Excision of 93 loose bodies of synovial osteochondromatosis in the left ankle: a case report

Primary synovial osteochondromatosis is an uncommon benign joint disorder characterized by the formation of cartilaginous bodies within the synovial of the different joints, tendon sheaths, and bursae. Loose bodies occur in the late stage of the disease. Excision of loose bodies is needed to treat synovial osteochondromatosis. A 20-year-old female patient presented to us with a chief complaint of pain, swelling, and discomfort sensation in the left ankle while walking. Plain X-ray on her left ankle showed loose bodies surrounding the ankle. We performed excision to remove the loose bodies. Histological examination confirmed the diagnosis. The range of motion (ROM) of the ankle increased after surgery. The patient was able to walk more comfortably. Synovial osteochondromatosis is considered benign. In this case, open excision was chosen because the ankle joint is not amenable to arthroscopy. Follow up is needed to detect early recurrence and transformation of malignancy.

Clinical Results of Surgical Resection and Histopathological Evaluation of Synovial Chondromatosis in the Shoulder: A Retrospective Study and Literature Review

BACKGROUND: Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical resection and the histopathological findings of synovial chondromatosis in the shoulder.METHODS: Ten shoulders with synovial chondromatosis that had been operatively resected were reviewed retrospectively. Osteochondral lesions were present in the glenohumeral joint in six shoulders and in the subacromial space in four shoulders. Two patients had a history of trauma with glenohumeral dislocation without recurrent instability, and the other seven patients (eight shoulders) did not have any traumatic episodes or past illness involving the ipsilateral shoulder girdle. The occurrences of osteochondral lesions, inferior humeral osteophytes, and acromial spurs were assessed on radiographs before resection, just after resection, and at final follow-up. The Constant scores were compared before resection and at final follow-up with Wilcoxon signed-rank tests. Resected lesions were histopathologically differentiated between primary and secondary synovial chondromatosis.RESULTS: Inferior humeral osteophytes were found in five shoulders with synovial chondromatosis in the glenohumeral joint, and all four shoulders with synovial chondromatosis in the subacromial space had acromial spur formation. Osteochondral lesions appeared to have been successfully removed in all shoulders on postoperative radiographs. At the final follow-up, however, one shoulder with secondary synovial chondromatosis in the subacromial space showed recurrence of osteochondral lesions and acromial spur formation. The mean Constant score improved significantly from 53.0 points before resection to 76.0 points at a mean follow-up of 6.0 years (p = 0.002). On histopathological evaluation, one shoulder was diagnosed as having primary synovial chondromatosis, while nine shoulders had secondary synovial chondromatosis.CONCLUSIONS: The present study showed that resection of shoulder osteochondral lesions successfully relieved the clinical symptoms and that primary synovial chondromatosis is less common than secondary synovial chondromatosis in the shoulder. Although most of the present osteochondral lesions were clinically determined to be primary chondromatosis, only one case was histopathologically categorized as primary synovial chondromatosis. These results suggest that histopathological identification is needed to differentiate between primary and secondary synovial chondromatosis.

Potential Adjunctive Role of Radiosynovectomy in Primary Synovial Osteochondromatosis of the Knee: A Case Report / 대한핵의학회잡지

Primary synovial osteochondromatosis (PSOC) is a rare but clinically significant cause of morbidity especially in the male population. Surgery is the primary treatment of choice, but the recurrence rate is reported to be high. Moreover, the presence of widespread loose bodies makes it a cumbersome procedure. The complete removal of the disease is tough at times and results in early recurrence. Radiosynovectomy is an established technique for treating various joint arthropathies. The role of radiosynovectomy in case of PSOC has not yet been explored. This case report described the case of a young male with PSOC of the knee joint who was treated with radiosynovectomy for pain relief. The patient reported complete relief from the pain along with significant improvement in joint mobility. The post-therapy three-phase bone scan also validated the reduction in joint inflammation. The patient was taken for surgical removal of the redundant loose bodies after a significant improvement in the pain and reduction in inflammation. Post-therapy radiation fibrosis of the synovium also helped in the en bloc removal of the disease. The role of radiosynovectomy in PSOC needs to be further explored concerning its potential role as an adjuvant to surgical procedures.

Synovial Osteochondromatosis

We report three patients with synovial osteochondromatosis to highlight that simple removal of loose bodies and limited synovectomy gives symptomatic relief and has low risk of recurrence in the short term

Primary Synovial Osteochondromatosis: A case report

Primary synovial osteochondromatosis is a disorder characterized by the formation of multiple intra-articular osteocartilaginous bodies. Clinical symptoms are not specific, which makes the diagnosis difficult. Magnetic resonance imaging is useful in the diagnosis of synovial osteochondromatosis of the hip, especially in cases in which ossified bodies are not present. Synovial osteochondromatosis tends to be progressive but self-limiting and the optional treatment is controversial. We described two patients with primary osteochondromatosis of hip who presented with symptoms and signs of single joint arthropathy of hip.

Imaging Dignosis of Primary Synovial Osteochondromatosis / 实用放射学杂志

Objective To analyze the X-ray,CT and MRI appearances of primary synovial osteochondromatosis.Methods CT scanning was performed in 22 cases,of which 16 cases underwent X-ray examination and 2 cases underwent MRI scan.Results Of 22 cases of synovial osteochondromatosis,13 cases were male and 9 cases were female.The monoarticular involvment was found in 20 cases,and double-articular involvment in 2 cases.Variable size and number of the cartilaginous nodules with calcification and ossification within and surround the joints were showed in 20 cases.The soft mass with calcification were showed in 2 cases.Bone destruction were found in 2 cases,which were induced by compression of the cartilaginous nodules,this was confirmed by operations.Conclusion The cartilaginous nodules with calcification or ossification can be shown by X-ray and CT san.The cartilaginous nodules without calcification or ossification can be shown by MR san.

Synovial Osteochondromatosis:Imaging Diagnosis / 实用放射学杂志

Objective To evaluate imaging diagnostic value of synovial osteochondromatosis.Methods Imaging features of synovial osteochondromatosis proved by surgery,arthroscopy and pathology in 39 cases were retrospectively analyzed.Results The lesions involving thejoints included knee in 11 cases,hip in 10,ankle in 7,shoulder in 8 and elbow in 3,and multiple joints involved in 5 cases.The loose bodies inside the joints or parajoints with different number,size,shape and calcification were seen on radiography.CT(25 cases) was superior to X-ray in showing these loose bodies and also could showed the thickened synovial membranes intra-articular effusion.MRI(30 cases)not only could showed the non-calcification cartilage nodules,but also the changes of soft tissue around the joints,the thickened synovial membranes and articular effusion,and could make the staging of this disease.Conclusion Imaging examination is of significant value in diagnosing synovial osteochnodromatosis and for clinical procedures.