Synovial hemangioma presenting with chronic painful infrapatellar mass: a case report.

BACKGROUND: Synovial hemangiomas are rare benign vascular anomalies surrounded by a synovial lining and were first described by Bouchut in 1856. These neoplasms can develop in the intra-articular region, resulting in effusions and knee pain. However, their cause remains unknown. Prompt diagnosis and intervention are critical to prevent chondral damage. Histopathological examination is used to achieve the diagnosis, which is often delayed because of a lack of specific clinical signs. This report describes a unique case in which a painful infrapatellar mass was diagnosed as a synovial hemangioma. The absence of typical magnetic resonance imaging (MRI) findings highlights the importance of arthroscopic excision for diagnosis and symptom relief. CASE PRESENTATION: A 20-year-old woman presented with persistent anterior left knee pain that became exacerbated when she climbed stairs. Despite previous pain management and physical therapy, she developed a painful lump beneath her patella that worsened over time. She had also undergone arthrocentesis, but this did not relieve her pain. Physical examination revealed a palpable, immobile 5-cm mass along the patellar tendon with limited knee flexion and extension and normal ligament stability. T1-weighted fat-saturated MRI of the left knee with gadolinium-based contrast revealed a lobulated intra-articular mass in Hoffa's fat pad that resembled a soft tissue chondroma. A biopsy of the mass was performed to provide histopathological evidence, confirming the benign nature of the mass. The subsequent excisional arthroscopy, combined with incision enlargement for mass removal, confirmed the histopathologic diagnosis of synovial hemangioma based on the presence of numerous dilated blood vessels and venous proliferation within sections of the synovium. Recovery was complete, and no residual tumor was detected on follow-up MRI after 1 year. CONCLUSION: This case study emphasizes the importance of arthroscopic excision over open surgery for patients with synovial hemangioma. The minimally invasive nature of arthroscopy combined with the well-encapsulated nature and location of the mass facilitates complete resection.

A rare presentation of a large suprascapular fossa lipoma causing suprascapular nerve traction injury leading to massive rotator cuff tear, treated arthroscopically - case report.

Suprascapular fossa lipoma extending to the suprascapular notch causing traction injury to the suprascapular nerve is a rare presentation. We report a 47-year-old male with progressive weakness of the right shoulder joint of 8 months duration, with a palpable mass over the spine of the scapula was noticed 2 months earlier and developed a sudden drop in arm following a moderate strain. A magnetic resonance imaging (MRI) scan revealed a rotator cuff tear involving the supraspinatus and infraspinatus muscles with a tumor like lesion in the suprascapular fossa, displacing the suprascapular muscle mass and extending into the suprascapular notch. Electromyography and nerve conduction velocity studies revealed suprascapular neuropathy. After histopathologic confirmation, an arthroscopic excision of the mass with decompression of the suprascapular notch was performed along with repair of the rotator cuff. Six months after the procedure, the patient had improved considerably in terms of function and postoperative MRI revealed a complete excision of the mass, and further follow-up of 2 years showed no recurrence. Suprascapular nerve entrapment can be caused by a lipoma in the shoulder, leading to weakness, atrophy, and consequent tear of the rotator cuff tendons. Arthroscopic management, after histopathological confirmation, gives good results in this situation. LEVEL OF EVIDENCE: Level IV.

Knee joint synovial hemangioma treated with arthroscopic resection without hemarthrosis: A case report.

INTRODUCTION: Intra-articular synovial hemangioma of the knee is a relatively rare benign tumor that if left undiagnosed and treated may be followed by degenerative cartilaginous changes and osteoarthritis. However, the non-specific symptoms of synovial hemangiomas limit its early diagnosis. We report our encounter with synovial hemangioma of the knee in which the diagnosis was based on a > 20-year history of chronic pain without joint swelling or hematoma. PRESENTATION OF CASE: A 34-year-old man with a localized vascular malformation on the upper edge of the left patella presented with pain and a restricted range of motion. CT and MRI revealed a tumorous lesion at this location. Upon excision of the lesion, the patient's symptoms disappeared, with no recurrence at the 1-year follow-up. DISCUSSION: Accurate diagnosis and appropriate early treatment are necessary for synovial hemangiomas to forestall articular cartilage degeneration due to recurrent intra-articular hemorrhages. CONCLUSION: Synovial hemangioma should be considered when a patient presents with recurrent knee pain, even in the absence of swelling or episodes of joint effusion.

Effectiveness of arthroscopic excision based on the distribution of the tenosynovial giant cell tumor around knee joint.

BACKGROUND: The mainstay treatment for tenosynovial giant cell tumor (TGCT) is open excision. However, open excision is associated with the risk of stiffness, infection, neurovascular injury, and prolonged hospital stay and rehabilitation. The purpose of this study was to evaluate the efficacy of arthroscopic excision of tenosynovial giant cell tumor (TGCT) of the knee joint, including the diffuse type of TGCT. METHODS: Patients who underwent arthroscopic excision of TGCT between April 2014 and November 2020 were retrospectively analyzed. TGCT lesions were divided into 12 distributions (nine intra- and three extra-articular lesions). The distribution of TGCT lesions, portals used, degree of excision, recurrence, and magnetic resonance imaging (MRI) scans were evaluated. The prevalence of intra-articular lesions in diffuse TGCT was also analyzed to validate the existence of a connection between intra- and extra-articular lesions. RESULTS: Twenty-nine patients were included in the study. Fifteen patients (52%) had localized TGCT, and 14 patients (48%) had diffuse TGCT. The recurrence rates for localized, and diffuse TGCT were 0%, and 7%, respectively. Intra-articular posteromedial (i-PM), intra-articular posterolateral (i-PL), and extra-articular posterolateral (e-PL) lesions were found in all patients with diffuse TGCT. The prevalence rates of i-PM and i-PL lesions among e-PL lesions were both 100% (p = 0.026 and p < 0.001, respectively). Diffuse TGCT lesions were managed with posterolateral capsulotomy and viewed from the trans-septal portal. CONCLUSIONS: Arthroscopic excision of TGCT was effective in both localized and diffuse TGCT. However, diffuse TGCT was associated with posterior and extra-articular lesions. Therefore, technical modification such as posterior, trans-septal portal, and capsulotomy were required. STUDY DESIGN: Retrospective case series; level Ⅳ.

Midterm Clinical, Radiological, and Functional Results of Arthroscopic Excision of Osteoid Osteoma of the Hip Joint: a Case Series.

Purpose: We aimed to evaluate the midterm functional and clinical outcomes of the patients who underwent arthroscopic excision of hip osteoid osteoma (OO). Methods: We reviewed records of patients diagnosed with intra-articular hip OO, treated with hip arthroscopic excision procedure, and a minimum of 1-year postoperative between 2011 and 2020. Clinical outcomes were assessed range of motion (ROM) pre and postoperatively, and functional outcomes were evaluated with a modified Harris hip score (modified HHS) and Visual analog scale test. All patients were assessed by hip radiography, and three radiological measurements, including lateral center-edge angle (LCEA), alpha angle, and Tönnis angle, were measured. These parameters were compared with unaffected hips. Results: Fifteen (5 female and 10 male) patients were included in the study, with a mean age of 32.6 ± 12.7 (range 12-53). The average postoperative follow-up period was 59.1 ± 28 (range 13-106) months. The functional and clinical scores were significantly improved at the final visit compared to the preoperative values. No differences were found between the operated and unaffected sides with respect to the radiological parameters. The preoperative alpha was significantly higher on the operated side than on the unaffected side (p = 0.007). Conclusion: In this study, within an average of 5 years after surgery, hip arthroscopy provided successful clinical outcomes in the treatment of OO of the hip joint without recurrence. The modified HHS, VAS, and HOS values improved significantly at the final follow-up; 14 of 15 patients had satisfactory outcomes after hip arthroscopy for hip OO. Level of Evidence: Prognostic Level IV study.

Intra-articular fibromembranous septum after intra-articular distal radial fracture: Arthroscopic excision and factors associated with formation of the septum.

BACKGROUND: Intra-articular fibromembranous septum in the radiocarpal joint can cause wrist contracture after distal radial fracture, but the mechanism underlying the formation of the septum is unknown. This study examined the clinical outcomes in patients treated with arthroscopic excision of the septum and the factors associated with formation of the septum in patients with and without a septum. METHODS: Fifty-three patients (22 with septum and 31 without septum) treated for intra-articular distal radial fracture with arthroscopy using a volar locking plate and secondary removal of the plate were included. Clinical outcomes and radiological assessments were analyzed. RESULTS: In patients with a septum, the range of wrist flexion and total wrist arc before the second operation were significantly more limited than in those without a septum (p < 0.01 and p = 0.03, respectively). The improvement rate (improvement in wrist arc divided by the wrist arc of the healthy side) after arthroscopic excision of the septum and plate removal was greater in patients with a septum than in those without a septum (6.1% vs. 2.0%, p = 0.08). The significant factors affecting formation of the septum were the residual articular gap and the height of the midradial ridge on computed tomography images. CONCLUSIONS: Intra-articular fibromembranous septum after surgically treated intra-articular distal radial fracture affects limited range of motion and secondary arthroscopic excision of the septum improves the wrist range of motion. Anatomical reduction and maintenance of the articular fragment, as well as anatomical characteristics might be causes of septum formation.

Osteoid osteoma of the base of the coracoid process - A case report.

INTRODUCTION: Osteoid osteomas (OO) are small, well-defined, benign bone tumors of the young that are commonly found in long bones. In rare circumstances, when present elsewhere, they can mimic the symptoms of other pathologies pertaining to that area. PRESENTATION OF CASE: We present such case in which an "OO" of the coracoid process led to a 2-year delay in diagnosis and management of a young male due to the presenting symptoms resembling those of other shoulder pathologies. Ultimately, the use of advanced imaging modalities proved to be useful in detecting the "OO", which was consequently arthroscopically excised. DISCUSSION: Appropriate imaging modalities such as CT or MRI often visualize the characteristic nidus more clearly as opposed to an X-ray and should therefore be used early when conservative management of shoulder pain has not been proven to be useful. CONCLUSION: A long history of shoulder pain that is not responsive to conservative management in young patients should raise the suspicion of an "OO", and physicians should be encouraged to use early advanced imaging modalities in order to confirm it.

Clinical manifestation and arthroscopic treatment of symptomatic posterior cruciate ligament cyst.

BACKGROUND: Ganglion cyst of cruciate ligaments is a rare lesion; the prevalence is 0.3-0.8%. The purpose of this study was to present clinical features of symptomatic posterior cruciate ligament (PCL) cyst, introduce the arthroscopic excision technique, and evaluate the clinical outcome. METHODS: A series of 11 patients with symptomatic PCL cyst from November 2012 to December 2014 were involved in this retrospective study. Detailed medical history collecting and physical examination were conducted. Magnetic resonance imaging (MRI) scan was used to confirm the diagnosis. Arthroscopic resection was performed, and the sample of the cyst was taken for pathologic examination. The follow-up averaged 30.7 months. International Knee Documentation Committee (IKDC) score, the range of motion (ROM), and MRI evaluations were obtained pre- and postoperatively to assess the surgical outcome. SPSS software was used for statistics analysis. RESULTS: Eight males and 3 females with 6 left knees and 5 right knees were enrolled, the mean age was 34.4 years, and the duration of symptom was 19.0 months. All cases had a definite history of knee trauma or injury. The most common symptom was knee pain at flexion or in flexion-associated activities. MRI revealed the location and size of the cyst in each case. Pathologic examination showed the cyst wall was composed of dense fibroconnective tissue and widespread thick bundles of collagen, which is similar to the structure of ganglion cyst. At the final follow-up, MRI evaluation showed no cyst recurrence. The preoperative ROM and IKDC score were 2.3° to 108.6° and 40.5 ± 11.3, respectively, compared with the postoperative ROM and IKDC score which were 0° to 134.1° and 85.5 ± 4.8 (p < 0.05) separately. CONCLUSIONS: We conclude that the etiology of symptomatic PCL cyst is most likely associated with trauma, pain on flexion is a typical manifestation of symptomatic PCL cyst, MRI evaluation is an ideal examination for the diagnosis, and arthroscopic resection of symptomatic PCL cysts has a good outcome with no recurrence.

Arthroscopic versus open excision of dorsal ganglion cysts: a systematic review.

We conducted a systematic review comparing recurrence and complication rate following open versus arthroscopic excision of ganglion cysts. Sixteen full-text articles were included. The pooled recurrence rate of open excision was 20% (range: 5.6-40.7%) with Q value of 27 and I2 of 82%. The pooled recurrence rate of arthroscopic excision was 9% (range: 0-17%) with Q value of 10 and I2 of 2%. Eleven of 16 studies were low quality or had a high risk of bias; however, excluding low quality studies or those with high risk of bias produced similar recurrence rates in arthroscopic and open excision (7.9% versus 9.8%). For the subset of studies with complete reporting of complications, rates were similar in open and arthroscopic excision (6% versus 4%). Our review suggests that arthroscopic and open approaches have comparable outcome profiles. Nevertheless, standardized study methods with adequate powering are required to collect high quality data, allowing for greater confidence in conclusions regarding these two approaches for existing ganglion cysts. LEVEL OF EVIDENCE: II.

Optimal management of symptomatic os acromiale: current perspectives.

The majority of os acromiale is asymptomatic and requires no treatment. In patients with shoulder pain, os acromiale is a possibility in the differential diagnosis and may imitate shoulder impingement. The diagnosis of symptomatic os acromiale can be proven by combining physical examination, conventional radiographs, magnetic resonance imaging, and selective injections. Surgical treatment is indicated in those patients with failed conservative therapy, in those with highly painful and unstable os acromiale, or in those with associated shoulder pathologies such as rotator cuff tears. Open or arthroscopic excision is indicated in patients with pre-type os acromiale. In meso-type acromiale, arthroscopic excision, acromioplasty, or open reduction and internal fixation have all been used, but fixation is usually preferred. Internal fixation should be done either with cannulated screws alone or in combination with tension band, which has biomechanical advantages.

Osteoid osteoma (OO) of the coracoid: a case report of arthroscopic excision and review of literature.

Osteoid osteoma (OO) of the coracoid is a rare entity that may present with variable symptoms from shoulder leading to delay in diagnosis and treatment. We present the clinical and radiological findings and management of one such case along with a review of similar cases reported in the literature. There was a delay of 2 years in diagnosis, which was later confirmed by computed tomography in addition to magnetic resonance imaging (MRI). The lesion was accessed arthroscopically and excised by unroofing and curettage. "OO" should be included in the differential diagnosis of shoulder pain in young patients not responding to long-term conservative treatment. Arthroscopic excision and curettage provide a good choice for management, with low morbidity and rapid recovery.

Arthroscopic excision of acetabular osteoid osteoma in a 7-year-old patient.

The purpose of this study was to present the case report of a 7-year-old patient who was treated with hip arthroscopy for an acetabular osteoid osteoma. A 7-year-old patient was referred to our clinic with hip pain. In the assessment of the patient, an acetabular osteoid osteoma was detected in his right hip; it was adjacent to his triradiate cartilage. An arthroscopic surgery was planned as an alternative to open safe hip dislocation. The osteoid osteoma was completely removed with hip arthroscopy. Postoperative CT scanning and histopathological analysis confirmed the diagnosis. Exposure of the acetabulum can be problematic in paediatric patients due to the potential risks of open safe dislocation. Hip arthroscopy can safely be used for benign hip lesions in paediatric patients. Level of evidence Case report, Level V.

Recurred Multiple Intraarticular Synovial Hemangioma of the Knee: Case Report / 대한정형외과연구학회지

Synovial hemangioma is a rare benign intraarticular tumor. Synovial hemangioma of the knee joint has unspecific symptoms, which are pain, limitation of motion and hemarthrosis, often seen as an internal derangement of the knee. A 24-year-old woman presented with intermittent joint effusion and pain of the left knee joint and physical examination revealed slight atrophy of the quadriceps and tenderness around lateral joint line of knee. The patient was performed arthroscopic surgery due to synovial hemangioma about 17-years ago. Magnetic resonance imaging (MRI) showed the synovial hemangioma from Hoffa fat pad to anterior aspect of lateral meniscus, and thus surgical treatment was planned. Arthroscopic excision was performed and additional lesion was observed in lateral gutter, suprapatellar pouch of the knee. The biopsy confirmed the diagnosis of synovial hemangiomas. After 3 year, the patient was completely asymptomatic and showed no signs of recurrence.

Arthroscopic excision of ganglion cysts.

Arthroscopy is an advancing field in orthopedics, the applications of which have been expanding over time. Traditionally, excision of ganglion cysts has been done in an open fashion. However, more recently, studies show outcomes following arthroscopic excision to be as good as open excision. Cosmetically, the incisions are smaller and heal faster following arthroscopy. In addition, there is the suggested benefit that patients will regain function and return to work faster following arthroscopic excision. More prospective studies comparing open and arthroscopic excision of ganglion cysts need to be done in order to delineate if there is a true functional benefit.

Arthroscopic Fragment Excision of Pipkin Type I Displaced Femoral Head Fracture: A Case Report / 대한고관절학회지

There has been a variety of options for treatment of femoral head fracture with hip dislocation according to the Pipkin classification. Pipkin type I fractures with minimal displacement have been treated conservatively. However, in cases where the fracture was displaced or reduced incongruently, it has been treated by open fragment excision or fixation after reduction. In our case, the patient was a 62-year-old man who sustained a displaced fracture of Pipkin type I. We achieved a satisfactory outcome by arthroscopic excision of a displaced bony fragment and small bony fragments that could not be confirmed by pre-operative imaging study. Therefore, we report on the case with a review of the literature.

Arthroscopic excision of a symptomatic os trigonum in a lateral decubitus position.

BACKGROUND: The purpose of this study was to introduce our technique of arthroscopic excision of the os trigonum in the lateral decubitus position through anterolateral, centrolateral, and posterolateral portals and also to investigate the safety and clinical results of this technique. METHODS: Between May 2007 and May 2011, 23 ankles of 23 consecutive patients underwent subtalar arthroscopic removal of the os trigonum in a lateral decubitus position. Twenty patients were male and 3 were female. All patients injured their ankles during sports activities. Mean duration of postoperative follow-up was 18 months, and no patients were lost to follow-up. Clinical evaluations were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analog scale (VAS) for pain. The time to return to work and sports activities was assessed. RESULTS: Average AOFAS ankle-hindfoot score increased from 71.3 (range, 59-85) preoperatively to 94.7 (range, 90-100) postoperatively, and VAS for pain decreased from 6.7 (range, 3-10) to 1.5 (range, 0-3). Average plantarflexion of the ankle increased from 28.8 degrees (range, 15-40) preoperatively to 42.5 degrees (range, 25-50) postoperatively. Mean time to resumption of sports activities was 6.7 weeks (range, 5-12). There were no major complications in any patient. CONCLUSION: Arthroscopic excision of a symptomatic os trigonum using anterolateral, centrolateral, and posterolateral portals in the lateral decubitus position was a safe and effective technique. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Arthroscopic versus posterior endoscopic excision of a symptomatic os trigonum: a retrospective cohort study.

BACKGROUND: Both subtalar arthroscopic and posterior endoscopic techniques are used to treat posterior ankle impingement syndrome (PAIS). However, there have been no studies comparing the 2 procedures. HYPOTHESIS: Both arthroscopic and endoscopic excisions of the os trigonum are safe and effective in treating PAIS. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Twenty-eight patients were treated with excision of the os trigonum either by an arthroscopic (16 patients) or endoscopic (12 patients) technique. The mean patient age was 29.8 years (range, 17-55 years), and the mean follow-up period was 30 months (range, 18-58 months). Preoperative and postoperative visual analog scale (VAS) score for pain, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Maryland Foot Score (MFS) were used to analyze the functional results. Duration of surgery, time to return to sports (RTS), and patient satisfaction were evaluated as well. The size of the os trigonum was measured using T1-weighted sagittal magnetic resonance imaging (MRI). The clinical and MRI results were compared between the 2 groups. RESULTS: The VAS score, AOFAS score, and MFS for both the arthroscopic group (preoperative: 6.3, 63.8, and 61.5, respectively; postoperative: 1.2, 89.9, and 89.6, respectively) and endoscopic group (preoperative: 6.7, 64.8, and 62.5, respectively; postoperative: 1.2, 89.9, and 88.4, respectively) improved significantly (P < .01). The mean surgery and RTS times were 39.4 minutes and 7.5 weeks in the arthroscopic group and 34.8 minutes and 8.0 weeks in the endoscopic group, respectively (P > .05). All patients were satisfied with the results. There were no significant differences between the 2 groups in the preoperative and postoperative VAS score, AOFAS score, or MFS (P > .05). The mean size of the os trigonum was 11.1 × 8.8 mm(2) in the arthroscopic group and 12.6 × 10.4 mm(2) in the endoscopic group, and the difference was significant (P < .05). Two patients underwent both arthroscopic and endoscopic procedures because of technical difficulty in removing the large os trigonum arthroscopically. CONCLUSION: Both arthroscopic and posterior endoscopic excisions of the os trigonum were safe and effective in treating PAIS. The arthroscopic procedure was more demanding, especially in cases of a large os trigonum. The posterior endoscopic approach had the advantage of addressing problems in the posterior ankle joint and allowed a more extensive release of the flexor hallucis longus.

Symptomatic Posterior Cruciate Ganglion Cyst Causing Impingement between Posterior Root of the Medial Meniscus and Anterior to the Posterior Cruciate Ligament.

There are several reports of symptomatic ganglion cysts near the posterior cruciate ligament (PCL), but no reports of a symptomatic ganglion originating from the anterior aspect of the PCL in the deep recess between the posterior root of the medial meniscus and the PCL, bulging into the posteromedial joint space. In this report, we present the clinical features of a patient with a symptomatic ganglion cyst treated successfully by arthroscopic excision.

Symptomatic Posterior Cruciate Ganglion Cyst Causing Impingement between Posterior Root of the Medial Meniscus and Anterior to the Posterior Cruciate Ligament

There are several reports of symptomatic ganglion cysts near the posterior cruciate ligament (PCL), but no reports of a symptomatic ganglion originating from the anterior aspect of the PCL in the deep recess between the posterior root of the medial meniscus and the PCL, bulging into the posteromedial joint space. In this report, we present the clinical features of a patient with a symptomatic ganglion cyst treated successfully by arthroscopic excision.

A Case of Synovial Hemangioma of the Knee

We report an unusual case of a 17-years-old male with complaints of pain and swelling of the left knee for the last 3 years with limitation of movement. He presented with spontaneous hemarthrosis of the knee joint. Magnetic resonance imaging revealed an intra articular mass. Arthroscopic excision was performed and the histology was characteristic of synovial hemangioma. After 1 year, the patient was completely asymptomatic and showed no signs of recurrence.