Extensive Synovial Chondromatosis of the Knee Managed by open radical synovectomy: A Case Report with review of literature

Abstract

Introduction: Synovial chondromatosis of the knee is an unusual, rare, benign metaplastic neoplasm of the synovium, characterized by the formation of focal cartilaginous nodules in the synovium. It predominantly involves the anterior compartment of knee and extensive, disseminated involvement is rarely reported. Diagnosis is usually established with clinicoradiological imaging and confirmed by histology. The paucity of literature on the management of synovial chondromatosis puts an orthopedician in dilemma regarding the optimal surgical intervention. Case Report: We report a case of 50-year-old male who presented with severe pain and swelling in his left knee associated with functional incapacitation. Magnetic resonance imaging demonstrated diffuse proliferation of synovium with mild effusion displaying multiple, disseminated calcific nodules. We managed the case by open removal of loose bodies and radical synovectomy through combined anterior and posterior approach. At 4 years follow-up, there are no clinical or radiological signs of recurrence. Conclusion: Extensive involvement of the knee with calcific nodules is extremely rare. Treatment is controversial which usually includes removal of loose bodies combined with an open or arthroscopic synovectomy. Our case report recommends single stage, open retrieval of loose bodies combined with radical synovectomy to decrease the incidence of recurrence in extensive synovial chondromatosis. To the best of our knowledge, disseminated synovial chondromatosis of the knee, managed by open, combined approach, has been reported only once in the literature.

Arthroscopic Synovectomy and Removal of Loose Bodies in Synovial Osteochondromatosis of the Knee

“… 1 , 2 It is characterized by proliferative metaplasia of synovial membrane into chondrocytes, resulting in the formation of multiple cartilaginous nodules. 1 , 2 , 3 These nodules enlarge and can detach from the synovium to become multiple intra-articular loose bodies. 1 , 2 …”

“…Synovial osteochondromatosis of the knee can present with pain and swelling of the joint, stiffness, crepitus, giving away, catching or locking symptoms. 1 , 2 , 3 , 4 It usually involves the anterior compartment, including infrapatellar fat pad, suprapatellar pouch, and anterior interval, and it rarely involves the posterior compartment of the knee. 1 , 3 , 4 , 5 , 6 …”

“… 1 , 2 , 3 , 4 It usually involves the anterior compartment, including infrapatellar fat pad, suprapatellar pouch, and anterior interval, and it rarely involves the posterior compartment of the knee. 1 , 3 , 4 , 5 , 6 …”

“… 1 , 4 Other nonoperative treatment, such as chemotherapy and radiotherapy, usually has no role in the treatment of synovial osteochondromatosis. 3 , 4 Surgical options include arthroscopic versus open removal of loose bodies and synovectomy with the aims of symptoms control, prevention of recurrence, and further joint destruction. 1 , 2 , 3 , 4 …”

“… 3 , 4 Surgical options include arthroscopic versus open removal of loose bodies and synovectomy with the aims of symptoms control, prevention of recurrence, and further joint destruction. 1 , 2 , 3 , 4 …”