Systematic Arthroscopic Treatment of Synovial Chondromatosis of the Knee

ABSTRACT: Synovial chondromatosis is a benign metaplastic disease of the synovial joints, characterized by the development of cartilaginous nodules in the synovium. Treatment generally includes open or arthroscopic loose body removal combined with a synovectomy. An all-arthroscopic approach has been described to minimize complications and reduce morbidity while providing adequate control of local disease. The purpose of this Technical Note is to describe our techniques and technical pearls that allow for adequate excision of disease while minimizing complications and disease recurrence. The combination of patient positioning, the establishment of multiple arthroscopic portals to ensure optimal visualization and freedom of instruments, the use of a leg holder, and the use of a variety of surgical instruments to facilitate loose body removal and synovectomy is critical to optimize clinical outcomes and minimize complications. Although technically demanding, our described technique can help facilitate extensive loose body removal and complete synovectomy. Technique Video Video 1 Surgical tips and techniques for systematic arthroscopic treatment of synovial chondromatosis of the knee. A case presentation outlining the clinical findings and relevant magnetic resonance imaging (sagittal and axial views) in a patient with this condition is provided. First, the relevant surface anatomy and the location of our arthroscopic portals are reviewed. Drainage of a significant knee effusion is then shown, whereby loose bodies can be found within the synovial fluid. A standard diagnostic arthroscopy is performed, and our technique of using multiple shavers, electrocautery, and various graspers to effectively remove embedded loose bodies within the synovium is described. To identify loose bodies and the nearby structures that must be protected, the compartments of the knee, intercondylar notch, and submeniscal regions are addressed. To access difficult regions of the knee, techniques such as shaving through the notch, using a modified Gillquist maneuver, and debriding with a trans-septal approach in the posterior aspect of the knee are reviewed. Finally, intraoperative images of our biopsy procedures and specimens are shown.

SUBMITTER: Wengle L 

PROVIDER: S-EPMC8556586 | biostudies-literature |

REPOSITORIES: biostudies-literature