History

The typical history of a patient with primary synovial chondromatosis of the knee is that of a middle-aged man with monoarticular pain, swelling, and stiffness with or without mechanical symptoms in the knee. No history of acute trauma is usually reported, but the patient may have a distant history of knee injury. No systemic signs of infection or illness are apparent.

Physical Examination

With regard to the physical examination, no obvious deformity is likely on inspection. The joint may be enlarged in comparison with the uninvolved side. No overlying skin changes are observed.

On palpation, a large effusion can be felt, and the joint has a spongy sensation. Variably present are palpable loose bodies in synovial recesses, tenderness along the medial or lateral joint line, and decreased patellar mobility. Range of motion (ROM) is typically decreased, with a 10-15° loss in flexion and extension. Pain varies with movement. With regard to special testing, results of a ligamentous examination (eg, Lachman test, drawer test) are normal. No specific maneuver is described.

Workup

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Media Gallery

Arthroscopic appearance of synovial chondromatosis loose bodies in shoulder.
Arthroscopic shaver during attempted removal of loose bodies.
Sagittal T2-weighted MRI through knee in adult with synovial chondromatosis demonstrates abnormal signal intensity in suprapatellar pouch. Also note hypertrophic synovium in intercondylar notch region and normal posterior cruciate ligament.
Sagittal T2-weighted MRI of patient with synovial chondromatosis. Note hypertrophic synovium and normal anterior cruciate ligament.
Sagittal T1-weighted MRI of knee in patient with synovial chondromatosis.
Coronal T2-weighted MRI of patient with synovial chondromatosis demonstrates punctate areas of low intensity within synovial fluid.
Coronal T2-weighted MRI of knee in patient with synovial chondromatosis.
Typical plain radiograph of knee in patient with synovial chondromatosis. No abnormalities are noted.
Arthroscopic image of pedunculated synovial chondromatosis in knee.
Arthroscopic image of pedunculated synovial chondromatosis in knee.

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Author

Nicolai B Baecher, MD Hand Surgery Fellow, Division of Hand, Microsurgery, and Reconstructive Orthopaedics, University of Pittsburgh Medical Center Hamot

Nicolai B Baecher, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, AO Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Evan H Argintar, MD Attending Physician, Washington Hospital Center, Washington DC

Disclosure: Nothing to disclose.

John J Christoforetti, II, MD Orthopaedic Surgeon, TriState Orthopaedics and Sports Medicine, Inc., Clinical Instructor, Department of Orthopaedics, University of Pittsburgh School of Medicine

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, Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Christopher C Annunziata, MD Orthopedic Surgeon, Commonwealth Orthopedics and Rehabilitation; Assistant Clinical Professor, Department of Orthopedic Surgery, Georgetown University Medical Center; Team Physician, Washington Redskins; Orthopaedic Consultant, The Washington Ballet

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Ian D Dickey, MD, FRCSC, LMCC Orthopedic Surgeon, Colorado Limb Consultants, Denver Clinic for Extremities at Risk; Medical Director, Denver Sarah Cannon Sarcoma Network; Staff Surgeon, Department of Orthopedics, Presbyterian/St Luke’s Hospital; Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine

Ian D Dickey, MD, FRCSC, LMCC is a member of the following medical societies: Canadian Orthopaedic Association, Maine Society of Orthopaedic Surgeons, Mayo Clinic Alumni Association, Musculoskeletal Tumor Society, New England Orthopedic Society, Royal College of Surgeons of Canada

Disclosure: Received consulting fee from Stryker Orthopaedics for consulting; Received honoraria from Cadence for speaking and teaching; Received grant/research funds from Wright Medical for research; Received honoraria from Angiotech for speaking and teaching; Received honoraria from Ferring for speaking and teaching.

Chief Editor

Omohodion (Odion) Binitie, MD Medical Director, Assistant Member, Department of Sarcoma, Section Head, Orthopedics, Adolescent/Young Adult and Pediatric Orthopedic Oncology, Medical Director, Physical Therapy, Speech Therapy, and Rehabilitation Services, Assistant Fellowship Program Director, Musculoskeletal Oncology, Moffitt Cancer Center; Assistant Professor, Department of Oncologic Sciences, Department of Ortho and Sports Medicine, University of South Florida Morsani College of Medicine

Omohodion (Odion) Binitie, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Children's Oncology Group, Florida Orthopaedic Society, Musculoskeletal Tumor Society

Disclosure: Nothing to disclose.

Synovial Chondromatosis Clinical Presentation

History

Physical Examination

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