We report eight cases of chondromatosis of the knee treated surgically. The aim of our work is to attract the attention of clinicians on the importance of early detection of disease to prevent progression of osteoarthritis. the therapeutic decision was facilitated by the use of the classification of Milgram. We observed superiority of arthroscopy compared to open surgery.
Synovial chondromatosis is an arthropathy that is characterized by compromised mono-articular most often, and by benign in their evolution. (1, 2) However it can occasionally be aggressive, but this is exceptional.
The aim of our work is to attract the attention of clinicians on the importance of early detection of disease to prevent progression of osteoarthritis. Our series consists of 8 patients (6 men and 2 women). Age between 20 and 60. The affected joint is the knee in 8 cas. The most common symptoms include:
1. Notion of a history of trauma in 3 cases.
2. The mechanical pain in 8 cases.
3. Joint blocks in 6 cases.
4. Joint effusion in 6 cases.
5. Joint stiffness in 2 cases.
1. Standard radiographs of anteroposterior and lateral in charge for all patients.
2. CT was performed in 4 patients.
3. Arthrography is performed in a single patient.
4. MRI is performed in only one patient. Surgical treatment is based on the removal of foreign bodies by arthroscopy with articular lavage in 6 patients and by open surgery in 2 patients with excision of the pathologic synovial
Evolution is good for 6 cases by regression of pain with loss of blocking. In 2 cases the evolution is characterized by osteoarthritis of the knee. Classification by MILGRAM can distinguished three stages:
Stage 1: cartilaginous metaplasia intra synovial.
Stage 2: inflammation and proliferation intra-synovial of cartilage and release of foreign bodies cartilaginous.
Stage 3: release of foreign bodies cartilaginous.
In our experience, it seems that the classification of Milgram can ask the therapeutic indications:
Stage 1: Surgical synovectomy or arthroscopic synovectomy with washing and removal of foreign bodies.
Stage 2: washing and removal of loose bodies with limited synovectomy (not mandatory). Stage 3: Arthroscopic articular lavage and removal of foreign bodies. The evolution depends on the degree of destruction of articular cartilage.
Metaplasia of the synovial membrane is rare and is responsible for the formation of cartilaginous bodies (chondroma) which may ossified (osteochondromas). (3, 4) It is primitive or reaction to the incorporation of synovial cartilage fragments released from the joint. (5) The nodules, first enshrined in the synovial, and will pédiculisent then are released into the joint cavity. They are often multiple, of substantially identical shape and small (rice grain). (6) When all chondromas had been released, the synovial becomes normal. (7) The chondromas can remain free and increase in size by feeding by soaking in the synovial fluid, merge together to form a large pile, or reattach to the synovium where they are absorbed or continuing to grow. (8) This synovial metaplasia affects the knee in more than half the cases, followed in order of decreasing frequency, elbow, hip, shoulder and ankle. (9) The attainment of a tendon sheath or bursary is much rarer. (10) Synovial chondromatosis essentially affects adults, middle-aged two to four times more often man. It can be revealed by mechanical pain, blockages, a joint effusion, palpable foreign bodies in case of localized superficial, rarely by the compression of an adjacent nerve. (11) Symptoms are often insidious and the disease progresses slowly. Malignant degeneration (synovial chondrosarcoma) is exceptional. (2, 12, 13) Standard radiography showed multiple rounded or oval formations, size and shape substantially identical, encircled by a cortex. However, their presence may be suspected in cases of bone erosions secondary to their pressure. A diastasis of the joint space secondary to their knee interposition is rare. (14, 15, 16) Arthrography: Do not inject a contrast too dense, which interferes with a detailed study of intraarticular content. on the initial radiographs filling, reveal synovial irregular, distorted by multiple lacunar small groups rounded or oblong. (14, 15) When chondromas are still included in the synovial membrane, the appearance arthrographic and arthro-CT is similar to pigmented villonodular synovitis. When chondromas are free, they are molded by the contrast product allows the differentiation between these two entities. (14, 15, 16) The CT arthrography is used to specify their exact location and the existence of chondrolysis associated. (14, 15, 16) MRI: MRI appearance of this disease depends on the relative importance of synovial proliferation and the release of chondromas. (14, 15, 16, 17) Ultrasonography can show the synovial thickening. Chondromas are hyperechogenic and are accompanied by a posterior acoustic interruption, when ossified. (14, 15, 16, 17) Differential Diagnosis: Secondary osteochondromatosis: any condition that may damage the articular surface osteochondral Grains of rice: present in the chronic effusions or bursitis, including arthritis. (1, 3, 7, 8) The treatment is not standardized and depends on the evolutionary stage, the functional impact and location. (5, 6) Therapeutic abstention is the rule in the absence of symptoms. Surgical treatment (arthroscopic or open surgery) involves the removal of foreign bodies, either alone or combined with synovectomy when synovitis is active. (6, 8, 9, 10) The advantage of arthroscopy resides in:
1. The simplicity of the follow.
2. Stiffness less than with arthrotomy. Two studies show good results of arthroscopy with a low number of recurrences, whether isolated resection of foreign bodies (18) or resection may be associated with synovectomy. (19) A third study comparing the results of resection only foreign bodies to the resection associated with synovectomy, shows than recurrences are observed only in the group without synovectomy. (20) The place of complementary synoviorthesis after synovectomy is not codified.
Synovial chondromatosis is a rare disease, usually benign, the diagnosis is relatively easy. Appropriate radiological assessment allows early diagnosis and arthroscopic techniques is the treatment of choice for this disease.
MRI: Magnetic resonance imaging
CT: Computed tomography
1. Abu-Youssef MM, El-Khoury GY Case report 307 : Synovial osteochondromatosis limited to a popliteal cyst. Skeletal Radiol : 1985; 13234-238.
2. Benoit J, Arnaud E, Moulucou A, Hardy P, Got C, Judet O Ostéochondromatose synoviale du genou et chondrosarcome synovial. Rev Chir Orthop : 1990 ;76198-203.
3. Blaudino A, Salvi I, Chirico G Synovial osteochondromatosis of the ankle : MR findings. Clin Imaging : 1992; ; 1634-39.
4. De Carvalho JF. Images in rheumatology. Knee synovial osteochondromatosis. Acta Reumatol Port. 2010 Jan-Mar;35(1):107-8.
5. Samson L, Mazurkiewicz S, Treder M, Wi?niewski P. Outcome in the arthroscopic treatment of synovial chondromatosis of the knee. Ortop Traumatol Rehabil. 2005 Aug 30;7(4):391-6.
6. Mohr W. Is synovial osteo-chondromatosis a proliferative disease? Pathol Res Pract. 2002;198(9):585-8.
7. Langguth DM, Klestov A, Denaro C. Synovial osteochondromatosis. Intern Med J.
8. Peh WC. Synovial osteochondromatosis. Am J Orthop (Belle Mead NJ). 2001 Feb;30(2):165.
9. Cohen AP, Giannoudis PV, Hinsche A, Smith RM, Matthews SJ. Post-traumatic giant intraarticular synovial osteochondroma of the knee. Injury. 2001 Jan;32(1):87-9.
10. Choi JK, Jeong JH, Lee CT, Kim SJ. Synovial chondromatosis in the quadriceps tendon. Arthroscopy. 2003 Apr;19(4):E36.
11. Goel A, Cullen C, Paul AS, Freemont AJ. Multiple giant synovial chondromatosis of the knee. Knee. 2001 Oct;8(3):243-5.
12. Wittkop B, Davies AM, Mangham DC. Primary synovial chondromatosis and synovial chondrosarcoma: a pictorial review. Eur Radiol. 2002 Aug;12(8):2112-9.
13. Hallam P, Ashwood N, Cobb J, Fazal A, Heatley W. Malignant transformation in synovial chondromatosis of the knee? Knee. 2001 Oct;8(3):239-42.
14. Blacksin MF, Ghelnam B, Freiberger RH, Salvata E Synovial chondromatosis of the hip : evaluation with air computed arthrotomography. Clin Imaging : 1990 ;14315-318.
15. Burnstein MI, Fisher DR, Yandow DR Case Report 502. Skeletal Radiol : 1988 ;17458-461.
16. Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics. 2007 Sep-Oct;27(5):1465-88.
17. Dorfmann H. [The revival of synovectomy thanks to arthroscopy]. Presse Med.
1989 Oct 21;18(34):1683-4. French.
18. Dorfmann H, De Bie B, Bonvarlet JP, Boyer T. Arthroscopic treatment of synovial chondromatosis of the knee. Arthroscopy. 1989;5(1):48-51.
19. Coolican MR, Dandy DJ. Arthroscopic management of synovial chondromatosis of the knee. Findings and results in 18 cases. J Bone Joint Surg Br. 1989 May;71(3):498-500.
20. Ogilvie-Harris DJ, Saleh K. Generalized synovial chondromatosis of the knee: a
comparison of removal of the loose bodies alone with arthroscopic synovectomy. Arthroscopy. 1994 Apr;10(2):166-70.
Source(s) of Funding
No source of funding for this article.
No conflict of interest
This article has been downloaded from WebmedCentral. With our unique author driven post publication peer
review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is
completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript
but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before
submitting any information that requires obtaining a consent or approval from a third party. Authors should also
ensure not to submit any information which they do not have the copyright of or of which they have transferred
the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to
the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor
replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the
WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm
that you may suffer or inflict on a third person by following the contents of this website.