SYNOVIAL CHONDROMATOSIS OF THE POSTERIOR COMPARTMENT OF THE KNEE: A Case Report & Literature Review Focusing on Arthroscopic Treatment.

Synovial chondromatosis is a rare panarticular synovial disease affecting large joints and especially the knee. When the disease is localized in the knee, it affects the anterior compartment. We report the case of a posterior localized disease with a review of the literature focusing on arthroscopic treatment.

Arthroscopic treatment of synovial chondromatosis of the hip.

BACKGROUND: Recently, arthroscopic loose body removal and synovectomy have been performed as treatments for synovial chondromatosis of the hip joint. However, to date, no reports have been published on the outcomes of arthroscopic treatments. HYPOTHESIS: Arthroscopic treatment is effective for synovial chondromatosis of the hip joint and has advantages such as low recurrence rates, faster return to activities of daily life, and few surgical complications. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From June 1996 to July 2008, 24 patients with synovial chondromatosis of the hip who were followed up after arthroscopic removal of loose bodies and synovectomy were evaluated. The common arthroscopic portals were the anterior, anterolateral, and posterolateral portals. In some cases, we applied a medial portal for removal of loose bodies in the posteromedial pouch. Preoperative and postoperative assessments were made through simple radiographs, 3-dimensional computed tomography, magnetic resonance imaging, visual analog scale (VAS) for pain, range of motion of the joint, Harris Hip Score, and Merle D'Aubigné and Postel score. RESULTS: Postoperative mean follow-up period was 41 months. There were no major complications. Patients were able to walk weightbearing on average 2 days after surgery and were discharged in an average of 3.5 days (range, 3-5 days) after surgery. In postoperative radiological imaging, 4 patients showed progression of joint osteoarthritis, and 1 of them underwent total hip arthroplasty. The VAS score before surgery was 8.1 ± 1.3 and after surgery was 3.1 ± 1.4. Range of motion of the hip joint before surgery was increased after surgery, except in 1 patient who required a third operation. Harris Hip Score before surgery was an average of 39 ± 6.9 and improved to an average of 82 ± 10.2 after surgery. Eighteen patients (75%) had good or excellent outcomes. Symptomatic disease recurred in 4 patients (16.7%), and 1 of these 4 patients showed a subsequent recurrence. CONCLUSION: The treatment of synovial chondromatosis of the hip using arthroscopic loose body removal and synovectomy is relatively successful, and rehabilitation of patients is fast, therefore making it an effective treatment with satisfactory postsurgical results. However, a technical limitation of arthroscopy is the difficulty in approaching the posterolateral and posteromedial areas of the peripheral compartment.

Arthroscopic technique for treatment of synovial chondromatosis of the glenohumeral joint.

Synovial chondromatosis of the shoulder has been treated in the past with an open arthrotomy, removal of loose bodies, and synovectomy. Several authors have described arthroscopy as a means of treating this rare disorder because of the excellent visualization of the glenohumeral joint, decreased morbidity, and early rehabilitation potential. This article offers a technique in which a large-bore cannula and high pressure and flow are used to facilitate the removal of loose bodies from the joint.

Arthroscopic treatment for synovial chondromatosis of the shoulder.

Synovial chondromatosis of the shoulder is a rare condition. The following is a description of such a case with the presenting symptoms, radiographic features, intraoperative findings, and the arthroscopic technique for treatment of this disease. Loose bodies were found in the long head of the biceps tendon sheath, the subscapularis recess, and throughout the glenohumeral joint, causing erosive damage. We feel that arthroscopy allows for better visualization of the entire glenohumeral joint, including the long head of the biceps tendon sheath and the subscapularis recess, and for ease of loose body removal. Additional advantages of arthroscopy include decreased postoperative pain, early active range of motion, shorter course of rehabilitation, and earlier functional return.

Synovial osteochondromatosis.

A 75-year-old man of Fijian-Indian extraction complained of a 3-year history of progressive right knee pain and stiffness which were limiting his mobility. On examination, multiple hard nodules were palpable in the popliteal fossa and along the path of the quadriceps tendon. The joint line was not tender, knee flexion was limited to 60 degrees and there was a fixed flexion deformity of 5 degrees. The knee ligaments were intact. Examination of other joints did not reveal nodules. His past medical history included: (i) polyarticular gout, (ii) osteoarthritis of the left knee requiring total knee joint replacement 7 years previously, (iii) ischaemic cardiomyopathy, (iv) chronic atrial fibrillation, (v) chronic renal impairment, (vi) recent bacteraemic melioidosis without a primary focus, (vii) chronic bilateral rotator cuff tears, (viii) low-grade multiple myeloma and (ix) idiopathic pulmonary fibrosis.

Cirugía artroscópica de la rodilla: experiencia en Puebla / Arthroscopic surgery of the knee: experience in the city of Puebla

Se presenta una serie de 250 pacientes con patología de la rodilla, tratados entre 1987 y 1992, con seguimiento promedio postoperatorio de cuatro años, sometidos todos a artroscopia terapéutica, de acuerdo con un protocolo establecido por medio del cual la mayoría de los enfermos se somete a cirugía ambulatoria. Los resultados encontrados fueron los siguientes: la patología más común fue la condromalacia patelar en 22 casos, seguida de la lesión del menisco medial en sus variedades de asa de balde y en aleta con 92 casos y del lateral con 72; posteriormente se encontró enfermedad articular degenerativoa u osteoartritis con 31 casos; 24 con lesiones del ligamento cruzado anterior, y finalmente hubo 16 con diversas formas de patología sinovial. El resultado global del tratamiento se considera bueno en más de 80 por ciento de los casos