Synovial chondromatosis combine with synovial tuberculosis of knee joint: a case report

Backgroud Synovial chondromatosis is a rare synovial-derived metaplasia disease that comes from the formation of cartilage nodules within the synovial connective tissue of the joint. Knee tuberculosis is a disease caused mostly by the pulmonary tuberculosis and a few by tuberculosis of the digestive tract and lymphatic. tube. Case presentation Herein we report a 3-year-old child admitted by intermittent swelling of left knee joint with lameness for half a year, the patient received surgical treatment. The loose bodies filled in the joint cavity was taken out and the degenerative synovium was excised. Biopsy confirmed as synovial chondromatosis combined with synovial tuberculosis of knee joint. After 6 months follow-ups, knee swelling and claudication get totally recovered and the gait of patient recover back to normal. Conclusion Careful investigation of children with knee pain is recommended to avoid misdiagnosis, Synovial chondromatosis combine with tuberculosis should be considered a differential diagnosis in a child with knee pain.

Arthroscopic Management of Synovial Chondromatosis of the Knee Joint

Synovial Chondromatosis is a rare and it is a benign condition characterized by multiple cartilaginous nodules in synovial facet spaces. Synovial Chondromatosis affects most commonly the knee joint. This is a case report of a 30-year-old male patient presented with pain and swelling over the left knee joint. On evaluation MRI shows loose bodies, for which he underwent, arthroscopic exploration. Viscous fluid and loose bodies were identified and showed synovial hyperemia. Synovial debridement was done and loose bodies were removed and sent to histopathological examination. The result signify that arthroscopy is efficient method both in diagnostic as well as therapeutic management of synovial chondromatosis.

The distribution in joint recesses and adjacent synovial compartments of loose bodies determined on MR and CT arthrographies of ankle joint

Loose bodies (LBs) are intraarticular free bodies that result from various pathological processes and cause synovial inflammation. Timely and complete identification of LBs is important for appropriate treatment and prevention of possible complications such as osteoarthritis. LBs in the ankle joint can reach all the compartments that are adjacent to the joint via physiological or pathological connections. The presence, localisation, and number of LBs in the ankle joint and adjacent synovial compartments can be optimally evaluated using high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA). On this review article, we aimed to determine the LB location and distribution using high-resolution MRA and CTA of the ankle joint, and to demonstrate that it may be used as a complementary examination to guide interventional arthroscopy in difficult-to-reach areas during treatment. Advances in knowledge Loose bodies (LBs) are intraarticular free bodies and may cause synovial inflammation. Accurate and complete determination of the number and location of LBs before surgery are very important for effective treatment. The location, number and distribution of LBs in the ankle joint may be determined successfully by high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA). For this purpose, MRA and CTA may increase the diagnostic and therapeutic success of the arthroscopy.

A Case of Synovial Chondromatosis of Temporomandibular Joint with Numerous Loose Bodies

Here, we report a case of synovial chondromatosis of the temporomandibular joint (TMJ) with numerous loose bodies. A 56-year-old woman was examined in the oral surgery department for trismus and pain in the left TMJ when opening the mouth. Imaging indicated TMJ synovial chondromatosis, and the patient was referred to our department for further examination. Her facial features were symmetrical, and no occlusal abnormalities were found. The maximum mouth opening was 30 mm, and movement of the left mandibular condyle was restricted and accompanied by pain and joint sounds. Panoramic radiography showed deformation of the left mandibular condyle and radiopaque lesions surrounding it. Computed tomography showed numerous small granules around the left mandibular condyle, some of which were calcified. Magnetic resonance imaging showed anterior disc displacement without reduction in the left TMJ and hypointense lesions on T2-weighted images. Bone scintigraphy showed an accumulation in the area of the left TMJ. Based on the diagnosis of the left TMJ synovial chondromatosis, the lesions were removed, and plastic surgery on the mandibular condyle was performed under general anesthesia. We removed 386 white loose bodies. Histopathologically, the loose bodies were consistent with synovial chondromatosis lesions. The postoperative course was uneventful, with no recurrence or TMJ dysfunction approximately 5 years after the surgery, indicating that open surgery is the best course of intervention in such cases.

A study on evaluation of knee osteoarthritis with MRI and comparing it with CT scan, high resolution USG and conventional radiography

Background: Knee osteo-arthritis is widely prevalent in the elderly population in our society and associated with significant morbidity and poor quality of life. Early diagnosis of the condition can enable timely and proper care for the patients. Magnetic Resonance Imaging, CT Scan, Ultrasonography and plain radiography are the different modalities of imaging that are commonly used for detection and diagnosis of knee osteo-arthritis. Aims and Objectives: To find out the early osteoarthritic changes of knee by Magnetic Resonance Imaging and compare those findings with conventional radiography, high frequency USG and CT scan findings. Materials and Methods: Patients suffering from knee osteoarthritis (OA) as per American College of Rheumatology guideline criteria (n=56) underwent imaging of the knee using plain radiography, ultrasonography, CT scan and MRI. The imaging findings studied in the patients were joint space narrowing (JSN), meniscal abnormality, Baker’s cyst, cruciate ligament abnormality, knee effusion, subchondral cyst, and loose bodies. A comparison between radiography, CT scan and USG was done for the imaging findings with MRI as the reference standard. Z-test of proportionality was used to find statistically significant difference for the three imaging modalities. A P<0.05 was deemed statistically significant. Results: The mean age of the patients was 61 years (38 males). The tibiofemoral compartment was most commonly affected. CT scan was more sensitive than radiography in detecting sub-chondral cyst (P=0.018) and loose bodies (P=0.004). USG and MRI were equally sensitive in detecting knee effusion (P=0.22) and synovial thickening (P=0.10). CT scan and MRI were equally sensitive in detecting subchondral cyst (P=1.00) and loose bodies (P=0.22). Conclusion: While CT imaging was more sensitive for detection of subchondral cysts and loose bodies than conventional radiography, it was as sensitive as MRI in detecting these findings in the study group. Additional study is warranted to assess diagnostic performance of CT scan and MRI in the diagnosis and progression of knee OA.

Migratory Loose Bodies from the Ankle Joint into the Flexor Hallucis Longus Tendon Sheath

Objective: Loose bodies resulting from any form of osteochondral insult can migrate out of their intra-articular position to adjacent compartments. This retrospective study aims to illustrate the phenomenon of loose bodies migration from the ankle joint into the flexor hallucis longus (FHL) tendon sheath. Materials and Methods: Cases of loose bodies in the FHL tendon sheath were identified from the authors' radiological database by way of keyword interrogation, covering the modalities of CT, MRI, and ultrasound over a period of 11 years. The imaging features of the loose bodies were recorded, together with the presence of ankle instability and osteoarthritis. Patient demographics and relevant history, including trauma and surgery, were collected. Results: Thirty-four cases including 33 patients, with a total of 125 loose bodies in the FHL tendon sheath, were identified. There were 58 loose bodies (46.4%) in Zone 1 of the FHL tendon sheath, 65 loose bodies (52%) in Zone 2, and 2 loose bodies (1.6%) in Zone 3. All patients had features of ankle osteoarthritis on imaging, 14 of which had imaging features of ankle instability, and 19 patients had previous ankle trauma. Conclusion: Osteochondral loose bodies originating from the ankle joint can migrate into the FHL tendon sheath. It is important to recognise this phenomenon as a distinct entity, different from primary tenosynovial chondromatosis of the FHL tendon sheath, which may have a different surgical management and clinical outcome. Detection of FHL tendon sheath loose bodies should also prompt closer examination for articular disease in the ankle joint.

Arthroscopic management of synovial chondromatosis of the shoulder: A case report

Synovial chondromatosis of the shoulder is a rare entity that is generally mono-articular and uncommon in diarthrodial joints. Treatment of synovial chondromatosis of the shoulder includes open arthrotomy retrieval of loose bodies and synovectomy. With advances in arthroscopy, the same could be achieved using arthroscopic techniques. This case report describes a case report of a 35-year-old male patient who presented with complaints of pain and restriction of movement for 6 months. The MRI of the patient was suggestive of multiple loose bodies in the shoulder joint, in the subdeltoid region, and subscapularis muscle with subacromial bursitis. Arthroscopically more than 100 loose bodies were retrieved with subacromial decompression. Shoulder synovial chondromatosis has been rarely reported in the literature. The malignant transformation although rare, but it is still a possibility. The recurrence rate varies from 3.2% to 22.3%. Open arthrotomy, synovectomy, and retrieval of loose bodies cause delayed recovery and more morbidity with high chances of subscapularis insufficiency due to the need of subscapularis tenotomy. Arthroscopic treatment although have limitations such as limited visualization, limited synovectomy, and difficult interventions around the axillary recess or biceps sheath, but provides with the advantage of lesser morbidity and early rehabilitation. Synovial chondromatosis can be successfully treated arthroscopically as it provides intra-articular and extra articular access with early rehabilitation, lesser morbidity, and early recovery.

Arthroscopic management of elbow stiffness

The elbow is particularly prone to stiffness. Loss of elbow motion is very limiting, and can be the result of trauma, primary osteoarthritis, heterotopic ossification and other conditions. Several exposures have been described for open elbow contracture release. Although a few decades ago elbow arthroscopy was considered only for diagnosis and removal of loose bodies, contemporary arthroscopic techniques allow successful management of the majority of conditions leading to elbow stiffness. Careful patient evaluation, use of advanced imaging studies, and acquisition of appropriate surgical skills are essential for the successful arthroscopic management of the stiff elbow. This expert opinion reviews some fundamentals of elbow stiffness as well as principles for the evaluation and arthroscopic management of the stiff elbow.

Assessment and Management of Loose Bodies in the Knee Joint and Related Disease: A Narrative Review

Background: Loose bodies are frequently encountered during clinical activity and a common finding during knee arthroscopy. Usually, treatment consists of the removal of the loose bodies, which can be challenging even for experienced surgeons. The excision alone is not always the complete treatment, because loose bodies are generally secondary to other diseases that can cause persistent symptoms with the risk of new loose body formation. The aim of this narrative review is to show the clinical, imaging and arthroscopic evaluation of loose bodies in order to plan optimal treatment. Methods: A comprehensive search of PubMed was conducted to find the most recent and relevant studies investigating the aetiopathogenesis, the assessment tools and the therapeutic strategies for knee loose bodies and their related diseases. Results: When dealing with a loose body, the first issue is the evaluation of the intra-articular fragment (location, size, number, symptoms) and its aetiopathogenesis by identifying the underlying pathology (e.g., osteochondritis dissecans, osteoarthritis, chondral defect, tumour-like lesions, rheumatoid arthritis, etc.). In the case of symptomatic intra-articular loose bodies, treatment consists of fragment removal and the management of related diseases (e.g., lifestyle modification, physiotherapy, pharmacological and surgical treatment). Conclusion: Loose bodies are not separate entities and in addition to their pathological aspect, must be evaluated within the context of the underlying disease. Correct assessment and comprehensive management allow for relief of symptomatology and prevention of loose body formation by removal and treatment of the associated diseases.