Arthroscopic treatment of a lipoma arborescens of the elbow

Abstract

Introduction: Lipoma Arborescens is a rare pathology that mainly affects the knee. Occurrences in the elbow are even more uncommon and mainly involve the bicipitoradial bursa. Case's description: We describe the case of a 54-year-old patient known for rheumatoid arthritis, who consulted for chronic elbow pain associated with swelling and limited extension. Diagnosis: The diagnosis of a lipoma arborescens of the elbow involving the whole joint was made using magnetic resonance imaging and confirmed during arthroscopy. Interventions: After a failed nonoperative treatment consisting in intra-articular cortisone injections and physiotherapy, the patient underwent arthroscopic synovectomy and arthrolysis. Outcome: At 1-year follow-up, he reported no pain, satisfactory range of motion, and major improvements in clinical scores. Conclusion: This is the first illustrated case report about lipoma arborescens involving the whole elbow joint. Even though it is a rare disease, awareness of its presentation, imaging patterns, and treatment options is therefore important for clinicians, radiologists, and surgeons. In this case, arthroscopic treatment resulted in satisfactory and long-lasting pain relief and functional results. It may be considered as a safe and effective option in case of failed nonoperative measures.

Surgical management of upper limb lipoma arborescens: a systematic review

“…A systematic review on the arthroscopic treatment of LA of the knee revealed a satisfactory short-term outcome [ 15 ]. The present study supports similar findings: patients may benefit from less invasive arthroscopic procedures when feasible, as arthroscopic treatment of shoulder [ 2 , 3 , 28 , 35 , 36 ] and elbow lesions [ 13 ] led to promising short-term outcomes. Although LA was recognized as a clinical entity decades ago, the evidence is scarce and long term outcome data are unavailable.…”

“…All patients had single lesion; one has a bilateral presentation [ 26 ]. Eleven lesions (50%) were located in the shoulder [ 1 – 3 , 22 , 24 , 28 , 30 , 32 , 33 , 35 , 36 ], seven (31.82%) in the elbow [ 13 , 23 , 25 , 26 , 29 , 34 ], and four (18.18%) in the wrist [ 14 , 27 , 31 , 37 ]. All patients but one had preoperative MRI scans during the diagnostic assessment [ 27 ].…”

“…Most studies evaluated the restoration of range of motion and symptom resolution for the functional outcome assessment. In one study [ 13 ], the Mayo Elbow Performance Score and Single Assessment Numeric Evaluation were employed. Open or arthroscopic excision and synovectomy were the most common surgical procedures for LA.…”

“…The secondary type is more common in the elderlies, and is associated with pathological conditions or lesions causing chronic irritation [ 7 , 12 ]. The knee is the most frequent location of LA [ 1 – 3 ]; however, lesions of the wrist, elbow, shoulder, ankle, and hip joints have been reported [ 2 , 10 , 13 – 16 ]. For LA in the knee, arthroscopic synovectomy demonstrated excellent short-term results and a low rate of recurrence [ 15 ].…”

A Rare Presentation of a True Intra-articular Lipoma: A Case Report and Review of Imaging Findings

“…Confirming lipoma arborescens is based on macroscopic appearance after resection [ 12 ]. The gross appearance of lipoma arborescens confirms radiologic findings, showing a frond-like or finger-like lipomatous proliferation [ 14 ].…”