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Arthroscopy Techniques Jul 2023Rheumatoid arthritis is characterized by hypertrophic synovitis destroying the involved joints. If medical treatment fails to control the synovitis, synovectomy is a...
Rheumatoid arthritis is characterized by hypertrophic synovitis destroying the involved joints. If medical treatment fails to control the synovitis, synovectomy is a worthwhile prophylactic procedure that might help to delay further distention of the joint capsule and ligament. Synovitis of the proximal interphalangeal joint is usually performed by an open approach. The major complication is scar development around the interphalangeal joint, leading to considerable joint contracture. Arthroscopy of the proximal interphalangeal joint is a minimally invasive technique that can eliminate the risk of joint contracture associated with open surgery. The purpose of this Technical Note is to report the technical details of arthroscopic complete synovectomy of the proximal interphalangeal joint of the finger. This procedure is indicated in patients with rheumatoid synovitis of the proximal interphalangeal joint of the finger recalcitrant to medical treatment. It is contraindicated in case of an established boutonniere or swan-neck deformity, the presence of large dorsal synovial cysts, advanced degeneration of the joint, the presence of joint instability, or a fresh skin lesion near portals.
PubMed: 37533917
DOI: 10.1016/j.eats.2023.03.004 -
Radiology Case Reports Jun 2024Lipoma arborescens is a rare and benign intra-articular lesion characterized by a lipomatous proliferation of the synovial membrane, usually affects the knee joint. It...
Lipoma arborescens is a rare and benign intra-articular lesion characterized by a lipomatous proliferation of the synovial membrane, usually affects the knee joint. It presents as an unusual cause of intermittent knee pain and joint effusion. We report a case of lipoma arborescens of the knee in a 23-year-old man that initially resembled inflammatory arthropathy. The diagnosis of Lipoma arborescens was made by magnetic resonance imaging of the knee and confirmed histologically by synovectomy. The purpose of our case is to show the imaging features enabling early diagnosis and appropriate treatment.
PubMed: 38559650
DOI: 10.1016/j.radcr.2024.02.106 -
Cureus Jan 2024Synovial chondromatosis is a rare and benign disorder that involves the synovial lining of joints, synovial sheaths and bursae. The synovial layer of the joint is...
Synovial chondromatosis is a rare and benign disorder that involves the synovial lining of joints, synovial sheaths and bursae. The synovial layer of the joint is affected by a metaplastic process which in turn converts it into cartilagenous tissue. Eventually, it gets dislodged and transformed into a loose body in the large joints. We report the case of a 24-year-old young athlete who presented with complaints of painful movements and restriction of joint movements associated with a growing deformity in the right knee joint. This case report aims to describe a rare synovial pathology that necessitated arthroscopic synovectomy and diagnostic arthroscopy to treat, particularly in younger individuals. The atypical feature, in this case, was metaplastic development from the peripheral joint capsule attached to the surrounding cartilage, which, to the extent that the authors are aware, has only been documented in one instance in the record. Magnetic resonance imaging (MRI) was performed which demonstrated evidence of the joint effusion, synovial hypertrophy and a loose calcific body just anterior of the distal femoral condyle causing pressure over the patellar tendon anteriorly as well as a hyper-dense cyst in the popliteal region. Treatment often requires partial or complete synovectomy with either an arthroscopic or open approach.
PubMed: 38420086
DOI: 10.7759/cureus.53173 -
International Journal of Surgery Case... Jun 2024Synovial lipomatosis is a rare disease that often results in joint discomfort, swelling, and effusion. Only a few reported cases have been documented so far.
INTRODUCTION AND IMPORTANCE
Synovial lipomatosis is a rare disease that often results in joint discomfort, swelling, and effusion. Only a few reported cases have been documented so far.
CASE PRESENTATION
We reported a 50-year-old woman with synovial lipomatosis of the ankle joint. The patient presented with left ankle pain since the least two years, accompanied by swelling and redness. Physical examination demonstrated swollen ankle with warmth palpation. Magnetic resonance imaging (MRI) demonstrated hyperintensity of the ankle joint on the posterior and anterolateral side, thickening of the synovium, and bone marrow edema around the talar bone, surrounding the sinus tarsi. Histopathological examination demonstrated fatty tissues with nonspecific inflammation, suggesting synovial lipomatosis. We performed synovectomy, and the pain did not recur at 1 year of follow-up.
CLINICAL DISCUSSION
Synovial lipomatosis is a highly uncommon benign condition. Histopathologically, synovial lipomatosis is characterized by notable adipocyte infiltration into the subsynovial tissue and a villous or frond-like morphology of the synovium. It also features transversely hyperplastic synovial lining cells.
CONCLUSION
Synovial lipomatosis of the ankle joint is a rare entity. Further studies are required to investigate this disease and its management.
PubMed: 38677252
DOI: 10.1016/j.ijscr.2024.109694 -
JSES International Nov 2023
PubMed: 37969494
DOI: 10.1016/j.jseint.2023.07.003 -
Journal of Orthopaedic Case Reports Nov 2023Pigmented villonodular synovitis (PVNS)is a very uncommon lesion that involves the synovium of joints, tendon sheaths, or bursae. Approximately 2.5% of cases occur...
INTRODUCTION
Pigmented villonodular synovitis (PVNS)is a very uncommon lesion that involves the synovium of joints, tendon sheaths, or bursae. Approximately 2.5% of cases occur around the ankle. PVNS was earlier considered to be a synovial malignancy. Complete surgical excision is curative if bony destruction is not there. Radiotherapy is rarely helpful for residual lesions.
CASE REPORT
We share a case report on PVNS of ankle in a 22-years old male patient. Clinical diagnosis was confirmed with the help of magnetic resonance imaging and histopathology. A surgical excision with synovectomy was carried out. There were no signs of recurrence in 1.5 years follow-up.
CONCLUSION
Complete surgical excision with radical synovectomy is crucial for the treatment of PVNS in rare locations like the ankle joint.
PubMed: 38025346
DOI: 10.13107/jocr.2023.v13.i11.4034 -
Orthopaedic Surgery Jul 2023Undifferentiated chronic monosecarthritis (UCMA) is a group of inflammatory joint diseases that has the potential to progress to other diseases and can seriously affect...
OBJECTIVE
Undifferentiated chronic monosecarthritis (UCMA) is a group of inflammatory joint diseases that has the potential to progress to other diseases and can seriously affect patients' quality of life. There is yet no unified consensus regarding treatment of UCMA. This study aimed to investigate the efficacy of arthroscopic synovectomy combined with partial wrist denervation in treating Larsen 1-3 UCMA.
METHODS
In this case series, we reviewed 14 patients with UCMA treated by arthroscopic synovectomy combined with partial denervation from February 2017 to June 2020. The mean duration of symptoms was 17.4 months (range, 4-60 months), and the mean follow-up was 13.3 months (range, 6-23 months). The anterior and posterior interosseous nerves were severed at the distal forearm, and the radiocarpal, midcarpal, and distal radial ulnar joint synovial membranes were arthroscopically resected at the wrist. The clinical evaluation indices included the visual analogue scale score (VAS) for pain, grip strength, range of (active) motion of the wrist, total active motion, and Mayo wrist score. Larsen's scoring method was used as the imaging evaluation index.
RESULTS
At the last follow-up, significant clinical improvements were observed in the visual analogue scale (VAS) score for pain (6.0 (5.0-6.3) vs 1.0 (1.0-2.3), P = 0.001) and Mayo wrist score (42.1 ± 9.7 vs 61.8 ± 12.3, P < 0.0001). No significant changes were found in grip strength (15.9 ± 4.5 vs 16.6 ± 4.7, P = 0.230) or the flexion-extension arc (58.9 ± 39.0 vs 64.3 ± 36.5, P = 0.317), although the mean and median did show positive changes. Among the three patients who showed progress in imaging, there was no significant difference in their pain and functional scores compared to those who did not progress. One patient underwent total wrist fusion 17 months after the operation.
CONCLUSION
Arthroscopic wrist synovectomy combined with partial wrist denervation can provide sustained pain relief and functional recovery for patients with Larsen 1-3 UCMA.
Topics: Humans; Arthritis; Arthroscopy; Denervation; Pain; Quality of Life; Range of Motion, Articular; Synovectomy; Synovial Membrane; Treatment Outcome; Wrist
PubMed: 37385950
DOI: 10.1111/os.13762 -
World Journal of Orthopedics Nov 2023Cyclops lesions are a known complication of anterior cruciate ligament (ACL) reconstruction, with symptomatic cyclops syndrome occurring in up to 11% of surgeries....
BACKGROUND
Cyclops lesions are a known complication of anterior cruciate ligament (ACL) reconstruction, with symptomatic cyclops syndrome occurring in up to 11% of surgeries. Recurrent cyclops lesions have been rarely documented; this case study documents the successful treatment of a recurrent cyclops lesion.
CASE SUMMARY
A 28-year-old female presented following a non-contact injury to the right knee. Workup and clinical exam revealed an ACL tear, and arthroscopic reconstruction was performed. Two years later a cyclops lesion was discovered and removed arthroscopic synovectomy. Seven months postoperatively, the patient presented with pain, stiffness, and difficulty achieving terminal extension. A smaller recurrent cyclops lesion was diagnosed, and a repeat synovectomy was performed. The patient recovered fully.
CONCLUSION
To the best of our knowledge, this is the first documented case of recurrent cyclops lesion after bone-patellar tendon-bone allograft ACL reconstruction presenting as cyclops syndrome.
PubMed: 38075472
DOI: 10.5312/wjo.v14.i11.836 -
Cureus May 2024Synovial chondromatosis is a rare condition characterized by benign metaplasia of the synovial membrane, leading to nodular growths within the joint space. We present...
Synovial chondromatosis is a rare condition characterized by benign metaplasia of the synovial membrane, leading to nodular growths within the joint space. We present the case of a 58-year-old woman with persistent pain and stiffness in her right elbow, ultimately diagnosed with synovial chondromatosis. Examination revealed joint effusion, tenderness, and restricted range of motion, with palpable loose bodies and ulnar nerve symptomatology. X-ray confirmed the diagnosis. Open synovectomy was performed, with meticulous attention to ulnar nerve protection and decompression. Postoperative care included analgesics, anti-inflammatories, and physiotherapy. Synovial chondromatosis of the elbow requires prompt diagnosis and surgical intervention to alleviate symptoms and prevent complications. Prognosis is favorable with complete removal of the affected tissue. Ulnar nerve palsy should be carefully addressed during surgical management.
PubMed: 38846186
DOI: 10.7759/cureus.59807 -
International Journal of Surgery Case... Sep 2023Patellar tendon ossification is a rare complication that primarily occurs following a knee injury. This article aims to describe, for the first time, a case of patellar...
INTRODUCTION
Patellar tendon ossification is a rare complication that primarily occurs following a knee injury. This article aims to describe, for the first time, a case of patellar tendon ossification following synovectomy.
CASE PRESENTATION
A 48-year-old male with a diagnosis of rheumatoid arthritis presented with swelling in his left knee following a synovectomy procedure. After a thorough physical examination, radiographic assessment, and computed tomography, the patient was diagnosed with total patellar tendon ossification. Subsequently, the patient underwent excision of the ossified mass and tendon reconstruction using an Achilles allograft.
DISCUSSION
The primary causes of patellar tendon ossification are iatrogenic and traumatic injuries. The presence of rheumatoid arthritis, which negatively affects tissue healing, may exacerbate this condition. Smaller lesions can be managed conservatively or through resection and repair. In cases of extensive ossification, resection and reconstruction are necessary. A comprehensive literature review is also provided.
CONCLUSION
The occurrence of patellar tendon swelling following trauma or surgery should raise suspicion of patellar tendon ossification. Rheumatoid arthritis is a risk factor for the development of patellar tendon ossification. In cases of extensive ossification, successful treatment can be achieved through reconstruction using an Achilles allograft.
PubMed: 37574628
DOI: 10.1016/j.ijscr.2023.108574