Presentación inusual de condromatosis sinovial de la rodilla: caso reportado / Unusual presentation of synovial chondromatosis of the knee. Case report

La condromatosis sinovial se caracteriza por la formación de múltiples nódulos cartilaginosos intraarticulares del tejido subsinovial, que puede ser diagnosticada erróneamente debido a la ausencia de un examen físico, o de hallazgos en RM característicos en etapas iniciales. Se presenta un caso de una mujer de 33 años que consulta por dolor, pseudobloqueo y contractura en flexión de rodilla izquierda sin antecedente traumático previo. Debido a la sospecha de condromatosis sinovial de rodilla, se indicó la exploración artroscópica. Intraoperatoriamente se identificaron múltiples cuerpos sueltos intra y extraarticulares cartilaginosos: se realizó una sinovectomía radical y extracción de cuerpos libres. Al año de seguimiento, el paciente recuperó el rango completo de movimiento y retornó íntegramente a la actividad deportiva. Los resultados del presente informe indican que, en casos en los que existe una sospecha de condromatosis sinovial, la exploración artroscópica es un método eficaz para el diagnóstico y tratamiento con resultados satisfactorios. Tipo de estudio: Reporte de caso. Nivel de evidencia: IV

We report an unusual presentation of synovial chondromatosis of the knee in a 33-year-old women. At this unusual age and location, there is a greater probability of missed diagnosis, due to the lack of definite informative incidence, and difficulty in finding the lesions. In this case, intra and extraarticular multiple loose bodies were hidden. After careful arthroscopic inspection, we found numerous cartilaginous loose bodies and removed them with arthroscopy in association with sinovectomy. Synovial chondromatosis, is a rare, benign condition characterized by the formation of multiple intraarticular cartilaginous nodules from the subsynovial tissue. Synovial chondromatosis can be often misdiagnosed due to the lack of a specific physical exam or MRI findings in early stages. The present report examines a 33-year-old female with symptoms of left knee flexion contracture, pain mechanical locking without previous traumatic event. Following admittance, an arthroscopic exploration was conducted. Multiple cartilage-like intra and extraarticular loose bodies were identified in the patient's joints during surgery. Radical synovectomy and removal of loose bodies were performed. Following one year follow-up, the patient recovered full range of motion and returned to sports activities. The results of the present report indicate that, in cases where synovial chondromatosis is suspected, arthroscopic exploration is an effective method for diagnosis and treatment with satisfactory results. Type of Study: Case report. Level of evidence: IV

Condromatosis sinovial en la articulación temporomandibular: presentación de caso clínico / Synovial chondromatosis of the temporomandibular joint: clinical case presentation

Objetivo: presentar las características clínicas y por imágenes de un paciente con condromatosis sinovial en la articulación temporomandibular izquierda y el tratamiento realizado. Caso clínico: la condromatosis sinovial es una artropatía benigna crónica, progresiva y proliferativa, que suele afectar las articulaciones largas y, con poca frecuencia, la articulación temporomandibular. En este último caso, la enfermedad se caracteriza por el desarrollo de nódulo cartilaginosos en el espacio articular. Los síntomas clínicos de condromatosis sinovial en la ATM son dolor, inflamación, crepitación, maloclusión y disfunción. Esta sintomatología es común a la de otras patologías en la misma articulación, por lo que la sospecha y el diagnóstico de condromatosis sinovial son en sí un desafío. Conclusión: la condromatosis sinovial es una patología poco frecuente en la articulación temporomandibular. Una vez diagnosticada, yta sea en estadíos tempranos o avanzados, se puede optar por diversos tratamientos, con excelentes pronósticos.

Cirugía endoscópica de la articulación temporomandibular: condromatosis sinovial / Endoscopic surgery of the temporomandibular joint: synovial chondromatosis / Cirurgia endoscópica de la articulação temporomandibular: condromatose sinovial

La condromatosis sinovial es una metaplasia cartilaginosa del tejido sinovial de las articulaciones. Es una enfermedad de etiología desconocida e infrecuente. Su localización en la articulación temporomandibular es más rara aún. Se describe el caso clínico de una paciente con diagnóstico de condromatosis sinovial de la articulación temporomandibular tratada con éxito mediante un abordaje quirúrgico combinado: externo y con endoscopios de 4 mm. Se realizó una revisión de la bibliografía sobre la información existente de la condromatosis sinovial.

Synovial chondromatosis is a cartilaginous metaplasia of the synovial tissue of joints. It is a disease of unknown etiology and infrequent. Its location in the temporomandibular joint is still more unusual. The case of a patient is described with a diagnosis of synovial chondromatosis of the temporomandibular joint successfully treated with a combined surgical approach: external and with 4 mm endoscopes. A review of the literature was conducted on the existing information on synovial chondromatosis.

A condromatose sinovial é uma metaplasia cartilaginosa do tecido sinovial das articulações. É uma doença de etiologia desconhecida e pouco frequente. A sua localização na articulação temporomandibular é ainda mais rara. Descreve-se o caso clínico de uma paciente com diagnóstico de condromatose sinovial da articulação temporomandibular tratada com sucesso mediante uma abordagem cirúrgica combinada: externa e com endoscópios de 4 mm. Realizou-se uma revisão da bibliografia sobre a informação existente da condromatose sinovial.

Uncalcified Synovial Chondromatosis in the Pisotriquetral Joint

Synovial chondromatosis is a rare lesion in the wrist, but some cases in the distal radioulnar joint have been reported and previous case reports emphasize joint calcifications, shown on preoperative plain radiographs. We report an extremely uncommon case of synovial chondromatosis in the pisotriquetral joint, in which radiographs and magnetic resonance imaging did not demonstrate apparent calcified bodies. In our case, for the accurate diagnosis and treatment, surgical exploration of the joint and synovectomy with removal of loose bodies was performed.

Condromatosis sinovial de cadera. Tratamiento artroscópico / Hip synovial chondromatosis. Arthroscopic treatment

Introducción: La condromatosis sinovial se define como una lesión metaplásica benigna, de baja incidencia en cadera. La técnica ideal de tratamiento genera controversia por la probable recurrencia y la progresión degenerativa descrita para técnicas tanto a cielo abierto como artroscópicas. El objetivo de este trabajo es reportar la técnica quirúrgica y los resultados a corto plazo en una serie de pacientes con condromatosis sinovial de cadera tratados por vía artroscópica. Materiales y Métodos: Entre abril de 2007 y mayo de 2011, 10 pacientes (9 mujeres y 1 hombre, edad promedio 38 años; rango 17-53) fueron operados por vía artroscópica a causa de una condromatosis sinovial de cadera. Se evaluaron la técnica quirúrgica, los resultados clínicos y radiológicos, y el grado de satisfacción con el procedimiento. La escala funcional de Harris modificada preoperatoria fue de 51 puntos (rango 49-54). La histología diferida confirmó el diagnóstico en todos los casos. El seguimiento prospectivo fue, en promedio, de 35 meses (rango 24-47). Resultados: En todos los casos, se realizó una técnica artroscópica convencional para extraer cuerpos libres y sinovectomía parcial anterolateral. En tres pacientes, se amplió la incisión de uno de los portales para extraer cuerpos de gran diámetro. La escala funcional de Harris modificada posoperatoria fue, en promedio, de 88 puntos (rango 85-91). No se observó progreso degenerativo articular radiológico en el último control. Todos los pacientes se mostraron satisfechos con el procedimiento. No se registraron complicaciones. Conclusiones: Los resultados a corto plazo favorables coinciden con los publicados. Los pacientes con condromatosis sinovial de cadera pueden ser tratados por vía artroscópica en forma segura y eficaz. Diseño del estudio: Estudio terapéutico Nivel de evidencia: IV...

Background: Synovial chondromatosis is defined as a benign metaplastic lesion, with a low incidence in hips. The ideal treatment technique is controversial due to the probable recurrence and degenerative progression described with both arthroscopic and open surgery. The aim of this study is to report the surgical technique and shortterm results in a series of patients with synovial chondromatosis treated with arthroscopic hip. Methods: From April 2007 to May 2011, 10 patients (9 women and a man; average age 38 years; range 17-53) underwent hip arthroscopy for synovial chondromatosis. Surgical technique, clinical and radiological results, and satisfaction with the procedure were evaluated. The preoperative modified Harris hip functional scale was 51 points (range 49-54). Delayed histology confirmed diagnosis in all cases. Prospective follow-up averaged 35 months (range 24-47). Results: The conventional arthroscopic technique to extract loose bodies and partial anterolateral synovectomy were performed in all patients. In three patients incision of one of the portals was extended to extract bodies of large diameter. The postoperative modified Harris hip functional scale averaged 88 points (range 85-91). No radiographic joint degenerative progress was seen at the last control. All patients were satisfied with the procedure. There were no complications. Conclusions: Favorable short-term results are consistent with those reported in the literature. Patients with synovial chondromatosis can be treated with hip arthroscopy safely and effectively. Design of the Study: Therapeutic. Level of Evidence: IV...

Radiological study of three cases of loose bodies in the temporomandibular joint

According to the literature, loose bodies in the temporomandibular joint (TMJ) primarily prompt to synovial chondromatosis (SC). SC is a cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue of the joints. Its main characteristic is the formation of cartilaginous nodules in the synovium and inside the articular space, described as loose bodies. The main symptoms are pain, limitation of jaw movement, crepitation and inflammation. Diagnosis is made by panoramic radiograph, computed tomography scan and mainly magnetic resonance imaging. SC is usually monoarticular. We report two cases of bilateral loose bodies in TMJ and one monoarticular evaluated through plain radiograph and cone beam volumetric tomography (CBVT). Clinical and radiologic findings are reviewed and discussed. References for diagnosis of SC affecting TMJ are supported. Patients presenting preauricular swelling, pain and restriction of TMJ movements should be evaluated with plain radiography, CBVT and if necessary,magnetic resonance imaging. If loose bodies are found, synovial chondromatosis must be the first suspicion. The definitive diagnosis depends on histology. A differential diagnosis of chondrosarcoma should be considered because of the life-threatening features of chondrosarcoma.

Synovial chondromatosis of the temporomandibular joint with extension to the middle cranial fossa.

A rare case of synovial chondromatosis with extension to the middle cranial fossa is reported. Synovial chondromatosis, a benign disorder characterized by multiple cartilaginous, free-floating nodules that originate from the synovial membrane is not exclusive to the temporomandibular joint (TMJ). This condition is commonly seen in the axial skeleton and can involve multiple joints. In this case, synovial chondromatosis of the TMJ led to complete bony erosion of the glenoid fossa extending into the middle cranial fossa. Although plain radiographs showed the involvement of the joint, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provided more detailed information about the lesion in all three dimensions. This case demonstrates the value of CT and MRI in both the diagnosis and treatment planning. A review of previously reported cases of synovial chondromatosis with cranial extensions is included.

Idiopathic Synovial Osteochondromatosis of the Hip: Radiographic and MR Appearances in 15 Patients

OBJECTIVE: To evaluate the radiographic and MR appearance of idiopathic synovial osteochondromatosis of the hip. MATERIALS AND METHODS: Radiographs and MR images of 15 patients with idiopathic synovial osteochondromatosis of the hip were assessed. The former were analysed in terms of the presence of 1) juxta-articular calcified and/ or ossified bodies, 2) osteophytes, 3) bone erosion, 4) juxta-articular osteopenia, and 5) joint space narrowing, while for the latter, analysis focused on 1) the configuration of intra-articular bodies, 2) bone erosion, 3) synovial thickening, 4) conglomeration of intra-articular bodies, and 5) extra-articular extension. RESULTS: At hip radiography, juxta-articular calcified and/ or ossified bodies were seen in 12 of the 15 patients (80%), bone erosion in eight (53%), osteophytes in seven (47%), juxta-articular osteopenia in five (33%) and joint space narrowing in five (33%). In eight patients (53%), MR imaging depicted intra-articular bodies of focal low signal intensity at all pulse sequences, and areas of isointensity at T1WI and hyperintensity at T2WI. In three (20%), intra-articular bodies of focal low signal intensity and areas of hyperintensity at all pulse sequences were observed, with areas of iso-intensity at T1WI and hyperintensity at T2WI, while in four (27%), intra-articular bodies of only focal low signal intensity at all pulse sequences were apparent. Synovial thickening was present in 13 patients (87%), bone erosion in 11 (73%), conglomeration of the intra-articular bodies in 11 (73%), and an extra-articular herniation sac in six (40%). CONCLUSION: The most common radiographic finding of synovial osteochondromatosis of the hip was the presence of juxta-articular calcified and/ or ossified bodies. MR imaging depicted intra-articular bodies of focal low signal intensity at all pulse sequences, with areas of iso-intensity at T1WI and hyperintensity at T2WI. In addition, the presence of an extra-articular herniation sac was not uncommon.

Condromatose sinovial: relato de um caso / Synovial chondromatosis: report of a case

Os autores relatam um caso de condromatose sinovial, que é uma patologia rara, encontrada nas bainhas de tendöes ou espaços articulares, por metaplasia das células subsinoviais em cartilaginosas, com presença, muitas vezes, de corpos livres na articulaçäo. O trabalho tem como objetivo fazer uma revisäo no conceito e tratamento da patologia, em um caso no ombro.

Condromatosis sinovial: revisión de 25 casos monoarticulares / Synovial chondromatosis: review of 25 monoarticular cases

We report 25 patients (20 female) aged 34 to 74 years old, with monoarticular synovial chondromatosis. Affected joints were tha knee in 25 cases, the ankle in one case and the elbow in one case. Chronic articular pain was the main symptom, followed by swelling, limitation in motion range, free palpable bodies and symptomatic popliteal cysts. X ray examination showed free calcified osteochondroid bodies in 48 percent of patients and secondary osteoarthritis in 36 percent. Bone scintiscan showed an increased focal uptake. All pathological samples had chondroid or osteochondroid nodules; 64 percent had small blood vessels, thickened with concentric collagen laminae and 20 percent had isolated chondrocytes. Malignant degeneration was not observed. Surgical or artroscopic synevectomy was the procedure of choice in 20 knees. In the affected elbow and ankle, extraction of free bodies was the sole procedure. No recurrences were observed. It is concluded that synovial chondromatosis must be considered in the differential diagnosis of chronic articular pain and monoartritis