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Case: Synovial chondromatosis is a rare, benign condition characterized by metaplasia of the synovial membrane with formation of multiple cartilaginous nodules within the synovium. This case is of a 58-year-old male who initially presented with right knee pain. The patient was ultimately found to have extensive synovial chondromatosis. The diagnosis was confirmed by histopathologic evaluation and treated with loose body removal and radical synovectomy via an arthroscopic approach. Conclusion: Fully arthroscopic approaches described have been shown to decrease patient morbidity while providing adequate synovial resection and thorough joint debridement. Here we describe the clinical presentation, pathophysiology, diagnostic modalities, and management options synovial chondromatosis of the knee.

Introduction: People with haemophilia (PWH) not administered primary haematological prophylaxis since childhood, that is, those treated haematologically on demand or not treated at all, often experience the degeneration of the ankles, leading to pain and functional impairment. Aim: To analyse the outcomes and complications of arthroscopic ankle surgery performed on PWH. Methods: For this narrative review of the literature, a search was conducted in PubMed on 2, December 2023, using the keywords "haemophilia", "ankle" and "arthroscopy". Of the 29 articles identified, 15 specifically related to ankle arthroscopy in PWH were selected (inclusion criterion). The remaining articles did not meet this requirement (exclusion criterion) and were therefore eliminated. Results: Arthroscopic procedures (arthroscopic synovectomy, debridement and arthrodesis of the ankle) are increasingly used in the surgical treatment of haemophilic ankle arthropathy. Although arthroscopic ankle surgery offers good outcomes in patients with haemophilia, the procedure is not free of complications, which range from 7.9% for arthroscopic ankle debridement to 13.1% in arthroscopic ankle synovectomy and 17.8% in arthroscopic ankle arthrodesis, respectively. The non‐union rate of arthroscopic ankle arthrodesis is 7.1% (2/28). Conclusion: Although arthroscopic interventions in the haemophilic ankle (synovectomy, debridement, arthrodesis) offer good functional outcomes, they are associated with a non‐negligible rate of complications. Arthroscopic ankle surgery in PWH is major surgery and should be treated as such. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the long-term clinical outcome of the treatment of complete arthroscopic synovectomy combined with low-dose external radiotherapy in the knee affected by primary intra-articular diffuse tenosynovial giant cell tumor (TGCT). Methods: From May 2009 to January 2016, 18 patients with intra-articular diffuse TGCT underwent complete arthroscopic synovectomy and low-dose external-beam radiotherapy in Zhongnan Hospital were enrolled in this retrospective study. The preoperative symptoms of patients, the complications during or after the arthroscopic procedure and the recurrence were collected and recorded. Each patient was evaluated before treatment and at the follow-up visit. Efficacy evaluation criteria were based on Ogilvie-Harris score, and the evaluation of the functional ability of knee was based on the International Knee Documentation Committee (IKDC) Score. Results: The mean time from symptom onset to surgery was 9.1 ± 5.8 months (range from 3 to 29 months). The most frequent preoperative symptoms were joint effusion (100%), diffuse non-specific knee pain (66.7%), and a decreased range of motion (83.3%). Mean follow-up time was 68.0 ± 18.1 months (range from 35 to 120 months). The mean evaluation score according to the Ogilvie-Harris criteria before treatment was 3.19 ± 0.74, which corresponded to a rating of "poor". The mean score after treatment was 8.79 ± 1.57, rated as "good". The Ogilvie-Harris score was significantly increased after treatment (P = 0.003). The IKDC score of all patients increased significantly from 37.1 ± 3.8 before treatment to 83.9 ± 11.3 after treatment. The IKDC score was obviously increased after treatment (P = 0.001). No recurrence was noted at final follow-up. There were no complications during or after the arthroscopic procedure. Conclusion: The outcome of this study proved that complete arthroscopic synovectomy combined with low-dose external radiotherapy was appropriate for treating primary intra-articular diffuse TGCT of the knee joint. It could be safely and reliably used with minimal complications, fast postoperative recovery and satisfactory control of recurrence rates. [ABSTRACT FROM AUTHOR]

The clinical symptoms of pigmented villonodular synovitis (PVNS) are usually insidious and non-specific; therefore, delays in diagnosis and treatment are common. Here, we describe a case of a 3-year-old patient presenting with long-term joint swelling to highlight the significance of considering PVNS as a differential diagnosis in children to prevent misdiagnosis and ensure early treatment. After arthroscopic debridement, our patient had a favorable clinical outcome and was free of recurrence.

Introduction: Lipoma Arborescens is an extremely rare, benign lesion effecting the synovial tissue of joints. It is characterized by villous lipomatous proliferation of the synovial tissue. The aim of our study was to evaluate its diagnostic features and analyse the functional outcome of arthroscopic management. Methods: We studied 13 patients who were diagnosed to have lipoma arborescens at our institution during the period from October 2005 to October 2019. All patients underwent arthroscopic synovectomy. Histopathological examination confirmed the diagnosis. Pre‐operative and post‐operative functional assessment was done using Tegner Lysholm score. Results: Mean age was 46.6 years. All patients presented with progressive swelling of knee joint, while 6 patients also complained of pain. Average duration of symptoms was 34 months. All the patients were diagnosed based on MRI findings. Tegner Lysholm scoring at last follow up visit, had 11 patients with excellent outcome, 1 patient with good outcome, and 1 patient with fair outcome. None of the patients had recurrence, nor underwent any subsequent procedure of the operated joint. Conclusions: Lipoma arborescens is a rare condition which should be a differential in patients with mono‐articular swelling of the knee joint, and can be confirmed with MRI. It should not be misdiagnosed or missed at early stages as prolonged duration of symptoms and delay in treatment is likely to lead to development of secondary arthritis of the joint. Arthroscopic synovectomy showed good functional outcome and no recurrence. [ABSTRACT FROM AUTHOR]

Introduction  Pigmented villonodular synovitis (PVNS) is a proliferative disorder that affects synovial joints. PVNS, also known as tenosynovial giant cell tumor (TGCT), is a broad term that refers to a variety of diseases, both localized and diffuse. The current study aims to describe the outcomes of PVNS in patients in King Abdulaziz Medical City (KAMC) Riyadh, Saudi Arabia especially after surgical resection, highlighting radiological and pathological evidence of disease recurrence and symptom progression. The study is also concerned with comparison between patients who had adjuvant radiotherapy versus patients who underwent surgery only in addition to comparison between patients who underwent arthroscopic surgery versus those who underwent open surgery. Objective Pigmented villonodular synovitis is a disorder that occurs in the synovial joints with the highest incidence rates in the third and fourth decades. PVNS is categorized into localized and diffuse. The current study aims at defining the recurrence rate and outcomes of PVNS in patients in KAMC between 2008 and 2019. Design A retrospective study that comprises patients with proven PVNS of the knee, hip, and elbow for a minimum follow-up duration of two years. Data was collected from the KAMC database, National Guard Health Affairs, Riyadh, Saudi Arabia. Results Nearly a third of patients reported a prior history of trauma. The knee joint was most frequently involved followed by the ankle followed by the hip. Diffuse PVNS was more common than localized disease with more affection on the right side. The most common presenting symptoms were pain and swelling followed by decreased range of motion (ROM). About one-fifth of patients had undergone prior surgery. 30.8% received adjuvant radiotherapy. Post-operative stiffness or decreased ROM were noted in 23.1% of cases. Half of the patients received follow-up for more than 24 months. Overall recurrence rate was 19.2%. Recurrence rates were significantly higher in patients with left-sided lesions and those with prior surgery but it did not reach statistical significance. Non-statistically significant trends for increased recurrences were also seen with older age, diffuse type PVNS, and knee involvement. Conclusions In summary, this study reports the outcomes of PVNS after surgical resection in patients in King Abdulaziz Medical City. The study showed recurrence rates being significantly higher in patients with left-sided lesions than those with prior surgery. Also, non-statistically significant trends for increased recurrences were also seen with older age, diffuse type PVNS, and knee involvement., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Aljuhani et al.)

This report describes the arthroscopic treatment of septic arthritis of the ankle joint in two patients with inflammatory diseases, including rheumatoid arthritis (RA) and nail psoriasis. We treated both the ankle joints with antibiotic administration and urgent arthroscopic synovectomy and irrigation, although the procedure was performed several days (4 and 6 days) after the time at which the infection would have occurred. Fortunately, no recurrence has been seen for more than 18 and 20 months, respectively, after surgery, without antibiotic administration. Although septic arthritis of the ankle joint accounts for a small proportion of joint arthritis cases, diagnosis as early as possible is important. Our experience suggests that arthroscopic synovectomy and irrigation are effective for septic ankle arthritis even in chronic inflammatory disease cases., (© Japan College of Rheumatology 2024. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Arthralgia is a well-known complication of cutaneous polyarteritis nodosa (CPN). However, few cases of destructive arthritis with CPN resulting in chronic pain and disability have been documented. Here we report a case of CPN associated with destructive arthritis of the right foot, accompanied by seronegative arthritis in the right ankle, for which orthopaedic surgery was necessary. X-ray and computed tomography revealed progressive joint destruction in the right talonavicular joint, and magnetic resonance imaging demonstrated severe synovitis of the right talocrural joint. When the talonavicular joint was opened, we observed marked synovitis and a defect in the cartilage that had expanded within the joint. Although mild cartilage degeneration was observed in the talocrural joint, arthroscopic observation revealed no massive defect on the articulated surface. Arthrodesis and arthroscopic synovectomy yielded a good midterm clinical outcome, indicating that surgical intervention was useful for the treatment for destructive arthritis with CPN. Rheumatologists and orthopaedic surgeons should be aware of potential complications such as destructive arthritis when treating patients with CPN. [ABSTRACT FROM AUTHOR]

Lipoma arborescens is a rare synovial lesion characterized by villous proliferation of the synovial membrane and replacement of subsynovial tissue with mature fat cells. The knee joint is the most frequently affected site, particularly in the suprapatellar pouch. However, there have been few reports regarding shoulder involvement, including the glenohumeral joint and subacromial subdeltoid bursa, associated with rotator cuff tear. This article reviews the case of a 67-year-old man who presented with lipoma arborescens of the left shoulder, associated with a rotator cuff tear. Sonography revealed a fluid collection with thickening of the synovial membrane with hyperechoic villous proliferation, located in the subdeltoid bursa. An arthroscopic synovectomy and rotator cuff repair were performed. Arthroscopic findings included yellow frond-like synovial proliferation of the synovium. Postoperatively, the patient was asymptomatic, and the lesion did not recur. Although magnetic resonance imaging is the first-line imaging modality for diagnosis of this lesion, sonography may be used initially for evaluation of chronic joint swelling. In addition, it can be useful for detection of recurrence after synovectomy. This case illustrates the typical sonographic features of lipoma arborescens. [ABSTRACT FROM AUTHOR]

The aim of the present study was to assess the clinical outcomes of arthroscopic synovectomy in adolescent or young adult patients with advanced haemophilic arthropathy. From January 2009-January 2012, clinical data from 11 adolescent or young adult patients with advanced haemophilic arthropathy who were treated with arthroscopic synovectomy were retrospectively collected. The mean follow-up period was 71.91±5.28 months. The evaluated indicators included frequency of joint bleeding, range of motion (ROM), X-ray staging, hospital for special surgery (HSS) knee score and HSS pain scores. Joint bleeding frequency, pain degree and HSS scores significantly improved following arthroscopic synovectomy at the end of the follow up period. The ROM did not significantly improve. Among the 11 patients, radiographic stage remained unchanged in 9 cases whereas the remaining 2 cases progressed from stage IV to stage V. No patients required total knee arthroplasty through the end of the follow-up period. These findings suggested that arthroscopic synovectomy appears to an effective treatment option to decrease the frequency of bleeding and knee pain, improve knee function and delay knee joint arthroplasty to a certain extent for adolescent or young adult patients with advanced haemophilic knee arthropathy. [ABSTRACT FROM AUTHOR]

We report the case of a 14-year-old girl of juvenile idiopathic arthritis (JIA) with isolated and chronic proximal tibiofibular (PTF) joint arthritis. The clinical history, magnetic resonance imaging, and pathological findings of the patient are presented. We should be careful to evaluate the patient for chronic lateral knee pain, and consider concomitant evaluation for JIA, including rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to present the long-term results of treatment of localized pigmented villonodular synovitis (LPVNS) comparing two operative procedures of excision of the lesion-the arthroscopic and the arthroscopically assisted mini-open. We hypothesized that the latter approach allowed for treatment of LPVNS with acceptable recurrence rates, complication rates and functional outcomes.Methods: Between 1990 and 2006, 21 patients with LPVNS were treated with partial synovectomy through an arthroscopically-assisted mini open technique (group A), and 23 patients were treated with an arthroscopic excision of the lesion (group B). All patients were clinically examined at one, three, and 12 months post-operatively and graded by the Lysholm knee score and the Ogilvie-Harris score.Results: The mean Lysholm score was improved from 58.7 ± 9 to 94.2 ± 7 for group A (p < 0.05) and from 57.4 ± 9.1 to 95.5 ± 8 for group B (p < 0.05). The mean Ogilvie-Harris score was improved from 7.2 ± 2 to 11.2 ± 0.9 for group A and from 7.1 ± 2 to 11.75 ± 0.5 for group B (p < 0.05). We encountered two cases of CRPS and one case of recurrence of the lesion in group A and no complications for group B.Conclusions: Arthroscopically-assisted mini open partial synovectomy is a safe alternative treatment, especially for surgeons without extended experience in arthroscopic techniques. The arthroscopic localization of the precise position of the lesion and its subsequent mini-open excision is a safe and effective technique with very low morbidity and recurrence rate and equivalent functional outcome to fully arthroscopic excision due to limited incision.Level Of Evidence: Retrospective comparative study, Level III. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic resection of tenosynovial giant cell tumor (TS-GCT) presents favorable outcomes. However, there are reportedly higher recurrence rates in patients who had incomplete resection. To minimize incomplete resection, we established a multiple portal approach depending on the location of the disease. In this study, we aimed to retrospectively evaluate the clinical outcomes of arthroscopic resection for both localized and diffuse types of TS-GCT of the knee., Methods: From 2009 to 2019, 13 patients who underwent arthroscopic synovectomy of the knee and were histologically diagnosed with TS-GCT were included in this study. The pre- and postoperative range of motion (ROM) of the knee was measured. The Japanese Orthopaedic Association (JOA) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were assessed at the final follow-up examination. Magnetic resonance imaging was performed to detect incomplete resection or local recurrence., Results: Among the 13 patients, seven and six had localized and diffuse type TS-GCT, respectively. Regarding the knee ROM, preoperative knee flexion in patients with the localized type was limited compared with that in those with the diffuse type. However, the ROM was significantly improved in patients with both types postoperatively. The JOA score and KOOS of patients with both types at the final follow-up were favorable, and there were no significant differences between both types. There was neither recurrence nor incomplete resection in any patient for both types., Conclusion: All patients, regardless of the TS-GCT type, achieved favorable outcomes after arthroscopic surgery; especially, the failure rate was 0%., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Most bleeding events in individuals with hemophilia occur within the ankle, knee, and elbow joints. Should the bleeding persist, the synovial membrane starts to hypertrophy and a vicious cycle of chronic hemophilic synovitis (CHS) occurs, leading to joint destruction., Areas Covered: This article covers the prompt diagnosis of CHS by point-of-care ultrasonography (POC-US) and its treatment by means of several types of synovectomy., Expert Opinion: It is essential to prevent, detect and treat hemophilic synovitis, because it indicates that the joint has bled and is at risk of bleeding further. Prophylaxis with standard half life (SHL) factor VIII (FVIII) concentrate is the standard of care for individuals with severe hemophilia A and can also be considered for selected patients with moderate disease. Several years of real-world experience with extended half life (EHL) FVIII, emicizumab, and other drugs in development will be needed to ascertain their final effect on bleeding and its complications. We must look for synovitis in individuals declaring joint pain and in asymptomatic patients, and POC-US is the most reasonable imaging instrument with which to carry out periodic joint screening. Radiosynovectomy, chemical synovectomy, and arthroscopic synovectomy markedly reduce bleeding events.

A large clinical material (1693 patients with rheumatic diseases — RD, 2066 operations) was used to develop a three-level medical rehabilitation system using differentiated, including high-technology surgical methods depending on the nosology, RD stage, localization of joint diseases of the upper and lower extremities during adequate drug therapy. A positive result persisting for 1 to 20 years was achieved in 60—92% of cases.

Summary Background/Introduction Hemophilic arthropathy (HA) is the most common complication in patients with hemophilia. Arthroscopic synovectomy in HA is the optimal choice of treatment because it is less invasive. Purpose/Aim To demonstrate the effectiveness of arthroscopic synovectomy for HA involving the knees, elbows, and ankles. Methods This study retrospectively analyzed 11 patients with chronic synovitis with repeated hemoarthrosis (13 joints: 5 knees, 4 elbows, and 4 ankles) between August 2011 and August 2013. The joints that did not respond well to secondary prophylactic factor replacement and physical therapy underwent arthroscopic synovectomy for further treatment. Patient profiles, joint pain scores, bleeding frequency, and joint function scores were reviewed. Results The mean visual analog scale scores for pain decreased from 77.1 mm preoperatively to 27.7 mm postoperatively ( p < 0.05). The mean annual bleeding frequencies before and after surgery were 6.1 times/y and 2.0 times/y, respectively ( p < 0.05). Functional scores for all the joints improved. The mean Lysholm knee scale score significantly increased from 45.2 preoperatively to 74.4 postoperatively ( p < 0.05). No major complications were observed. Conclusion Arthroscopic synovectomy, a less invasive procedure for HA, significantly reduced joint pain, prevented bleeding episodes, and improved joint function with few complications. [ABSTRACT FROM AUTHOR]

Purpose: There are few reports detailing recurrence rates or functional outcomes after combined arthroscopic and open synovectomy to treat diffuse pigmented villonodular synovitis (DPVNS) of the knee.Methods: Patients with DPVNS of the knee treated with combined synovectomy, followed for a minimum of 12 months at a tertiary orthopaedic oncology centre, were identified. We extracted data pertaining to demographics, complications, clinical outcomes and recurrence. Functional status was evaluated prospectively using the Toronto Extremity Salvage Score (TESS) and the Musculoskeletal Tumor Society (MSTS) 1987 and 1993 surveys. Data were reported descriptively as mean (SD) unless otherwise specified.Results: Fifteen patients [80% female; mean age 38.9 (SD 14.2) years] representing 15 knees were treated with combined synovectomies and followed for 81 (SD 55) months. Posterior arthroscopy was utilized in 73% of patients. External beam radiation was utilized post-operatively in 73% of patients. Two patients (13%) experienced symptomatic disease recurrence. The mean post-operative knee range of motion was 1° (range 0-10°) to 115° (range 90-135°). TESS and MSTS 1987/1993 scores all suggested excellent patient function. Post-operative complications included one posterior wound dehiscence, one case of femoral condyle avascular necrosis and one patient with lymphedema.Conclusions: Combined synovectomy resulted in a low rate of symptomatic disease recurrence and good to excellent functional outcomes for diffuse PVNS of the knee. A literature review identified this as largest case series focusing on combined synovectomies for DPVNS of the knee and the only one describing functional outcomes or the use of external beam radiotherapy.Level Of Evidence: Retrospective case series, Level IV. [ABSTRACT FROM AUTHOR]