Arthroscopic Removal of Suprapatellar Fibroma of Tendon Sheath

Abstract

Fibroma of tendon sheath (FTS) is a rare dense fibrous benign tumor that majorities are found over the tendons or tendon sheaths of limbs, with predilection in order starting with fingers, hands, wrists, and other parts.1 Almost 80% of tendon sheath fibromas are found over hands and wrists. 2 The typical morphological feature is a solid nodule that is painless and slow growing in nature. Fibromas of tendon sheath rarely arise from knee joints. To our best knowledge, less than 20 such cases have been reported, and none of them was a Chinese patient. We present a case of intra-articular fibroma of tendon sheath of the knee that was excised arthroscopically. Case ReportA 36-year-old male patient had complained a painless mass over the suprapatellar region of left knee for 2 months. He did not complain any systemic upset, and he did not recall any trauma history. Physical examination showed a palpable mass over a suprapatellar region of left knee, which was mobile and firm. The range of motion of the left knee was from 0 to 110 degrees. The joint line was not tender. All special tests including McMurray test, Lachman test, and grinding test of patella were negative. X-ray examination of the knee showed no bony abnormality. Preoperative magnetic resonance imaging (MRI) of the left knee showed a suprapatellar mass measured 3 cm  2 cm, hypointense in T1-weighted image (►Fig. 1) but hyperintense in T2-weighted image (►Fig. 2).Arthroscopic examination of left knee was performed under spinal anesthesia. The tumor was located at the suprapatellar region as shown in MRI. The isolated circumferential mass was grayish, and there was a stalk attaching to the superior pole of the patella (►Fig. 3). The tumor was excised through anterolateral and anteromedial portals (►Fig. 4). Pathology showed that the mass was covered by synovium on one side with the solid grayish white cut surface (►Fig. 5). Histology confirmed a bland-looking spindle-celled neoplasm with infarctive necrosis at the subsynovial region (►Fig. 6). The tumor had low cellularity, Keywords► intra-articular fibroma ► fibroma of tendon sheath ► knee joint ► arthroscopy AbstractIntra-articular fibroma of tendon sheath is a rare disease. To our knowledge, less than 20 cases have been reported in the literature, and none of them was a Chinese patient. In this case report, we present a Chinese patient with intra-articular fibroma of tendon sheath of the knee joint which was excised arthroscopically. We also summarized the clinical presentation, diagnosis, and subsequent management of intra-articular fibroma of tendon sheath.

Fibroma of tendon sheath embedded in carpal bones mimicking carpal enchondroma

“…Treatment strategies for FTS include both open excision and arthroscopic excision. [6,7] The typical approach involves marginal excision of the lesion with or without removal of the adjacent structures. [4] In our case, the mass was well-delineated from the surrounding tissues.…”

Arthroscopic treatment for intra-articular fibroma of the tendon sheath in a teenager

“…FTS commonly presents in tendons of the finger, hand and wrist but is much less common in large joints like the knee or shoulder 1 2. To our knowledge, there are 51 reported cases of FTS occurring around large joints 1–31. Incidence of FTS around large joints follows a male to female ratio of 2 to 1 with a reported mean age of 40.9 in a literature review by Suzuki et al 1.…”

“…Incidence of FTS around large joints follows a male to female ratio of 2 to 1 with a reported mean age of 40.9 in a literature review by Suzuki et al 1. Of the 51 reported cases, 40 cases (78.4%) involved the knee, 5 cases (11.1%) the elbow, 4 cases (7.8%) the ankle and 2 cases (3.9%) the shoulder 1–31. Of the 51 reported cases, 32 cases disclosed the precise location of the FTS and 28 referred to the knee joint as the only area of involvement.…”

“…Of the 51 reported cases, 32 cases disclosed the precise location of the FTS and 28 referred to the knee joint as the only area of involvement. In reports of knee FTS, there is a higher occurrence of intra-articular FTS (89.3%) versus extra-articular FTS (10.7%) 1 2 7–31. The intra-articular location of FTS is variable; however, it most frequently arises around the posterior cruciate ligament (9) and/or posterior capsule (32.1%) 1 2 7–31…”

“…In reports of knee FTS, there is a higher occurrence of intra-articular FTS (89.3%) versus extra-articular FTS (10.7%) 1 2 7–31. The intra-articular location of FTS is variable; however, it most frequently arises around the posterior cruciate ligament (9) and/or posterior capsule (32.1%) 1 2 7–31…”