-
World Journal of Orthopedics Jun 2024In this case report featured in , Kelmer describe a rare finding of a 28-year-old female patient who presented with a recurrent fibroreactive nodule 7 months following...
In this case report featured in , Kelmer describe a rare finding of a 28-year-old female patient who presented with a recurrent fibroreactive nodule 7 months following the resection of a primary cyclops lesion, suggesting recurrent cyclops syndrome. The patient had undergone an initial anterior cruciate ligament reconstruction for a non-contact right knee injury and reported successful recovery. Two years later, the patient sustained a repeat right knee injury followed by a positive McMurray test and acute pain with terminal extension. Arthroscopic synovectomy confirmed magnetic resonance imaging (MRI) finding of a cyclops lesion, which was surgically removed. Seven months postoperatively, the patient reported stiffness and difficulty with terminal extension. Repeat MRI indicated a recurrent cyclops lesion, which was surgically resected. Following resection of the second lesion, the patient underwent physical therapy and achieved full range of motion, maintaining complete recovery 19 months postoperatively. Recurrent cyclops lesions have rarely been reported in the literature, and this article is novel in its report of recurrent cyclops syndrome following a bone-patellar tendon-bone allograft. The presentation of this unusual finding exposes a need for further investigation of cyclops lesion pathology, which will aid its prevention and treatment.
PubMed: 38947257
DOI: 10.5312/wjo.v15.i6.495 -
Arthroplasty Today Jun 2024A 78-year-old Thai male presented with chronic bilateral knee pain and swelling. X-ray imaging revealed osteoarthritis in both knees, with a suspicious soft tissue... (Review)
Review
A 78-year-old Thai male presented with chronic bilateral knee pain and swelling. X-ray imaging revealed osteoarthritis in both knees, with a suspicious soft tissue shadow. Magnetic resonance imaging suggested lipoma arborescens (LA). The patient underwent LA excision with a complete synovectomy, followed by simultaneous bilateral total knee arthroplasty (SBTKA). Pathological examination confirmed LA. At the 2-year follow-up, the patient reported no complications, adverse outcomes, or recurrence. The intervention improved joint function and pain relief, allowing for early ambulation and full weight-bearing post-surgery. This case highlights the success of complete synovectomy with SBTKA, addressing bilateral knee pathology concurrently. The combined approach reduced operative time and significantly improved joint function and pain relief, emphasizing the benefits of timely surgical intervention and suggest potential advantages of SBTKA for optimal patient outcomes.
PubMed: 38946921
DOI: 10.1016/j.artd.2024.101406 -
Rheumatology (Oxford, England) Jun 2024Recurrent monoarthritis (RM) is a major challenge of many rheumatic diseases. Ablation is a well-known technique in the treatment of benign or malign lesions of...
OBJECTIVES
Recurrent monoarthritis (RM) is a major challenge of many rheumatic diseases. Ablation is a well-known technique in the treatment of benign or malign lesions of different etiologies. We aimed to to investigate the success and safety of microwave ablation (MWA) as an adjunctive therapy in a cohort of medical treatment-resistant RM.
METHODS
Patients with RM associated with different inflammatory diseases were included. MWA was performed after measuring the size of synovial hypertrophy with 15 or 20-watt power and different durations until microbubbles were shown indicating necrosis. Both clinical and radiologic data were recorded.
RESULTS
We applied MWA in total of 24 knee joints of 10 female and 12 male patients aged between 22-71 years. Median intra-articular aspiration (IAA) need in the last 6 months before MWA was 5 (0-15). The median follow-up was 10 (3-16) months. Overall IAA count in the last 6 months before MWA in total of 144 months was 129 and decreased to 7 in post-MWA in total of 226 months (0.89 vs 0.03 per month, p< 0.001). The second MWA session was needed for 3 patients and a third session for 1. Functional disability and pain scores were improved significantly (median score from 9 to 1, p< 0.00001, in both). In magnetic resonance imaging, follow-up significant regression in synovial hypertrophy size was shown especially after 6th month. No complication was observed during the procedure or follow-up.
CONCLUSION
As a less invasive technique compared with the surgical approach, MWA of synovial hypertrophy showed significant clinical improvement in RM safely. MWA seems promising as a treatment option candidate in the management of RM.
PubMed: 38941501
DOI: 10.1093/rheumatology/keae348 -
Cureus May 2024Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the...
Primary synovial osteochondromatosis (PSO), a seldom-seen synovial proliferative disease involving chondral metaplasia, presents a unique challenge when affecting the ankle joint. Controversy exists regarding whether a combined posterior-anterior approach with total synovectomy is necessary to avert recurrence or malignancy. An 18-year-old Caucasian male presented to the outpatient clinic with clinical and imaging findings indicative of a stage III PSO. The surgical intervention involved a combined posterior-anterior arthroscopic approach with the removal of multiple loose bodies and complete synovectomy, resulting in complete relief of symptoms without recurrence at the 12-month follow-up. Pathological examination confirmed the diagnosis. The management of PSO in the ankle joint using a combined posterior-anterior arthroscopic approach with complete synovectomy demonstrated effectiveness in this case. Regular follow-ups are essential for monitoring long-term outcomes and detecting potential recurrence or malignant transformation.
PubMed: 38910686
DOI: 10.7759/cureus.60843 -
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 -
BMJ Case Reports May 2024We present a case of a woman in her 30s who visited the rheumatology clinic due to her persistent knee pain for 5 years, which spread to multiple joints. She was...
We present a case of a woman in her 30s who visited the rheumatology clinic due to her persistent knee pain for 5 years, which spread to multiple joints. She was diagnosed with seropositive rheumatoid arthritis (RA). While most joints responded well to methotrexate and subsequently etanercept, persistent unilateral knee pain prompted further investigation. Imaging revealed synovitis and joint effusion in her knee, prompting arthroscopy and synovial biopsy, revealing pigmented villonodular synovitis (PVNS). Despite initial success with a tricompartmental synovectomy, her disease recurred. The decision was made to pursue medical therapy, with pexidartinib initiated by the oncology team. Our case report highlights the importance of considering other underlying conditions in patients with RA who do not achieve full clinical improvement despite standard treatment. Physicians should remain vigilant for atypical presentations and imaging features in patients with RA, for early recognition of PVNS can significantly impact treatment decisions and patient outcomes.
Topics: Humans; Synovitis, Pigmented Villonodular; Female; Arthritis, Rheumatoid; Knee Joint; Adult; Arthroscopy; Arthralgia; Synovectomy; Antirheumatic Agents; Magnetic Resonance Imaging; Diagnosis, Differential
PubMed: 38821562
DOI: 10.1136/bcr-2023-258004 -
Current Rheumatology Reviews 2024Synovial hemangioma is a benign soft-tissue tumor of vascular origin. Hemangioma only accounts for 1% of all bone lesions and is mostly an incidental finding among the...
INTRODUCTION
Synovial hemangioma is a benign soft-tissue tumor of vascular origin. Hemangioma only accounts for 1% of all bone lesions and is mostly an incidental finding among the primary skeleton tumors. A delay in diagnosis results in joint degeneration and osteoarthritic damage because of infiltrating tumor growth.
CASE PRESENTATION
We presented a rare case of an intra-articular synovial hemangioma in a 13- year-old pediatric patient who was asymptomatic for 5 years. She attended orthopedics OPD at AIIMS, Mangalagiri. Surgical excision of the mass and partial synovectomy was done. Synovial hemangioma came out to be the diagnosis following a histologic study.
CONCLUSION
As radiography has limited diagnostic ability, synovial hemangiomas are difficult and challenging to identify on an outpatient basis. Histological examination and magnetic resonance imaging are extremely helpful. To minimize the hemarthrosis risks, early complete excision can be used as the best treatment modality.
Topics: Humans; Female; Adolescent; Hemangioma; Knee Joint; Synovial Membrane; Arthralgia; Synovectomy; Soft Tissue Neoplasms; Magnetic Resonance Imaging; Edema
PubMed: 38807471
DOI: 10.2174/0115733971266035231123154807 -
Journal of the Chinese Medical... May 2024Ligamentous laxity, cartilage wear, and diffuse synovitis are frequently seen in thumb basal joint arthritis. Although these degenerative changes may be mild for the...
BACKGROUND
Ligamentous laxity, cartilage wear, and diffuse synovitis are frequently seen in thumb basal joint arthritis. Although these degenerative changes may be mild for the majority, they have the potential to cause discomfort during movement and compromised hand function. This study assesses the long-term outcomes of arthroscopic debridement, synovectomy, and thermal shrinkage in managing early-stage basal joint arthritis.
METHODS
We retrospectively reviewed patients with basal joint arthritis who underwent arthroscopic debridement, synovectomy, and thermal shrinkage between November 2010 and January 2021 by a single surgeon at our medical institute. We assessed functional outcomes, thumb range of motion, perioperative nonsteroidal anti-inflammatory drug (NSAID) use, return to work and satisfaction level.
RESULTS
A total of 12 patients (13 hands), with a mean follow-up of 72 months, were included in this study. Significant improvements were observed in pain scores and functional outcomes, along with a reduction in postoperative NSAID use. Patients also reported a relatively quick return to work and a high satisfaction level.
CONCLUSION
The study highlights the benefits of arthroscopic intervention, providing a minimally invasive approach with favorable long-term outcomes for patients with symptomatic basal joint arthritis.
PubMed: 38771089
DOI: 10.1097/JCMA.0000000000001110 -
Cureus Apr 2024Introduction Pigmented villonodular synovitis (PVNS) is a relatively rare disorder affecting the synovial membrane and tendon sheath of a joint. It rarely affects the...
Introduction Pigmented villonodular synovitis (PVNS) is a relatively rare disorder affecting the synovial membrane and tendon sheath of a joint. It rarely affects the shoulder joint. This prospective study aims to document the challenges encountered in achieving total synovectomy and assesses the clinical outcomes of arthroscopic synovectomy for PVNS in shoulder patients. Methods This is a prospective study conducted from April 2017 to September 2023. This monoarticular disease was observed among six patients (four females and two males). All patients underwent arthroscopic extensile synovectomy with biopsy and culture. The outcomes were measured using Constant score, American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) scores. All patients were followed up for a minimum of 36 months after arthroscopic synovectomy. Results All intraoperative findings were consistent with PVNS and confirmed with histopathological examination. All patients achieved a satisfactory, painless range of movements following surgery. The individual Constant score improved from a mean value of 64.83 to 94.50, the ASES score improved from a mean value of 81.15 to 99.73, and the UCLA score improved from a mean value of 23.16 to 34.83 post-arthroscopic intervention, proving its effectiveness. No recurrences were reported after 36 months of follow-up. Conclusion PVNS can be easily missed, and one must have a high index of suspicion to diagnose early. Delayed presentation of the disease had led to severe destruction of the joint. Early diagnosis and arthroscopic intervention prior to joint destruction are crucial for achieving a good functional outcome. Incomplete excision may lead to recurrence of the disease. Therefore, we propose extensile arthroscopic synovectomy of the shoulder, wherein by expecting and addressing the intraoperative challenges, complete excision can be achieved, thus preventing recurrence.
PubMed: 38707076
DOI: 10.7759/cureus.57492 -
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