Disseminated synovial chondromatosis of the knee managed by combined anterior and posterior approaches: A rare case report

Abstract

Background: Synovial chondromatosis of the knee is an unusual, rare, benign metaplastic neoplasm of the synovium, characterized by formation of focal cartilaginous nodules in the synovium. It predominantly involves the anterior compartment of knee and extensive, disseminated involvement is rarely reported. Diagnosis is usually established with clinico-radiological imaging and confirmed by histology. The paucity of literature on the management of synovial chondromtosis, puts an orthopaedician in dilemma regarding the optimal surgical intervention. Case report: We report a case of 50-year-old male who presented with severe pain and swelling in his left knee associated with functional incapacitation. Magnetic Resonance Imaging (MRI) demonstrated diffuse proliferation of synovium with mild effusion displaying multiple, disseminated calcific nodules. We managed the case by open removal of loose bodies and radical synovectomy through combined anterior and posterior approach. At four years follow-up, there are no clinical or radiological signs of recurrence. Conclusion: Extensive involvement of the knee with calcific nodules is extremely rare. Treatment is controversial which usually includes removal of loose bodies combined with an open or arthroscopic synovectomy. Our case report recommends single stage, open retrieval of loose bodies combined with radical synovectomy to decrease the incidence of recurrence in extensive synovial chondromatosis. To our knowledge, disseminated synovial chondromatosis of the knee, managed by open, combined approach has been reported only once in the literature.