Arthroscopic treatment of synovial osteochondromatosis of the elbow. Case report and literature review

Abstract

Synovial osteochondromatosis is a benign proliferative disorder with metaplasia of the synovial membrane that affects the fibroblasts of the synovial joints, tendons and bursae. In literature, there are few descriptions of synovial osteochondromatosis of the elbow. The objective of this article was to report a case of synovial osteochondromatosis of the elbow in a patient aged 32, basketball athlete, in which surgical treatment was chosen because of the pain and functional limitation and stage of disease with multiple loose bodies. Patient 32, male, presented with pain and limitation of motion of the elbow. The range of passive motion was 100° of flexion and 30° extension. The range of active motion was 40–90°. Magnetic resonance observed many loose bodies mainly in the posterior compartment in the olecranon fossa plus some chondral lesions in the capitellum. The arthroscopic treatment was chosen with two anteriors portals (medial and lateral) and two posterior portals (standard posterior and posterolateral) for easing loose bodies and osteoplasty of the olecranon fossa. The visual analog scale pain was 9–3 and its arc of active motion was 110° to −20° of flexion and extension. On a scale of performance from Mayo Clinic patients was 65 points preoperatively to 90 postoperatively with 9 months follow-up and the patient was satisfied with the treatment outcome. Arthroscopic treatment of synovial osteochondromatosis of the elbow is an effective and safe therapeutic management with low morbidity and early return to activities.

Arthroscopic Management of Synovial Osteochondromatosis of the Elbow

“…It is believed that recurrence implies that there is a greater chance of malignant transformation to chondrosarcoma. 1,2 Complete removal of all of the involved synovium is advisable in patients with PSC as this is likely to reduce the risk of future recurrent loose body formation. 2,3 Although intraoperative appearances as usually presenting a local nest-like arrangement of synovitis and a varying number of loose or adherent bodies and general synovitis of the elbow joint is not a feature of PSC, arthroscopy of all compartments of the Small loose bodies should be removed before removal of the large ones.…”

“…P rimary synovial chondromatosis (PSC) is a rare, benign proliferative pathologic condition with benign metaplasia of the synovial membrane that affects the fibroblasts of the synovial joints, tendons, and bursas. [1][2][3] It is characterized by proliferation of chondrocytes and newly formed chondral or osteochondral nodules in the synovial membrane. 1 These nodules may detach and form loose bodies.…”

“…The elbow is the most affected joint in the upper limbs. 2 Because the dominant elbow is more commonly involved, biomechanical stress might be a causal factor in PSC in the elbow. 3 Three distinct stages can be identified in PSC: phase I is active synovitis without loose bodies, phase II shows nodular synovitis along with loose bodies, and phase III is characterized by the presence of loose bodies with the resolution of synovitis.…”

“…1 The other differential diagnoses should include synovial chondrosarcoma, calcifying aponeurotic fibroma, hydroxyapatite deposition, pigmented villonodular synovitis, elbow tuberculosis, and rheumatoid arthritis. 1,2,7 Pain relief can be achieved by nonsurgical therapy in phase I (nonsteroidal anti-inflammatory medications and corticosteroid injection). Surgical treatment has been recommended as the first choice of therapy in phases II and III by most authorities.…”

Role of synovium‐derived fibrous cartilage in temporomandibular joint synovial chondromatosis

“…It is characterized by formation of hyaline cartilaginous nodules (CNs) in sublining layer (SL) of synovium, subsequently separation from synovium and formation of loose bodies (LBs) in joint compartment . Though large joints such as knee, elbow, and hip are usually affected by SC, SC in temporomandibular joint (TMJ) only occupies 3% cases . More than 200 cases of TMJSC had been presented in literatures .…”