Anterior and Posterior Arthroscopic Treatment of Primary Synovial Chondromatosis of the Ankle

Abstract

Background: Primary synovial chondromatosis (PSC) is a progressive disorder of unknown etiology resulting in formation of multiple loose bodies. If left untreated, it may lead to degenerative changes or malignant transformation to chondrosarcoma. Methods: Seventeen patients who underwent combined posterior and anterior ankle arthroscopy within the same operative session and had histologically confirmed PSC were included in this retrospective study. American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score was used to evaluate ankle function preoperatively and at a final follow-up. A 3-question survey was used to evaluate patient’s satisfaction at the final follow-up. Results: In 14 patients, loose bodies were found in both compartments of the ankle, in 2 only in the anterior compartment, and in 1 only in the posterior compartment. All patients had evident signs of synovial inflammation in both compartments. The AOFAS Ankle-Hindfoot score increased from the preoperative median score of 65 (range, 29-90) to 95 (range, 65-100) at the final follow-up. Fourteen patients reported they were extremely satisfied with the outcome, 1 was moderately satisfied, and 2 were dissatisfied. No cases of recurrence of synovitis or loose body formation were noted, nor any signs of malignant transformation during the follow-up period. Conclusion: We believe the risk of recurrence of PSC, which is in close relation to malignant transformation, can be minimized by performing a complete synovectomy of the ankle. Our experience and review of literature makes us believe that ankle PSC should be regarded as a whole joint disorder. Performing a combined posterior and anterior arthroscopic procedure within the same operative session should always be considered in patients with ankle PSC. Level of Evidence: Level IV, retrospective case series.

Arthroscopic Management of Anterior Ankle Synovial Osteochondromatosis

“…Removal of loose bodies and synovectomy at early phase of the disease may prevent the occurrence of secondary osteoarthritis. 16 The aim of the treatment of synovial chondromatosis consists of decreasing pain and limiting the development of early osteoarthritis. Synovectomy and removal of all accessible loose bodies is the surgical treatment of choice.…”

“…6,17 The risk of recurrence of primary synovial chondromatosis, which is in close relation to malignant transformation, can be minimized by performing a complete synovectomy of the ankle. 16 If the posterior ankle compartment is also involved by the disease, a combined posterior and anterior arthroscopic procedure within the same operative session should be considered. 16 The advantages of this minimally invasive technique include better cosmetic result, minimal soft tissue dissection, fewer wound complications, and adequate joint assessment under magnified arthroscopic visualization.…”

“…16 If the posterior ankle compartment is also involved by the disease, a combined posterior and anterior arthroscopic procedure within the same operative session should be considered. 16 The advantages of this minimally invasive technique include better cosmetic result, minimal soft tissue dissection, fewer wound complications, and adequate joint assessment under magnified arthroscopic visualization. The potential risks of this technique include injury to the anterior tibial artery, injury to the superficial or deep peroneal nerve, incomplete synovectomy and recurrence of the disease, residual loose bodies, extensor tendon injury, and damage of the articular cartilage (Table 3).…”

Synovial chondromatosis as an etiology of ankle impingement: a case report

“…This type of chondromatosis more often affects the knee, the elbow, and the hip, being less reported in the ankle (2) . It may also affect soft tissues, such as tendon sheaths and bursae (2,3) . Clinically, when chondromatosis is concentrated on the anterior compartment of the ankle, it manifests with signs and symptoms typically observed in anterior impingement syndromes: pain, edema, and limited range of motion, especially dorsiflexion (1) .…”

Synovial chondromatosis in unusual locations treated with arthroscopy: A report of three cases

“…[1] There are also reports about wrist, elbow and, far less commonly, shoulder and ankle joint involvement. [2][3][4] The classical approach would be arthrotomy and synovectomy, but owing to advancements in arthroscopic techniques and instrument design, arthroscopy has emerged as a viable option in recent years. [3,4] Although arthroscopy is a much less invasive technique with faster recovery Synovial chondromatosis (SC) rarely occurs in the shoulder and ankle joints.…”