Surgical Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee

Result of arthroscopic treatment of pigmented villonodular synovitis of the knee

“…Byers et al 27 reported 46%; Johansson et al 21 reported 33%; and Schwartz et al 28 reported 25%, increasing to 35% after 25 years. The best results are those obtained by Flandry et al, 23 who reporting a recurrence rate of 8% with a radical open-approach synovectomy. Many authors suggest that recurrence is due to an incomplete resection of the pathological tissue, highlighting the fact that it is fundamental to execute a radical resection of the lesion.…”

“…26,27 In the diffused form, the commonly suggested treatment is partial or extensive synovectomy. 4,5,10,21,23,24,27 The main problem appears to be the high rate of recurrence. In our cases, we obtained an improved clinical result and lower rate of recurrences with extensive synovectomy, using 4 or 5 access points to reach the posteromedial and posterolateral part of the joint cavity.…”

Outcomes after Excision of Pigmented Villonodular Synovitis of the Knee

“…Several options have been an all arthroscopic procedure [9,[15][16][17]25], an extensile open anteroposterior approach [6,11], a combined anterior arthroscopic and open posterior synovectomy [9], and a subtotal synovectomy with adjuvant radiotherapy [3,20].…”

How I do it: Pigmented villonodular synovitis

“…A recurrence in only 2 patients has been reported after open surgical synovectomy of 23 knees with diffuse PVNS, followed for 5 years (Flandry et al 1994). In a review by Schwartz et al (1989), 99 patients with diffuse PVNS of the hip, knee, shoulder or elbow were followed for 14 (1-47) years after surgery, with 25 recurrences.…”

“…Even if PVNS, by definition, is a monoarticular disease, polyarticular involvement has been reported in a few cases (Wendt et al 1986, Flandry et al 1994. …”