability should involve the reconstruction of the torn ligaments because it is accepted that from three weeks after the injury, these structures may lack healing potential. Here, we provide a review of the literature regarding the management of chronic acromioclavicular joint instability.Level of evidence Expert opinion, Level V.
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