Arthroscopic treatment of synovial chondromatosis of hip joint.

PURPOSE: This retrospective study summarized the clinical, radiographic, and arthroscopic manifestation of synovial chondromatosis (SC) of the hip, along with the post-operative effect to discuss the curative effect of arthroscopic management of hip SC. METHODS: Twenty-one patients who underwent arthroscopic surgery from the same surgeon for hip SC were followed up for an average of 45 months. T-shaped capsulotomy was routinely performed in each case. Visual analog scale, range of motion, modified Harris Hip Score, and International Hip Outcome Tool score were collected preoperatively and at the time of the latest follow-up. All patients' demographics, radiographs, and arthroscopic images were collected to summarize and conclude the similarities and differences of their manifestation. RESULTS: Large wedged clumps of loose bodies demonstrated distinguishable radiographic, arthroscopic appearance and demanded a different surgical strategy. Postoperative scores were all significantly improved. One case of residual pain and two cases of residual loose bodies with no symptom related were reported at the final follow-up. All but one patient were satisfied with the outcome. CONCLUSION: Arthroscopy treatment of hip SC with T-shaped capsulotomy has demonstrated a good result in terms of clinical outcome score, recurrence rate, and complication rate. On the basis of this study, we concluded the clinical performance of large wedged clumps of loose bodies of hip SC.

Posterior interosseous nerve palsy caused by synovial osteochondromatosis of the elbow analyzed by three-dimensional reconstruction: a case report.

BACKGROUND: Synovial osteochondromatosis, a benign tumor consisting of cartilage and bone, generally presents as multiple osteochondral or chondral nodules. Peripheral nerve palsy caused by synovial osteochondromatosis is rare. Three-dimensional reconstruction based on magnetic resonance imaging shows the specific shape and location of the tumor and its relation to the nerve. CASE PRESENTATION: We describe a case of posterior interosseous nerve palsy caused by synovial osteochondromatosis of the elbow in a 66-year-old Japanese man. A three-dimensional reconstructed image based on magnetic resonance imaging was used to determine the location and shape of the giant tumor, which was composed of bone and cartilage. After surgical resection of the giant tumor and neurolysis of the posterior interosseous nerve, he fully recovered from nerve palsy 9 months postoperatively. There was no recurrence of the lesion 1 year postoperatively. CONCLUSION: Synovial osteochondromatosis that causes posterior interosseous nerve palsy has a characteristic morphology and location, that is, a giant tumor located anterior to the humeroradial joint, as revealed by three-dimensional magnetic resonance image reconstruction.

Arthroscopic management of elbow synovial chondromatosis.

OBJECTIVE: We aimed to identify factors that affect pain, complications, and function following elbow arthroscopy for elbow synovial chondromatosis. METHODS: We retrospectively reviewed the cases of all patients with elbow synovial chondromatosis treated by arthroscopic synovectomy and loose body removal between January 2000 and January 2016 at our institution. Eleven patients were enrolled (8 male; mean age, 41.7 years). The mean duration of symptoms was 13.7 months, and all patients had a decreased range of motion (ROM) in the affected elbow. By Milgram criteria, there was 1 phase II case, and 10 cases were phase III. RESULTS: All patients were followed postoperatively (mean follow-up, 65 months). The preoperatively restricted ROM of 100° flexion (range, 78°-120°) and extension of 30° (range, 15°-40°) were improved to 130° flexion (range, 120°-140°) and -5° hyperextension (range, -10°-0°). Pain, recorded as the pain subscore of the American Shoulder and Elbow Surgeons questionnaire for elbows, was significantly improved from 32 points (range, 20-50) preoperatively to 85 (range, 70-100) postoperatively (on a scale ranging from 0 [worst pain] to 100 [pain-free]). Recurrence occurred in 2 patients (18.2%) who then received arthroscopic synovectomy and loose body removal again. There were no fractures or neurovascular complications, and no patient developed an infection. CONCLUSION: Arthroscopic management of synovial chondromatosis of the elbow was an effective and safe therapeutic method. After the intervention, immediate and durable improvement of elbow function can be expected.

An unusual presentation of synovial chondromatosis of the knee in a 10-year-old girl.

Synovial chondromatosis commonly occurs in the anterior compartment of the knee joint, predominantly in middle-aged men. It is relatively unusual in female children and is rarely encountered in the synovium beneath the meniscus. The present report describes a rare case of synovial chondromatosis that developed in the synovium just inferior to both menisci of the right knee in a 10-year-old girl. 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 during arthroscopic examinations. In the present case, multiple loose bodies were hidden by the meniscus, and thus, there were no structural abnormalities in the initial arthroscopic views before probing the meniscus. After careful inspection, we found numerous cartilaginous loose bodies and removed them as much as possible with arthroscopy.

Clinical and Imaging Findings of Temporomandibular Joint Synovial Chondromatosis: An Analysis of 10 Cases and Literature Review.

PURPOSE: This study investigated clinical and imaging features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) for use in clinical applications. MATERIALS AND METHODS: We analyzed clinical data from 10 patients with SC of the TMJ in our hospital from 2011 to 2015. We also reviewed and analyzed relevant literature included in the National Center for Biotechnology Information database in the past decade using the search terms "synovial chondromatosis" and "temporomandibular joint." RESULTS: The incidence of SC of the TMJ was higher in female patients than in male patients (male-to-female ratio, 1:2.22). It occurred most often in middle age (mean, 47.2 years). The characteristic symptoms of SC in the TMJ were pain (90.8%), swelling (67.1%), limited ability to open the mouth (68.4%), deviant jaw opening (34.2%), and crepitation (31.6%). Computed tomography (CT) (42.9%) and magnetic resonance imaging (45.4%) were the most common techniques used to assess SC in the TMJ, and cone-beam CT (10.9%) also was used to make preliminary diagnoses based on its imaging findings. Open surgery was the preferred treatment of SC of the TMJ, and the recurrence rate was low. CONCLUSIONS: The main clinical characteristics of SC of the TMJ are pain, swelling, limited mouth opening, joint sounds, and deviant jaw opening. Imaging features include abnormal high-density shadows, condyle hyperostosis or destruction, changes in the temporal bone, and widening of the joint space. Cone-beam CT is useful for diagnosis of SC of the TMJ.

Pediatric Subtalar Joint Synovial Chondromatosis Report of a Case and an Up-to-date Review.

Synovial chondromatosis is a rare, usually benign disorder affecting the population predominantly in the third and fourth decades of life and mainly involving the large weightbearing joints of the lower limb-the knees and the hip. In this report, we highlight an unusual pediatric clinical presentation of synovial osteochondromatosis involving the subtalar joint and discuss its surgical management; we also provide a comprehensive up-to-date literature review of the disorder. This patient was successfully treated with en masse surgical excision. He has been doing well, with complete pain relief and improved range of motion at 1-year follow-up. An exceptional involvement of the subtalar joint and an unusual presentation in the pediatric age group makes this case unique.

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.

Synovial chondromatosis affecting a digital proximal interphalangeal joint.

We present a case of synovial chondromatosis affecting the interphalangeal joint where the disease did not clearly manifest itself on pre-operative radiographs. Although rare, surgeons should consider articular synovial chondromatosis as a differential for pain and stiffness in any joint, even those of the hand.

Condromatosis sinovial de la articulación temporomandibular con extensión a la base de cráneo / Synovial chondromatosis of the temporomandibular joint. a rare case with subcranial extension

La condromatosis sinovial (CS) es una metaplasia cartilaginosa de los remanentes mesenquimales del tejido sinovial de las articulaciones. Es una enfermedad de etiología desconocida y poco frecuente. Puede definirse como un proceso benigno sinovial caracterizado por la formación de nódulos cartilaginosos (cuerpos libres). La CS afecta principalmente a grandes articulaciones sinoviales siendo poco común su aparición en la articulación temporomandibular. La sintomatología predominante es dolor, inflamación, limitación de los movimientos mandibulares, crepitación y laterodesviación mandibular. El diagnóstico se realiza mediante el estudio radiológico y artroscópico de la articulación. El tratamiento adecuado englobaría la extirpación completa de los cuerpos libres y de la sinovial afecta, bien mediante artroscopia o mediante cirugía abierta. Cuando está afectada la articulación temporomandibular las lesiones suelen estar localizadas en la cavidad articular, siendo rara su extensión extraarticular. En este artículo describimos un caso excepcional de condromatosis sinovial con extensión a la fosa craneal media(AU)

Synovial chondromatosis (SC) is a cartilaginous metaplasia of the mesenchymal remnants of the synovial tissue of joints. It is an uncommon disease of unknown origin. This benign synovial process involves the formation of cartilaginous nodules (loose bodies) in the synovium and within the articular space. SC mainly affects large synovial joints, and only very rarely affects the temporomandibular joint (TMJ). The main symptoms are pain, swelling, mouth opening limitation, crepitation, and lateral mandibular deviation. Diagnosis can be made by panoramic radiograph, computed tomography scan, magnetic resonance imaging, and arthroscopy of the TMJ. The main treatment includes complete removal of the loose bodies in conjunction with excision of the affected synovium. It can be performed by arthroscopy or by open surgery. In cases with TMJ involvement, the lesion is usually confined to the joint cavity. In this report, a rare case of SC of the TMJ with subcranial extension is presented(AU)

Giant extra-articular synovial osteochondromatosis of the sinus tarsi: a case report.

A 32-year-old male presented with painful swelling of the sinus tarsi that occurred during daily activities. Diagnostic imaging suggested the presence of a large synovial osteochondromatosis that blocked subtalar motion with deformity of the adjacent bone. The large bony mass was excised, and normal subtalar motion was achieved.

Synovial chondromatosis of the shoulder: open synovectomy and insertion of osteoarticular allogaft with internal fixation to repair intraoperative glenohumeral joint instability.

Synovial chondromatosis is a rare benign disorder characterized by chondroid metaplasia with multinodular proliferation of the synovial lining of a diarthroidal joint, bursa, or tendon sheath. These cartilaginous nodules may become embedded within the proliferating synovium and may extend into the surrounding soft tissues. They also can detach from the synovium, where they can calcify and may present as intra-articular loose bodies. Presence of these nodules leads to joint pain, dysfunction, and ultimately, destruction. Clinically, patients often present with a chronic monoarthropathy. In this article, we report a case of extensive synovial chondromatosis of the right shoulder and surrounding soft tissues with extensive erosion of the humeral head, discuss combined anterior and posterior surgical excision of the cartilaginous fragments, and describe insertion of an osteoarticular allograft to repair the humeral head defect and secondary anterior glenohumeral joint instability.

Asymptomatic synovial chondromatosis of the ankle: an incidental finding.

Synovial chondromatosis is an uncommon, benign lesion of nodular cartilaginous neoplastic development of the synovium that can lead to loose bodies and arthritic degeneration if left untreated. Although very rare, malignant transformation to chondrosarcoma can occur. Primary and secondary forms of synovial chondromatosis also exist, and each has distinct clinical, radiographic, and histologic characteristics. In this article, we describe a case of extensive primary synovial chondromatosis of the ankle that was asymptomatic until just before presentation, and that was treated by means of open synovectomy with excision of the osteochondromatous lesions within the joint.

Intra-articular loose body removal during hip arthroscopy.

Loose bodies are common findings in hip arthroscopy. Loose body removal can be challenging because of the inner position of the acetabulum in which the loose bodies tend to accumulate. Moreover, the standard removal procedure of a considerable number of loose bodies may need a long time under limb traction, thereby increasing the risk of complications. This article describes a new easy method for intra-articular loose body removal. A flexible endotracheal catheter, connected with suction system, is inserted via the anterior or midanterior portal. The catheter can easily be directed toward the inner parts of the joint in proximity of loose bodies. The suction system allows the loose body to be captured in contact with the tip of the catheter, which is then retrieved carrying the loose body outside the cannula. We performed this technique on 4 consecutive patients with synovial chondromatosis. Patients were evaluated preoperatively and 1 month postoperatively by completing self-administered questionnaires. The technique effectiveness was evaluated in terms of overall surgery time, traction time, radiographic appearance of loose bodies left in situ, and postoperative complications. Mean overall surgery time and central time was 175 and 78 minutes, respectively. All patients showed improvement in the operated hip. All radiographs showed hip joint space free of osteochondral loose bodies. No patients reported paraesthesia, nerve palsy, or other postoperative complications. This technique allows for retrieval of a greater amount of loose bodies in a short time, reducing the possibility of undesirable complications.

Synovial chondromatosis of the metacarpophalangeal joint of the ring finger.

Synovial chondromatosis is an uncommon condition, characterized by multinodular cartilagineous proliferation of the joint synovium. There are only a few case reports of synovial chondromatosis involving the hand in the literature. A case of synovial chondromatosis of the ring finger is reported in this paper.

Condromatosis sinovial de cadera en un niño con síndrome de Down / Synovial chondromatosis of the hip in a child with down syndrome

La condromatosis sinovial de la cadera es una patologíapoco frecuente, generalmente benigna que se caracterizapor múltiples cuerpos libres intraarticulares.Se presenta el caso clínico de un paciente de 14 añoscon síndrome Down, afecto de condromatosis sinovialsintomática de cadera, intervenido mediante artrotomíacon control radiológico intraoperatorio para confirmarla exéresis de todos los cuerpos libres.Se revisa la bibliografía sobre las opciones terapéuticas,y los puntos más controvertidos de esta patología (AU)

Synovial chondromatosis of the hip is a rare benigncondition characterized by multiple intraarticular loosebodies. We report the case of a fourteen-year-old childwith Down syndrome who suffered symptomatic synovialchondromatosis of the hip, treated by means ofarthrotomy and intraoperative radiological assessmentto confirm the removal of all loose bodies.The literature about treatment options is reviewed,and controversial points of this condition are discussed (AU)