Average 22-Year Results of Total Hip Arthroplasty Using Harris-Galante Prosthesis in Patients under 50 Years

Background@#The Harris-Galante (HG) prosthesis is a first-generation, cementless total hip arthroplasty (THA) prosthesis. Considering the recent increase in the demand for THA in young patients and their life expectancy, a study with a follow-up duration of longer than 20 years in a young population is needed. Therefore, we evaluated the long-term clinical and radiographic results after cementless THA using the HG prosthesis in patients younger than 50 years. @*Methods@#A total of 61 THAs performed using the HG with a minimum follow-up of 10 years were included. There were 38 men and 11 women with an average age of 46 years and the mean follow-up duration was 22 years. Clinical evaluation included modified Harris Hip Score (HHS) and radiographic analysis consisted of cup inclination, anteversion angle, component stability, osteolysis, liner wear rate, wear-through, liner dissociation, and heterotopic ossification. Complications included recurrent dislocation, periprosthetic femoral fracture, and periprosthetic joint infection. Survivorship analysis included cup and stem revision for aseptic loosening, as well as any revision. @*Results@#The HHS improved from 46.5 preoperatively to 81.8 postoperatively (p < 0.001). The average linear wear rate was 0.36 mm/yr. A total of 34 hips (56%) were revised: stem revision in 10 (16.4%), cup revision in 9 (14.8%), exchange limited to bearing surface in 8 (13.1%), and revision of all components in 7 (11.5%). Estimated survivorship at 34 years postoperatively was 90.9% for cup revision for aseptic loosening, 80.5% for stem revision for aseptic loosening, and 22.1% for any revision. @*Conclusions@#THA using the HG prosthesis showed satisfactory estimated survivorship of the acetabular and femoral components at 34 years postoperatively with good clinical outcomes. Bearing-related problems, such as osteolysis and liner dissociation, accounted for 56% of revision operations and were concerns in patients younger than 50 years.

The Importance of Interface Irregularity between the Tumor and Brain Parenchyma in Differentiating between Typical and Atypical Meningiomas: Correlation with Pathology

PURPOSE: To understand clinical significance of irregular interface between meningioma and adjacent brain parenchyma in predicting histological grading of tumor, focusing on brain parenchymal invasion. MATERIALS AND METHODS: Pathologically confirmed 79 cases with meningiomas with pathological reports about the presence of parenchymal invasion were included. We defined the presence of interface irregularity as either spiculations or fuzzy margins between the tumor and brain parenchyma. We counted number of spiculations and measured ratio of fuzzy margin length to whole length of mass with consensus of two neuroradiologists. We classified the patients into Present group and Absent group, and the two groups were compared by using the Mann-Whitney U test. Statistical correlations between the presence of an interface irregularity and brain parenchymal invasion by the tumor as well as meningioma histological grade were tested with chi-square test. The optimal cutoff values of spiculation numbers and the ratio of fuzzy margins were determined. The sensitivity and specificity of number of spiculations, ratio of fuzzy margin and the presence of irregular interface as combined parameters for predicting the parenchymal invasion were calculated using ROC curve analysis. RESULTS: Statistically significant differences were noted between the Present and Absent groups for number of spiculations and ratio of fuzzy margin (P = 0.038 and P = 0.028, respectively). The optimal cutoff value for number of spiculations (> 4.5 with 61.1% sensitivity and 68.9% specificity) and the ratio of fuzzy margin (> 0.24 with 66.7% sensitivity and 65.6% specificity) were determined. The sensitivity and specificity of interface irregularity as the combined parameters were 72% and 59%, respectively. The interface irregularity between tumor and brain parenchyma significantly correlated with not only brain parenchymal invasion (P = 0.001) and but also histological grade (P < 0.001). CONCLUSION: The interface irregularity between tumor and brain parenchyma in MRI can be a strong predictive factor for brain parenchymal invasion and high grade meningioma.

A Comparison of Bicortical and Intramedullary Screw Fixations in Jones' Fractures Using Finite Element Analysis: Preliminary Report / 대한스포츠의학회지

Intramedullary screw fixation and bicortical screw fixation are widely used operation methods in the surgical treatment of Jones fractures. The purpose of this study is to evaluate of mechnical stability in two kind of Jones fracture. Using Mimics, three-dimensional models of the fifth metatarsal were reconstructed form computed tomography images of a 23-year-old Korean healthy male. Normal and osteoporotic bone models were made by changing bone density or thickness of cortical and cancellous bone. Two kinds of fixation techniques, i.e., intramedullary and bicortical screw fixation models, were simulated and muscles forces related to the fifth metatarsal base were applied. Maximum contact pressure difference were measured as 20,818 MPa, 12,155 MPa in normal bone, 23,371 MPa, 13,765 MPa in 85% cancellous osteoporotic bone, 24,310 MPa and 14,264 MPa in 75% cancellos osteoporotic model, 21,337 MPa, 20,971 MPa in -0.5 mm cortical osteoporotic bone, 26,322 MPa and 36,153 MPa in -1 mm cortical osteoporotic model, respectively for intramedullary screw fixation and bicortical screw fixation. Displacements on fracture interface were 0.208 mm, 0.126 mm in normal bone while 0.229 mm, 0.127 mm in 85% cancellos osteoporotic model, 0.241 mm, 0.127 mm in 75% cancellos osteoporotic model, 0.223 mm, 0.271 mm in -0.5 mm cortical osteoporotic model, 0.292 mm, 0.480 mm in -1 mm cortical osteoporotic model, respectively for intramedullary screw fixation and bicortical screw fixation. Bicortical screw fixation is superior in mechanical stability than intramedullary screw fixation for normal bone quality Jones fractures. For cortical osteoporotic bone Jones fractures, however, intramedullary screw fixation can give a better mechanical stability than bicortical screw fixation.

MR Findings of the Osteofibrous Dysplasia

OBJECTIVE: The aim of this study was to describe MR findings of osteofibrous dysplasia. MATERIALS AND METHODS: MR images of 24 pathologically proven osteofibrous dysplasia cases were retrospectively analyzed for a signal intensity of the lesion, presence of intralesional fat signal, internal hypointense band, multilocular appearance, cortical expansion, intramedullary extension, cystic area, cortical breakage and extraosseous extension, abnormal signal from the adjacent bone marrow and soft tissue and patterns of contrast enhancement. RESULTS: All cases of osteofibrous dysplasia exhibited intermediate signal intensity on T1-weighted images. On T2-weighted images, 20 and 4 cases exhibited heterogeneously intermediate and high signal intensity, respectively. Intralesional fat was identified in 12% of the cases. Internal low-signal bands and multilocular appearance were observed in 91%. Cortical expansion was present in 58%. Intramedullary extension was present in all cases, and an entire intramedullary replacement was observed in 33%. Cortical breakage (n = 3) and extraosseous mass formation (n = 1) were observed in cases with pathologic fractures only. A cystic area was observed in one case. Among 21 cases without a pathologic fracture, abnormal signal intensity in the surrounding bone marrow and adjacent soft tissue was observed in 43% and 48%, respectively. All cases exhibited diffuse contrast enhancement. CONCLUSION: Osteofibrous dysplasia exhibited diverse imaging features ranging from lesions confined to the cortex to more aggressive lesions with complete intramedullary involvement or perilesional marrow edema.

Ancient Schwannoma of the Thigh mimicking a Plexiform Malignant Peripheral Nerve Sheath Tumor: A Case Report

Ancient schwannoma is a rare variant of schwannoma and a slow growing benign tumor associated with degeneration that may be diagnosed as a malignant tumor, because it presents with a large size and an inhomogeneous signal intensity. The main differential diagnosis of plexiform soft tissue tumor includes plexiform neurofibroma, malignant peripheral nerve sheath tumor (MPNST). In this case, we describe the MRI findings in a case of ancient schwannoma involving left thigh of a 63-year-old woman mimicking a plexiform MPNST. The tumor appeared as an inhomogeneous signal intensity and multinodular appearance, causing misdiagnosis as a plexiform MPNST.

MRI of a Subcutaneous Myolipoma in the Ankle: a Case Report

Myolipoma is a rare benign tumor, composed of irregularly admixed adipose tissue and smooth muscle fibers. Few literature studies have described the radiologic appearance of myolipoma, especially in the soft tissue. No MRI findings in subcutaneous myolipoma of an extremity have been reported. Here, we report on the case of a 34-year-old woman with myolipoma in the subcutaneous tissue of the ankle and describe MRI features of the lesion.

Serial MR Imaging of Intramuscular Hematoma: Experimental Study in a Rat Model with the Pathologic Correlation

OBJECTIVE: We wanted to demonstrate the temporal changes of the magnetic resonance imaging (MRI) findings in experimentally-induced intramuscular hematomas in rats and to correlate these data with the concurrent pathologic observations. MATERIALS AND METHODS: Intramuscular hematoma was induced in 30 rats. The MR images were obtained at 1, 4, 7 and 10 days and at 2, 3, 4, 6 and 8 weeks after muscle injury. The characteristic serial MRI findings were evaluated and the relative signal intensities were calculated. Pathologic specimens were obtained at each time point. RESULTS: On the T1-weighted imaging (T1WI), the intramuscular hematomas exhibited isointensity compared to that of muscle or the development of a high signal intensity (SI) rim on day one after injury. The high SI persisted until eight weeks after injury. On the T2-weighted imaging (T2WI), the hematomas showed high SI or centrally low SI on day one after injury, and mainly high SI after four days. A dark signal rim was apparent after seven days, which was indicative of hemosiderin on the pathology. The gradient echo (GRE) imaging yielded dark signal intensities at all stages. CONCLUSION: Unlike brain hematomas, experimentally-induced intramuscular hematomas show increased SI on both the T1WI and T2WI from the acute stage onward, and this is pathologically correlated with a rich blood supply and rapid healing response to injury in the muscle. On the T2WI and GRE imaging, high SI with a peripheral dark signal rim is apparent from seven days to the chronic stage.

Prognostic Role of Rb, p16, Cyclin D1 Proteins in Soft Tissue Sarcomas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study was to determine the expressions of Rb, p16, and cyclin D1 in soft tissue sarcomas, and we also wanted to identify the prognostic factors according to the clinicalpathologic features. MATERIALS AND METHODS: We reviewed the charts and radiographic films of 66 sarcoma patients. Tissue samples were collected from these patients. Immunochemistry was performed using formalin-fixed, paraffin-embedded tissue samples to examine the expressions of p16, Rb, and cyclin D1 proteins. RESULTS: The median duration of overall survival was 47.8 months (range, 20.0 to 70.7 months) and the 5 years survival rate was 39%. As for the correlation between the degree of immunohistochemical staining for Rb protein and the histological tumor grades, there was a significant difference with a p-value of 0.019. However, no significant correlation was shown for p16 and cyclin D1. The overall survival duration of the Rb negative group (staining cell <20%) and the heterogeneous group (cell staining 20 to 80%) was 53.5+/-6.6 months and the overall survival duration of the Rb homogeneous group was 18.3+/-6.4 months, and there was a significant difference with a p-value of 0.016. However, no significant difference was shown between the survival rate according to the p16 and cyclin D1 expressions. On the multivariate analysis that was done with Rb, p16, the tumor size, grade and site, and patient age, the Rb gene expression was the most significant independent prognostic factor with a risk ratio of 3.01 (p=0.04). CONCLUSION: The expression of Rb protein was correlated with the histologic grade and overall survival of patients with soft tissue sarcomas.

The Surgical Treatment of Pyogenic and Tubercular Infection in the Sternoclavicular Joint: Case Report

PURPOSE: Here we report clinical results for surgical treatment of 2 cases of pyogenic arthritis and 1 case of tubercular arthritis, which only rarely develops in the sternoclavicular joint. MATERIALS AND METHODS: From September 2003 to September 2008, we did early marginal resection and thorough debridement of osteomyelitis of the sternum and distal clavicle in 3 patients and evaluated clinical results after short-term follow up. RESULTS: All 3 patients were satisfied with their clinical results and none had any recurrences according to follow up X-rays and laboratory datas. The follow up MRI showed bone edema in the distal clavicle and proximal sternum and a little fluid retention around the sternoclavicular joint. CONCLUSION: Even though diagnosis of these diseases are made earlier, infection of the adjacent bone and osteomyelitis could already have developed. We did early marginal resection and thorough debridement of osteomyelitis of the sternum and distal clavicle and achieved satisfactory results.

Radiation Therapy Combined with (or without) Cisplatin-based Chemotherapy for Patients with Nasopharyngeal Cancer: 15-years Experience of a Single Institution in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This retrospective study was carried out to evaluate the efficacy and toxicity of radiation therapy (RT) with/without cisplatin-based chemotherapy in nasopharyngeal cancer (NPC). MATERIALS AND METHODS: One hundred forty six patients with NPC received curative RT and/or cisplatin-based chemotherapy. Thirty-nine patients were treated with induction chemotherapy (IC), including cisplatin and 5-fluorouracil followed by RT. Another 63 patients were treated with concurrent chemoradiotherapy (CCRT) using cisplatin, and 22 patients were treated with IC followed by CCRT. The remaining 22 patients were treated with RT alone. RESULTS: One hundred four (80.0%) patients achieved complete response (CR), and 23 (17.7%) patients achieved partial response (PR). The patterns of failure were: locoregional recurrences in 21.2% and distant metastases in 17.1%. Five-year overall survival (OS) and progression free survival (PFS) were 50.7% and 45.0%, respectively. Multivariate Cox stepwise regression analysis revealed CR to chemoradiotherapy to be a powerful prognostic factor for OS. CR to chemoradiotherapy and completion of radiation according to the time schedule were favorable prognostic factors for PFS. A comparison of each treatment group (IC --> RT vs. CCRT vs. IC --> CCRT vs. RT alone) revealed no significant differences in the OS or PFS. However, subgroup analysis showed significant differences in both OS and DFS in favor of the combined chemoradiotherapy group compared with RT alone, for stage IV and T3-4 tumors. Grade 3-4 toxicities were more common in the combined chemoradiotherapy arm, particularly in the CCRT group. CONCLUSIONS: This study was limited in that it was a retrospective study, much time was required to collect patients, and there were imbalances in the number of patients in each treatment group. Combined chemoradiotherapy remarkably prolonged the OS and PFS in subgroup patients with stage IV or T3-4 NPC.

Brain Diffusion Tensor MR Imaging

The development of MR imaging techniques during the past decade has enabled researchers to use MR imaging as a noninvasive tool for evaluating structural and physiologic states in biologic tissues by measuring the diffusion process of water molecules. More recently, diffusion tensor MR imaging (DTI) technique based on the dependency of molecular diffusion on the orientation of white matter fiber tracts has been used to analyze the trajectory, shape, fiber structure, location, topology and connectivity of neuronal fiber pathways in living humans. Numerous efforts have been made by MR physicists, brain scientists, and medical doctors to advance MR techniques and computer-based algorithms which result in more accurate quantification of diffusion tensor and the generation of white matter fiber tract maps and to determine the pathophysiology of brain disease by DTI and useful clinical applications of DTI. In this article, we describe the tensor theory used to characterize molecular diffusion in white matter and a process of measuring tensor elements using diffusion-sensitive MR images to fiber mapping. We then provide review of current literature and some clinical examples that have been published and are on-going.

Intracapsular and Paraarticular Chondroma of the Knee: Case Report

We report here on a case of intracapsular and paraarticular chondroma of the left knee in a patient with a 6-month history of knee pain and swelling. Magnetic resonance image (MRI) revealed a well-defined solid mass with central hemorrhagic necrosis in the infrapatellar area of the knee.

Tumoral Calcinosis of the Foot: MRI & Histologic Findings; Two Cases Report / 대한족부족관절학회지

Tumoral calcinosis is rarely encountered disease, and most of reported cases involved large joints such as hip or elbow. We report two patients with tumoral calcinosis in the foot. In the 1st case, the lesion was observed at the 1st MP joint of foot, and in the 2nd case it was found at the DIP joint of 5th toe area with bony erosion which is rare in other tumoral calcinosis. They all needed evaluation with MRI, and eventually surgical excision.

MRI Findings of Adhesive Capsulitis of Shoulder

OBJECTIVE: MRI findings of adhesive capsulitis (AC) have been rarely documented even though the disease is a rather common disorder. To find reliable MRI parameters, we studied MRI findings of the patients with arthrographically-proven AC. METHOD: Eighteen patients with AC (patient group) and eight subjects without AC (control group) were enrolled. Mean age of the former was 55.1 years and that of the latter was 41.4 years. Mean duration of the diseases in patient group was 5.9 months. Oblique coronal and axial MRI images of the shoulder were measured for the thickness of capsule and synovium around the axillary fold (TAF), volume of axillary recess (VAR), and volume of biceps tendon sheath (VBTS), which were compared in both groups using unpaired t-test. RESULTS: TAF was significantly increased in patient group (p<0.0001), and the thickened axillary fold greater than 5.1 mm was a useful MRI criterion for the diagnosis of AC with sensitivity of 93% and with specificity of 100%. VBTS was also significantly diminished in patient group (p<0.05), whereas there was no significant difference in VAR between two groups. CONCLUSION: TAF, especially greater than 5.1 mm, and decreased VBTS are useful MRI parameters for the diagnosis of AC of shoulder.

Effect of Combined Therapy of Cisapride and Lactulose on Neurogenic Bowel Dysfunction in Spinal Cord Injury

OBJECTIVE: To calculate the colonic transit time (CTT) and to evaluate the effect of combined therapy of cisapride and lactulose on neurogenic bowel dysfunction in patients with chronic spinal cord injury. METHOD: This study was prospectively designed. Right (rCTT), left (lCTT), rectosigmoid (rsCTT), and total (tCTT) colonic transit times were measured using the radio-opaque marker technique in twenty patients with spinal cord injury (SCI group), of which mean age was 39 years (range: 13~67 years) and median duration after SCI was 15 months (4-252 months). Ten ambulatory stroke patients (mean age 49 years, median duration, 12 months) were also evaluated as control group. All CTTs in both groups were compared by unpaired Student's t-test. In SCI group, the therapeutic effect of combined administration of cisapride (10 mg p.o. t.i.d) and lactulose (134.0 g/100 ml, 30-45 ml per day p.o.) was statistically analyzed by paired Student's t-test. RESULTS: Total (p<0.0001) and segmental CTT (p<0.01) except right colon were significantly delayed in SCI group when compared to the control group. In SCI group, tCTT of non-ambulatory patients (n=13) and rCTT, lCTT, rsCTT and total CTT of ambulatory patients (n=7) were significantly decreased after the combined drug therapy (p<0.05). In ambulatory SCI patients, duration after injury showed negative correlation with tCTT (Pearson's correlation coefficient r = 0.8407, p=0.0178). CONCLUSION: Combined therapy of cisapride and lactulose can improve tCTT in SCI patients with neurogenic bowel dysfunction.

Arthrographic Findings of Frozen Shoulder and Therapeutic Effect of Distension Arthrography

OBJECTIVE: To define arthrographic findings in patients with frozen shoulder and to evaluate the therapeutic effect of arthrographic capsular distension and rupture. METHOD: Thirty patients who were clinically diagnosed as frozen shoulder were enrolled. During a trial of intra-articular injection of 35 mL of fluid which contained 8 mL of 1% lidocaine, 2 mL of prednisolone (80 mg) and 25 mL of radiocontrast material, arthrographic findings and the occurrence of iatrogenic capsular tear were observed. Passive range of shoulder motion (percent of normal, %) at flexion, abduction, internal rotation, and external rotation was measured at pre- and 1 week post-injection. The therapeutic effect of the procedure was statistically analyzed by paired Student's t-test. RESULTS: Mean age of the subjects was 57-years-old (range: 40~76 years) and mean duration of the symptom was 6 months (2~42 months). A decreased joint volume of less than 10 mL (100%), poor or absent filling of the axillary recess or subscapular bursa (75.9%), nonfill of the biceps tendon sheath (37.9%), and irregularity of capsular insertion (31.0%) were typical abnormal arthrographic findings. In one week after arthrographic distension and rupture, the passive range of shoulder motion was significantly (p<0.05) increased at flexion, abduction and external rotation, of which the range of external rotation was the most remarkably increased (mean, 23.9%). CONCLUSION: Distension arthrography was useful for increasing shoulder motion in frozen shoulder, especially at flexion, abduction and external rotation.

Clinical Significance of Nerve Root Enhancement in Contrast-Enhanced MR Imaging of the Postoperative Lumbar Spine

PURPOSE: To determine the significance of nerve root contrast enhancement in patients with residual or recurrent symptomatic postoperative lumbar spine. MATERIALS AND METHODS: Eighty-eight patients with 116 postoperative lumbar disc lesions causing radiating back pain underwent enhanced MR imaging. Intradural nerve root enhancement was quantified by pixel measurement, and affected nerve roots were compared before and after contrast administration. Extradural nerve root enhancement was assessed visually, and nerve root enhancement and clinical symptoms were correlated. Associated lesions such as recurrent disc herniation, scar tissue, nerve root thickening and nerve root displacement were also evaluated. RESULTS: Of 26 cases(22.4%) involving intradural nerve root enhancement, 22 (84.6%) showed significant clinical symptoms (p=0.002). and of 59 (50.9%) demonstrating extradural enhancement, clinical symptoms showed significant correlation in 47 (79.7%) (p=0.001). Nerve root enhancement, including eleven cases where this was both intra-and extradural, showed highly significant association with clinical symptoms in 74 of the 116 cases (63.8%) (p=0.000). Among 33 cases (28.4%) of recurrent disc herniation, nerve root enhancement was observed in 28 (84.8%) and in 24 of these 28 (85.7%), significant correlation with clinical symptoms was observed (p=0.000). Where epidural fibrosis was present, correlation between nerve root enhancement and clinical symptoms was not significant (p>0.05). Nerve root thickening and displaced nerve root were, however, significantly associated with symptoms(87.2% and 88.6%, respectively). CONCLUSION: In patients with postoperative lumbar spine, the association between nerve root enhancement revealed by MRI and clinical symptoms was highly significant.

Reversible Posterior Leukoencephalopathy Syndrome

PURPOSE: To review reversible posterior leukoencephalopathy syndrome. MATERIALS AND METHODS: We reviewed 22 patients (M:F=3:19; age, 17-46 years) with the characteristic clinical and imaging features of reversible posterior leukoencephalopathy syndrome. All underwent brain MRI, and in three cases both CT and MRI were performed. In one, MRA was obtained, and in eleven, follow-up MR images were obtained. We evaluated the causes of this syndrome, its clinical manifestations, and MR findings including the locations of lesions, the presence or absence of contrast enhancement, and the changes seen at follow-up MRI. RESULTS: Of the 22 patients, 13 had eclampsia (six during pregnancy and seven during puerperium). Four were receiving immunosuppressive therapy (three, cyclosporine; one, FK 506). Four suffered renal failure and one had complicated migraine. The clinical manifestations included headache (n=12), visual disturbance (n=13), seizure (n=15), focal neurologic sign (n=3), and altered mental status (n=2). Fifteen patients had hypertension and the others normotension. MRI revealed that lesions were bilateral (n=20) or unilateral (n=2). In all patients the lesion was found in the cortical and subcortical areas of the parieto-occipital lobes; other locations were the basal ganglia (n=9), posterior temporal lobe (n=8), frontal lobe (n=5), cerebellum (n=5), pons (n=2), and thalamus (n=1). All lesions were of high signal intensity on T2-weighted images, and of iso to low intensity on T1-weighted images. One was combined with acute hematoma in the left basal ganglia. In eight of 11 patients who underwent postcontrast T1-weighted MRI, there was no definite enhancement; in one, enhancement was mild, and in two, patchy. CT studies showed low attenuation, and MRA revealed mild vasospasm. The symptoms of all patients improved. Follow-up MRI in nine of 11 patients depicted complete resolution of the lesions; in two, small infarctions remained but the extent of the lesions had decreased. CONCLUSION: Reversible posterior leukoencephalopathy syndrome develops in patients with toxemia of pregnancy, renal insufficiency or complicated migraine, and those who undergo immonosuppresive therapy. The characteristic MR finding is edema in cortical or subcortical areas of the parietal and occipital lobes, without enhancement after Gd-DTPA injection. Early recognition of this readily treatable condition may obviate the need for extensive, invasive investigations, and prompt treatment can lead to a favorable prognosis.

Bilateral Simultaneous Quadriceps Tendon Rupture in a Patient with Secondary Hyperparathyroidism: A Case Report

Simultaneous bilateral rupture of the quadriceps tendon without a significant history of trauma may occur in association with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism, though has rarely been reported. We describe a case of spontaneous bilateral quadriceps tendon rupture in a 36-year-old female patient with secondary hyperparathyroidism.

Synovial Hemangioma of the Knee: A Case Report

A hemangioma in the knee joint of a 13-year-old girl was diagnosed by magnetic resonance imaging. There was pain and a tender localized swelling around to the patellar tendon. Arthroscopy verified the diagnosis but did not allow visualization of the full extent of the tumor. After arthroscopic excision of the associated hypertrophic medial plica, a miniarthrotomy was done. The tumor was attached to the periph-ery of the anterior horn of the medial meniscus, the anterior tibial plateau, and the fat pad. Its origin was from the venous plexus just below the anterior lip of the central tibial plateau. The patient was asympto-matic one and a half years after surgery. If the case is not amenable to arthroscopic surgery, open excision through miniarthrotomy ensures complete removal of the hemangiomas without recurrence.