Arthroscopic Findings in Melorheostosis

Abstract

Melorheostosis is a rare dysplastic bone formation disease that can also affect the joints. We present a case of a patient with knee pain that was radiographically diagnosed as melorheostosis because of "dripping wax" image. An exploratory arthroscopy was made. In the joint, we found hyperplasic synovial tissue and an increased retropatellar Hoffa pad, which was surrounding an intra-articular ossification resulting from the disease. This was removed and led to a clinical and functional improvement.

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“…Successful rates and long term outcomes of fasiotomies, capsulotomies and open soft tissue release are variable between studies [17,18]. Our case study and two previous studies [15,16] suggested that arthroscopic arthrolysis and manipulation could be an effective procedure in the treatment of knee contracture. Yet, in patients with more severe joint stiffness, recurrence can occur for which further surgeries would be necessary.…”

“…Minarro reported findings on a 23-year-old female who presented with anterior knee pain, very mild flexion contracture (5-7 degrees) and low grade osteoarthritis. During arthroscopy, a small 2 x 2 cm calcifications was removed and hyperplastic synovial membrane was debrided [15]. Six months later, this patient was asymptomatic with no recurrent flexion deformity.…”

“…However, the outcomes after arthroscopic surgeries were less predictable in knee joint stiffness secondary to melorheostosis. Recurrence may occur due to its continuous soft tissue contracture characteristic [12,15,16]. There are limited reports on using arthroscopic surgeries for knee melorheostosis.…”

“…With the advancement in medical technologies and surgical techniques, arthroscopically assisted procedures are becoming more common. To the best of our knowledge, there were only three case reports on the arthroscopic treatment for knee pain and joint stiffness due to melorheostosis, and none of them documented long-term outcomes [12,15,16]. Hence, we would like to present a female patient with recurrent knee joint stiffness and pain secondary to melorheostosis who underwent arthroscopic arthrolysis, synovectomry and manipulations.…”

“…Knee contracture is not uncommon in patients with melorheostosis involving their knee joints [12][13][14][15][16]. Conservative treatments, including local analgesia, bracing, serial casting and physical therapy, often fail to manage the contracture long-term.…”