eMedicine Specialties > Orthopedic Surgery > Neoplasms

Synovial Chondromatosis: Treatment

Author: Christopher C Annunziata, MD, Orthopedic Surgeon, Commonwealth Orthopedics and Rehabilitation; Assistant Clinical Professor, Department of Orthopedic Surgery, Georgetown University Medical Center; Team Physician, DC United, Major League Soccer
Coauthor(s): John J Christoforetti II, MD, Board Certified Orthopaedic Surgeon, TriState Orthopaedics and Sports Medicine, Inc., and Clinical Instructor, Department of Orthopaedics, University of Pittsburgh Medical School
Contributor Information and Disclosures

Updated: Nov 2, 2009

Treatment

Medical Therapy

Nonsteroidal anti-inflammatory drugs can be used along with transcutaneous therapies (eg, ultrasound, thermal therapies) for reduction of inflammation. Patients with primarily mechanical symptoms do not benefit significantly from nonoperative therapy.

Surgical Therapy

Treatment includes arthroscopic examination and excision of loose bodies, with limited synovectomy of involved synovium only.

Preoperative Details

Patients who have a history and have physical, plain radiographic, and MRI findings that are consistent with a diagnosis of synovial chondromatosis requiring surgical intervention are referred for a preoperative medical evaluation and clearance for surgery.

Frank discussion of the risks of arthroscopic surgery should address rates of infection (<1%), thromboembolic disease (1-3%), iatrogenic neurovascular injury ( <1%), complications related to anesthesia, and recurrence of symptoms that require further surgery (0-20%).

Consent is obtained for surgical intervention on an elective basis.

Intraoperative Details

Arthroscopic treatment of synovial chondromatosis of the knee

After general anesthesia is induced, the affected limb is correctly identified and examined with the patient under anesthesia. If multiple loose bodies are present, limited passive range of motion or crepitus may be present. Examination of ligamentous stability typically yields normal findings.

The procedure proceeds as follows:

  1. Apply a nonsterile thigh tourniquet.
  2. Surgically prepare the affected leg to the level of the tourniquet.
  3. Standard arthroscopic portals are established in the medial suprapatellar and medial and lateral parapatellar locations.
    • When access to the posterior compartment of the knee is required, a posteromedial portal should be established.
    • The surgeon should be comfortable with establishing this portal, and he or she must be aware of the increased potential for damage to the saphenous nerve superficially and to the popliteal artery and tibial nerve posteriorly.
  4. A 30° arthroscope is inserted through the lateral parapatellar portal, and diagnostic arthroscopy is performed. When the arthroscope is introduced, abundant round cartilaginous bodies are typically present, both free in the joint and embedded in the synovial lining.
    • In primary synovial chondromatosis, the articular surfaces are typically normal.
    • In secondary synovial chondromatosis, chondromalacia or osteochondral defects reflective of underlying disease may be present.
  5. Arthroscopic graspers are used to remove all free loose bodies.
  6. Large or pedunculated lesions embedded in the synovium are excised by using arthroscopic graspers and shavers. A large outflow cannula can be helpful for extracting loose cartilaginous pieces.
  7. All specimens are sent to a pathologist for histologic evaluation.
  8. Arthroscopic instruments are withdrawn, and portals are closed with monofilament nonabsorbable sutures.
  9. A sterile dressing is applied, and the knee is placed in an immobilizer.
  10. The patient is transferred to the recovery room for observation and recovery from anesthesia.

Postoperative Details

The patient is discharged from the surgical suite with narcotic pain medication, enteric-coated aspirin for deep venous thrombosis prophylaxis, and a nonsteroidal anti-inflammatory drug. Pathology results are carefully followed up. Immediate, full weight bearing is permitted in a knee immobilizer, with instructions to elevate and apply ice to the knee for the first 3-7 days.

Follow-up

The patient is seen for a follow-up visit 3-7 days after surgery for evaluation of surgical wounds. Sutures are removed and sterile bandages (eg, Steri-Strips) are applied.

Physical therapy for full active, active-assisted, and passive range of motion begins. When full range of motion is achieved (at a goal of 3 wk after surgery), the therapist is instructed to focus on quadriceps strengthening. Full return to activity can be anticipated by 6-8 weeks after surgery.

Complications

The most common complications include stiffness and recurrence of mechanical symptoms due to loose-body generation. In most series, rates of recurrent symptoms that required repeat arthroscopic surgery were <20%. With aggressive postoperative rehabilitation, use of the arthroscopic approach typically helps prevent stiffness.

More on Synovial Chondromatosis

Overview: Synovial Chondromatosis
Workup: Synovial Chondromatosis
Treatment: Synovial Chondromatosis
Follow-up: Synovial Chondromatosis
Multimedia: Synovial Chondromatosis
References
Further Reading
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References

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Further Reading

Related eMedicine topic
Synovial Osteochondromatosis (Radiology)

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Keywords

synovial chondrometaplasia, articular chondromatosis, osteochondromatosis, chondrocalcinosis articularis, tenosynovial chondrometaplasia, joint chondromata, diffuse endochondromatosis

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Contributor Information and Disclosures

Author

Christopher C Annunziata, MD, Orthopedic Surgeon, Commonwealth Orthopedics and Rehabilitation; Assistant Clinical Professor, Department of Orthopedic Surgery, Georgetown University Medical Center; Team Physician, DC United, Major League Soccer
Christopher C Annunziata, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Eastern Orthopaedic Association, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Coauthor(s)

John J Christoforetti II, MD, Board Certified Orthopaedic Surgeon, TriState Orthopaedics and Sports Medicine, Inc., and Clinical Instructor, Department of Orthopaedics, University of Pittsburgh Medical School
John J Christoforetti II, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Medical Editor

Miguel A Schmitz, MD, Consulting Surgeon, Department of Orthopedics, Klamath Orthopedic and Sports Medicine Clinic
Miguel A Schmitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ian D Dickey, MD, FRCSC, Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center
Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, British Columbia Medical Association, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Stryker Orthopaedics Consulting fee Consulting; Sanofi-Aventis Honoraria Speaking and teaching

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

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