Left Knee Pain and Bilateral Knee Swelling in an Adolescent

Mistovich, R. Justin; O’Toole, Patrick; Chauvin, Nancy A.; Ganley, Theodore J.

doi:10.1007/s11999-014-3883-4

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…LA typically presents as frond-like areas of proliferation that have signal characteristics isointense with subcutaneous fat. The hypertrophied subsynovial fatty tissue does not enhance while the overlying synovium often shows diffuse enhancement after intravenous contrast administration ( 1 , 4 , 5 , 14 – 17 ). Besides the typical characteristics of LA, the adipocytes may incompletely replace the synovial tissue, so atypical MRI findings with dominant synovial proliferation or irregular mixture of synovial and fatty tissue may also be observed ( 1 , 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Besides the typical characteristics of LA, the adipocytes may incompletely replace the synovial tissue, so atypical MRI findings with dominant synovial proliferation or irregular mixture of synovial and fatty tissue may also be observed ( 1 , 14 ). Because of the possible atypical LA presentation and other differential diagnoses, histopathological examination of the specimen obtained by needle or arthroscopic biopsy is usually recommended as a confirmative diagnostic procedure ( 2 , 6 , 14 , 17 ). In all above-mentioned cases of unsuccessful conservative therapy of the underlying JIA, LA was confirmed by the combination of MRI and histopathological analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Although the pathogenesis of JIA, as the most common rheumatic disease of the childhood, is closely associated with chronic synovitis, there are only several reports of LA in JIA patients ( 13 – 16 ). Despite the rare occurrence, LA should be considered a differential diagnosis of persistent joint/s swelling in children, adolescents, and adults in general, and in a sub-population of consistently treated JIA patients ( 1 , 2 , 5 – 8 , 11 , 14 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

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Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature

et al. 2022

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Lipoma arborescens (LA) is a chronic, slowly progressive intra-articular mass associated with the proliferation of synovial villi. It can affect one or several joints and has been commonly described in adults with degenerative joint disease. Most patients have been diagnosed with MRI and/or biopsy findings and are usually treated with partial or total synovectomy. Case reports of LA in children, particularly with juvenile idiopathic arthritis (JIA) are scarce. We present a 16-year-old girl with a prolonged course of psoriatic JIA (initial bilateral knee affection and subsequent involvement of wrists and elbows combined with psoriatic scalp lesions) and LA of both knees. Psoriatic JIA has been diagnosed at the age of 13, with immediate start of methotrexate (MTX) therapy. Several weeks later, magnetic resonance imaging (MRI) of the right knee, performed with the aim of the most swollen joint additional evaluation, revealed synovial changes consistent with LA; arthroscopic biopsy confirmed the diagnosis. After two years of MTX treatment, despite the successful maintenance of minimal JIA activity except for repetitive bilateral knee swelling, control MRI revealed bilateral knee lesions identical to those described two years earlier in the right knee. Following the step-up approach in JIA treatment, the TNF inhibitor adalimumab was added in therapy. Finally, six months later, clinical reduction of both knees swelling was noticed with almost complete LA regression in the right, and partial regression in the left knee, confirmed by final MRI control. A conservative approach, including TNF inhibitors, instead of usually performing synovectomy, seems like a reasonable option in cases of LA with underlying JIA.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature

et al. 2022

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Knee Arthroscopy for the Treatment of Lipoma Arborescens

et al. 2019

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Background: Lipoma arborescens is a rare, intra-articular benign lesion characterized by hyperplastic formation of villous projections that commonly presents as nonspecific mechanical knee pain. The treatment of choice for lipoma arborescens of the knee is open or arthroscopic synovectomy. However, data are lacking on the success of arthroscopic treatment, despite its increasingly widespread use. We aimed to systemically review the outcomes of arthroscopic treatment of lipoma arborescens.Methods: PubMed and Embase were searched by 2 reviewers independently on October 9, 2018, and all relevant articles in the English and French languages up to and including that date were considered. The search terms "lipoma arborescens," "knee," "arthroscopy," and "arthroscopic" were used. Articles were screened on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.Results: Among the 110 initial studies that were retrieved, 28 satisfied the inclusion criteria. A total of 71 knees in 65 patients ranging from 13 to 78 years of age underwent arthroscopic synovectomy for the treatment of lipoma arborescens. The duration of follow-up ranged from 3 weeks to 84 months. The recurrence rate was 2.8%, and 2 patients underwent conversion to open surgery. One patient had postoperative hematoma that required evacuation, and another patient reported persistent residual pain at the time of the latest follow-up.Conclusions: On the basis of this uncontrolled, systematic review, arthroscopic synovectomy is a safe and effective treatment for lipoma arborescens of the knee, with a success rate of .95%.

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Left Knee Pain and Bilateral Knee Swelling in an Adolescent

Abstract: Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Cited by 2 publications

References 24 publications

Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature

Successful use of adalimumab as a conservative treatment for bilateral knee lipoma arborescens in patient with psoriatic juvenile idiopathic arthritis – case report and review of literature

Knee Arthroscopy for the Treatment of Lipoma Arborescens

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