Synovial chondromatosis of the foot: two case reports and literature review

Abstract

BACKGROUNDPrimary synovial chondromatosis (PSC) is a rare arthropathy of the synovial joints characterized by the formation of cartilaginous nodules, which may detach and become loose bodies within the joint and may undergo secondary proliferation. PSC of the foot and ankle is exceedingly rare, with only a few cases reported in the literature. The diagnosis may be difficult and delayed until operative treatment, when it is confirmed by histological assessment. PSC may degenerate into chondrosarcoma. Operative treatment is the gold standard aiming to minimize pain, improve function, prevent or limit progression of arthritis. Surgical treatment consists in debridement by arthrotomic or arthroscopic management, but there is no consensus in the literature about timing of surgery and surgical technique. Thus, the aim of this study is to report the outcomes of the surgical treatment of two cases, together with a literature review.CASE SUMMARYWe report two cases of patients affected by PSC of the foot in stage III, according to the Milgram classification: the former PSC localized in the ankle that underwent open surgery consisted of loose bodies removal; the latter in the subtalar joint, and the choice of treatment was the arthrotomy and debridement from loose bodies, in addition to the subtalar arthrodesis. Both patients returned to complete daily and working life after surgery.CONCLUSIONSynovial chondromatosis is a rare benign pathology, even rarer in the ankle joint and especially in the foot. Surgery should be minimal in patients with ankle PSC, choosing the correct timing, waiting if possible until stage III. More aggressive and early surgery should be performed in patients with PSC of the foot, particularly the subtalar joint, due to the high risk of arthritic evolution.

Anterior and Posterior Arthroscopic Treatment of Primary Synovial Chondromatosis of the Ankle

“…PSC occurs 2 to 3 times more commonly in men than women, usually between the third and fifth decade. 29,31 This is evident in most reported cases of ankle PSC (Table 2). * In our study, 88% of patients were male, and the onset of symptoms between the third and fifth decade was noticed in 82% of patients.…”

Recurrent Synovial Chondromatosis managed with Subtalar Fusion

“…One case report showed a similar treatment strategy where after removal of all loose bodies, a subtalar arthrodesis was done. At the follow up after a year, the patient was pain free with a full range of motion and did not experience any recurrence [15].…”

“…To our knowledge, arthrodesis for the management of recurrent synovial chondromatosis in the subtalar joint has been rarely reported [15]. The patient has been followed up regularly, with no recurrence and great improvement in mobility and pain.…”

Synovial chondromatosis combine with synovial tuberculosis of knee joint: a case report

“…Therefore, the literature is basically in the form of case reports. The minimum age of synovial chondromatosis reported at present is 2 years old [ 5 ], but there are few reports of SC complications Ben Efrima reported a 37 year old female hip joint SC with pigmented villonodular synovitis [ 6 ], Jones reported 2 cases of SC with peripheral nerve compression [ 7 ], Monestier reported 2 cases of foot fat deposition combined with SC [ 8 ]. However, no case of knee synovial chondromatosis combined with tuberculosis has been reported in the literature.…”