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BACKGROUND: Arthroscopic treatment is recommended for hip synovial chondromatosis. However, evidence regarding long-term clinical outcomes is limited. PURPOSE: To evaluate long-term patient-reported outcomes (PROs) and survival, and to determine the potential effect of residual loose bodies, as evaluated by immediate postoperative computed tomography (CT), on clinical outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between March 2010 and May 2015 were included in the study. Preoperative radiography, CT, and magnetic resonance imaging were performed. Preoperative, midterm (minimum of 4 years), and long-term (minimum of 8 years) PROs were collected for visual analog scale for pain, modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and 12-item international Hip Outcome Tool (iHOT-12). The percentages achieving minimal clinically important difference (MCID) were calculated. PROs and survival were compared between patients with and without residual loose bodies evident on immediate postoperative CT scan. RESULTS: A total of 28 patients (20% of patients were lost to follow-up) were included in the study with a mean follow-up period of 104.9 months (range, 96-139 months). PROs including visual analog scale for pain (preoperative, 3.8 ± 1.2; midterm, 0.9 ± 1.7; long-term, 0.8 ± 1.4), mHHS (preoperative, 66.4 ± 14.4; midterm, 92.8 ± 12.3; long-term, 93.5 ± 10.5), NAHS (preoperative, 45.2 ± 16.2; midterm, 81.8 ± 15.3; long-term, 83.1 ± 12.9), and iHOT-12 (preoperative, 48.4 ± 15.6; midterm, 69.3 ± 11.7; long-term, 72.7 ± 11.4) were improved at both midterm and long-term follow-up (all with P < .001). In total, 27 (96.4%), 28 (100%), and 26 (92.9%) patients achieved MCID for mHHS, NAHS and iHOT-12, respectively, at the long-term follow-up. No significant difference was found in any of the PROs and the rate of achieving MCID between midterm and long-term follow-up (all with P > .05). One patient (3.6%) underwent revision surgery. Among the 23 patients who had loose bodies on preoperative CT or radiographs, 14 patients (60.9%) with residual loose bodies evident on immediate postoperative CT demonstrated lower NAHS (P = .045) and iHOT-12 (P = .037) scores but a comparable survival (P > .05) at long-term follow-up compared with those who did not have loose bodies. CONCLUSION: Arthroscopic treatment for hip synovial chondromatosis achieved satisfactory long-term clinical outcomes with strong survival. Most patients maintained or improved their overall functional status between midterm and long-term follow-up. Furthermore, patients with residual loose bodies had less favorable clinical outcomes, although the survival rate was comparable.
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Artroscopía , Condromatosis Sinovial , Articulación de la Cadera , Medición de Resultados Informados por el Paciente , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/diagnóstico por imagen , Estudios de Seguimiento , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Cuerpos Libres Articulares/cirugía , Cuerpos Libres Articulares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Estudios Longitudinales , Resultado del Tratamiento , Anciano , Imagen por Resonancia Magnética , Dimensión del DolorRESUMEN
abstract: Primary synovial chondromatosis of the hip is a rare joint condition characterized by the abnormal proliferation of cartilaginous tissue within the synovial membrane, which leads to the formation of clusters of chondrocytes floating in the joint space. This commentary provides a comprehensive overview of the pathology, including symptoms, diagnosis, treatment options and long-term management. Patients with primary synovial chondromatosis complaint pain and functional impairment, together with a peculiar joint popping sensation during movement, so determining early disability. The early treatment can lead to better clinical outcomes, with increased preservation of joint function and reduced risk of long-term disability, but strictly depend on symptoms acknowledgement and proper imaging interpretation. As a chronic pathology, surgical approach must necessarily be part of a larger medical and rehabilitative care planning, with long period follow-up. Multidisciplinary team management, with the active involvement of the patient is pivotal in improving the clinical outcomes and quality of life.
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Condromatosis Sinovial , Articulación de la Cadera , Modalidades de Fisioterapia , Humanos , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/diagnóstico por imagenRESUMEN
PURPOSE: To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy. METHODS: A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5 cm mass within the spinal canal at the C4-6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4-5 and C5-6 facet joints. RESULTS: After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3 months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4-5 and C5-6 intervertebral foramen 2 years postoperatively. CONCLUSIONS: Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.
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Vértebras Cervicales , Condromatosis Sinovial , Laminectomía , Humanos , Masculino , Niño , Vértebras Cervicales/cirugía , Vértebras Cervicales/diagnóstico por imagen , Laminectomía/métodos , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/diagnóstico por imagen , Parálisis/etiología , Parálisis/cirugía , Resultado del Tratamiento , Recuperación de la Función , Compresión de la Médula Espinal/cirugía , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Synovial chondromatosis is a non-malignant synovial disorder characterized by the presence of cartilage formation within the synovial membrane, leading to the emergence of multiple cartilaginous nodules that may be either attached or unattached. The presence of this anatomical feature is frequently observed in articulations such as the knee, hip, elbow, and ankle. CASE REPORT: In this study, we present a case of synovial chondromatosis in the knee joint of a healthy male in his early 60s. Notably, the patient exhibited the simultaneous presence of 87 large loose bodies. The occurrence of a substantial quantity of unattached entities of notable dimensions within the joint is highly uncommon. CONCLUSIONS: The patient had several synovial chondromas, a rare disease. Synovial chondromatosis is a benign disorder; however, growing synovium can cause pyogenic cartilage nodules. Most loose bodies in joints can abrade and degenerate articular cartilage, causing long-term discomfort. Thus, an early-stage procedure to remove loose bodies and carefully excise synovial tissue is necessary to treat this condition.
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Cartílago Articular , Condromatosis Sinovial , Humanos , Masculino , Articulación del Tobillo , Cartílago Articular/patología , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/patología , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/patología , Membrana Sinovial/patología , Persona de Mediana EdadRESUMEN
Synovial chondromatosis (SC) is a disorder of the synovium characterized by the formation of osteochondral nodules within the synovium. This study aimed to identify the abnormally differentiated progenitor cells and possible pathogenic signaling pathways. Loose bodies and synovium were obtained from patients with SC during knee arthroplasty. Single-cell RNA sequencing was used to identify cell subsets and their gene signatures in SC synovium. Cells derived from osteoarthritis (OA) synovium were used as controls. Multi-differentiation and colony-forming assays were used to identify progenitor cells. The roles of transcription factors and signaling pathways were investigated through computational analysis and experimental verification. We identified an increased proportion of CD34+ sublining fibroblasts in SC synovium. CD34+CD31- cells and CD34-CD31- cells were sorted from SC synovium. Compared with CD34- cells, CD34+ cells had larger alkaline phosphatase (ALP)-stained area and calcified area after osteogenic induction. In addition, CD34+ cells exhibited a stronger tube formation ability than CD34- cells. Our bioinformatic analysis suggested the expression of TWIST1, a negative regulator of osteogenesis, in CD34- sublining fibroblasts and was regulated by the TGF-ß signaling pathway. The experiment showed that CD34+ cells acquired the TWIST1 expression during culture and the combination of TGF-ß1 and harmine, an inhibitor of Twist1, could further stimulate the osteogenesis of CD34+ cells. Overall, CD34+ synovial fibroblasts in SC synovium have multiple differentiation potentials, especially osteogenic differentiation potential, and might be responsible for the pathogenesis of SC.
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Antígenos CD34 , Condromatosis Sinovial , Fibroblastos , Osteogénesis , Membrana Sinovial , Humanos , Antígenos CD34/metabolismo , Fibroblastos/metabolismo , Fibroblastos/patología , Condromatosis Sinovial/patología , Condromatosis Sinovial/metabolismo , Membrana Sinovial/patología , Membrana Sinovial/metabolismo , Femenino , Masculino , Persona de Mediana Edad , Diferenciación Celular , Anciano , Proteína 1 Relacionada con Twist/metabolismo , Proteína 1 Relacionada con Twist/genética , Proteínas NuclearesRESUMEN
Introduction: Apatite rheumatism (AR), chondrocalcinosis (Ch-C), and primary synovial chondromatosis (prSynCh) are regarded as distinct clinical entities. The introduction of the non-staining technique by Bély and Apáthy (2013) opened a new era in the microscopic diagnosis of crystal induced diseases, allowing the analysis of MSU (monosodium urate monohydrate) HA (calcium hydroxyapatite), CPPD (calcium pyrophosphate dihydrate) crystals, cholesterol, crystalline liquid lipid droplets, and other crystals in unstained sections of conventionally proceeded (aqueous formaldehyde fixed, paraffin-embedded) tissue samples. The aim of this study was to describe the characteristic histology of crystal deposits in AR, Ch-C, and prSynCh with traditional stains and histochemical reactions comparing with unstained tissue sections according to Bély and Apáthy (2013). Patients and methods: Tissue samples of 4 with apatite rheumatism (Milwaukee syndrome), 16 with chondrocalcinosis, and 20 with clinically diagnosed primary synovial chondromatosis were analyzed. Results and conclusion: Apatite rheumatism, chondrocalcinosis, and primary synovial chondromatosis are related metabolic disorders with HA and CPPD depositions. The authors assume that AR and Ch-C are different stages of the same metabolic disorder, which differ from prSynCh in amorphous mineral production, furthermore in the production of chondroid, osteoid and/or bone. prSynCh is a defective variant of HA and CPPD induced metabolic disorders with reduced mineralization capabilities, where the deficient mineralization is replaced by chondroid and/or bone formation. The non-staining technique of Bély and Apáthy proved to be a much more effective method for the demonstration of crystals in metabolic diseases than conventional stains and histochemical reactions.
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Condrocalcinosis , Condromatosis Sinovial , Enfermedades Metabólicas , Enfermedades Reumáticas , Humanos , Condrocalcinosis/diagnóstico , Condrocalcinosis/patología , ApatitasRESUMEN
Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a rare benign disease associated with the formation of multiple cartilaginous nodules in the synovial tissue of the TMJ. This can result in pain, swelling, clicking, limited mouth opening, and osseous degenerative joint changes. A retrospective cross-sectional study was performed to summarize the clinical features, radiographic findings, and surgical and histopathological findings of TMJ SC patients who underwent open surgery over a 24-year period. A radiographic scoring system was used to evaluate osseous changes and correlate condyle and joint fossa degeneration. The study included 38 patients and focused on 38 joints. All 38 of these joints showed degenerative changes in the condyle, while 37 showed osseous degenerative changes in the articular fossa. The degree of condylar degenerative changes was related to the duration of the chief complaints (r = 0.342, P = 0.036) and the histopathological stage of the TMJ SC (r = 0.440, P = 0.006), while the degree of joint fossa degenerative changes was associated with the radiographic extent of the SC (r = 0.504, P = 0.001), type of calcification (r = 0.365, P = 0.024), and the histopathological stage (r = 0.458, P = 0.004).
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Condromatosis Sinovial , Trastornos de la Articulación Temporomandibular , Humanos , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/complicaciones , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Estudios Retrospectivos , Estudios Transversales , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/patología , Cóndilo Mandibular/diagnóstico por imagen , Cóndilo Mandibular/cirugía , Cóndilo Mandibular/patologíaRESUMEN
OBJECTIVE: Herein, we aimed to study the clinical, radiographical, and histopathologic features of synovial chondromatosis in the temporomandibular joint (SC in TMJ) and provide references for early diagnosis and treatment prognosis. STUDY DESIGN: The medical records and imaging examinations of patients with SC in TMJ, diagnosed using postoperative histopathologic examination, were reviewed and analyzed. Among them, 18 cases who lacked calcified loose bodies on spiral computed tomography or cone beam computed tomography (SCT/CBCT) were selected for further study. Descriptive statistical methods were used to analyze the clinical characteristics of patients. RESULTS: The study included 100 patients with SC in TMJ, who were predominantly female (male to female: 1:3), and were aged from 21 to 77 years (median, 47). Radiopaque calcified lesions on SCT/CBCT were missing in 18 cases, but cartilaginous nodules were observed during surgery. The cases lacking calcification had a relatively shorter disease course, suggesting they were in the early stages of SC. CONCLUSION: In the early stage of SC, although calcified loose bodies cannot be detected on SCT/CBCT, attention should be paid to the widening of the posterior superior joint space and sclerosis or slight erosion of the joint fossa. Magnetic resonance imaging would be helpful to detect the early-stage SC in TMJ.
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Condromatosis Sinovial , Humanos , Femenino , Masculino , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Estudios Retrospectivos , Articulación Temporomandibular/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Progresión de la EnfermedadRESUMEN
BACKGROUND: Synovial chondromatosis (SC) primarily affects the major joints and is characterized by the formation of benign cartilaginous nodules. In the present study, we evaluated the differences in the histology and gene expression of SC and normal cartilages and further elucidated the function of hub genes in SC. METHODS: Histological staining and biochemical analysis were performed to measure collagen and glycosaminoglycan (GAG) contents in SC and normal cartilage samples. Then, microarray analysis was performed using knee joint samples (three normal and three SC samples) to identify the differentially expressed genes (DEGs). Subsequently, bioinformatics analysis was performed to identify the hub genes and explore the mechanisms underlying SC. The intersection of the top 10 upregulated DEGs, top 10 downregulated DEGs, and hub genes was validated in SC tissues. Lastly, in vitro experiments and our clinical cohort were used to determine the potential biological functions and diagnostic value, respectively, of the most significant gene. RESULTS: The GAG and collagen contents were comparable to or higher in SC tissues than in normal tissues. Microarray analysis revealed 143 upregulated and 107 downregulated DEGs in SC. Furthermore, functional enrichment analysis revealed an association between immunity and metabolism-related pathways and SC development. Among 20 hub genes, two intersection genes, namely, collagen type III alpha 1 chain (COL3A1) and HSPA8, were notably expressed in SC tissues, with COL3A1 exhibiting a more significant difference in mRNA expression. Furthermore, COL3A1 can promote chondrocyte migration and cell cycle progression. Additionally, clinical data revealed COL3A1 can be a diagnostic marker for primary SC (AUC = 0.82) and be a positive correlation with neutrophil-to-lymphocyte ratio. CONCLUSIONS: These results suggest that SC tissues contained the abundant GAG and collagen. COL3A1 can affect the function of chondrocytes and be a diagnostic marker of primary SC patients. These findings provide a novel approach and a fundamental contribution for diagnosis and treatment in SC.
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Condrocitos , Condromatosis Sinovial , Humanos , Condrocitos/patología , Condromatosis Sinovial/patología , Biomarcadores , Ciclo Celular/genética , Colágeno , Biología Computacional/métodos , Colágeno Tipo IIIRESUMEN
Synovial chondromatosis is a rare pathology that involves most frequently the weight-bearing joints. It is due to the development of cartilaginous bodies from the synovial membrane that could migrate threw the joint. Primary and secondary forms exist. Clinical examination will be marked by swellings and loss of mobility. Cross-sectional imaging has the preference. The treatment of choice is the removal of cartilaginous loose bodies with or without a synovectomy.
L'ostéochondromatose synoviale est une pathologie rare touchant plus fréquemment les articulations en charge. Il s'agit du développement de corps cartilagineux à partir de la membrane synoviale, pouvant devenir intra-articulaires. Il existe des formes primaires et secondaires. L'examen clinique sera principalement marqué par des épanchements et des limitations d'amplitudes articulaires. L'imagerie de choix sera l'imagerie en coupes. Le traitement de choix est l'exérèse des corps cartilagineux sous arthroscopie associée à une synovectomie.
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Condromatosis Sinovial , Cuerpos Libres Articulares , Humanos , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , SinovectomíaRESUMEN
CASE: Synovial chondromatosis is a rare condition affecting synovial joints. It occurs uncommonly in the shoulder and is rare in the pediatric population. We present a case of a 13-year-old male patient with shoulder pain who was diagnosed with synovial chondromatosis and a posterior labral tear. He was treated with arthroscopic loose body removal, synovectomy, and posterior labral repair and recovered well from the surgery. Four years after the surgery, he developed pain in the same shoulder, but the cause of the pain was not investigated per the patient's decision. CONCLUSION: Synovial chondromatosis should be considered in pediatric patients presenting with shoulder pain and loss of function with potential for recurrence.
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Condromatosis Sinovial , Articulación del Hombro , Adolescente , Humanos , Masculino , Artroscopía , Condromatosis Sinovial/complicaciones , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Hombro , Articulación del Hombro/cirugía , Dolor de Hombro/etiología , Dolor de Hombro/cirugíaRESUMEN
This case series reviews 2 patients worked up and treated for unilateral synovial chondromatosis of the temporomandibular joint (TMJ). The first was a 58-year-old female evaluated and treated for synovial chondromatosis of the left TMJ using an arthrotomy of the joint to remove the cartilaginous and osteocartilaginous nodules. The second is a 63-year-old male who was evaluated and treated for synovial chondromatosis of the right TMJ with the removal of extracapsular masses and an arthrotomy with intra-joint removal of nodules. Six-year radiographic follow-up demonstrated no recurrence of the pathology in his case. The cases are reviewed in this article, along with a current review of the literature.
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Condromatosis Sinovial , Trastornos de la Articulación Temporomandibular , Masculino , Femenino , Humanos , Persona de Mediana Edad , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/patología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/patología , Articulación Temporomandibular/patologíaRESUMEN
BACKGROUND: Synovial chondromatosis is an uncommon metaplastic process of the synovial lining that results in the formation of cartilaginous nodules within joints or their associated bursae or tendon sheaths. Radiologic evidence of mineralized bodies within these structures is typically pathognomonic for this condition. Extraarticular chondromatosis is rarer than intraarticular chondromatosis, and the knee is affected less frequently than the smaller joints of the hands and feet. To our knowledge, no reports describing this condition in the semimembranosus-medial collateral ligament (SM-MCL) bursa have been published. CASE PRESENTATION: We describe a case of tenosynovial chondromatosis in a 37-year-old woman. The case was atypical for both the location within the SM-MCL bursa and the paucity of radiodense or hypointense changes to support a clinical suspicion of chondroid metaplasia on radiographs and T2-weighted MRI, respectively. Recreational weightlifting and swimming by the patient were impaired by chronic pain, and restricted range of motion of the ipsilateral knee persisted despite extensive skilled physical therapy and injections of both corticosteroids and platelet-rich plasma. Thirteen months after a diagnostic and therapeutic knee arthroscopy, open surgical excision of the SM-MCL bursal body was performed, and knee pain and range of motion improved by the 6-week postoperative reevaluation. Pathologic evaluation of the excised tissue was consistent with tenosynovial chondromatosis. CONCLUSIONS: Synovial chondromatosis should be considered in the differential diagnosis for recalcitrant bursitis, even in the absence of classic imaging findings.
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Condromatosis Sinovial , Condromatosis , Ligamentos Colaterales , Músculos Isquiosurales , Femenino , Humanos , Adulto , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Imagen por Resonancia Magnética/métodosRESUMEN
We report the case of an 80-year-old woman who presented with an asymptomatic slowly growing mass in the dorsal aspect of her right wrist. Radiographs revealed a snail-shaped radiopaque structure. Surgical exploration and excision revealed a calcified lesion over the extensor digitorum communis. Histopathological analysis confirmed the diagnosis of tenosynovial chondromatosis. At the last follow-up, four years after surgery, the patient was asymptomatic and free of recurrence. Practitioners and hand surgeons should be aware of the dorsal involvement and evocative radiological calcifications of tenosynovial chondromatosis, which is a rare benign soft tissue neoplasm that affects all tendon sheaths of the hand.
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Condromatosis Sinovial , Condromatosis , Neoplasias de los Tejidos Blandos , Humanos , Femenino , Anciano de 80 o más Años , Muñeca , Condromatosis/patología , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugía , Neoplasias de los Tejidos Blandos/diagnóstico por imagen , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/patologíaRESUMEN
OBJECTIVE: Synovial chondromatosis (SC) of the temporomandibular joint (TMJ) is a synovial membrane disease characterized by the formation of cartilaginous nodules (CN), that may erode the skull base. Historically, cases with skull base involvement have been treated with open surgery. We report a case of TMJ SC with skull base perforation treated and repaired via minimally invasive TMJ arthroscopy and describe the advanced endoscopic operative maneuvers performed. CASE REPORT: A 34-year-old male presented with a 4-year history of malocclusion and right TMJ arthralgia. Clinical examination demonstrated malocclusion and direct pressure loading pain. Advanced imaging revealed glenoid fossa erosion and numerous homogenous hypointense lesions within an effusion. The initial surgical plan included diagnostic TMJ arthroscopy followed by conversion to open arthroplasty. Endoscopic operative maneuvers allowed for the accomplishment of the surgical goals, completely arthroscopically. Histopathology confirmed SC, and the patient remains on observation, with relief of symptoms. CONCLUSION: Advanced arthroscopy is a viable treatment option for select cases of TMJ SC with skull base involvement that allowed for access to the joint space, retrieval of biopsy specimens and CN, and repair of the skull defect.
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Condromatosis Sinovial , Trastornos de la Articulación Temporomandibular , Masculino , Humanos , Adulto , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Condromatosis Sinovial/patología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/patología , Tomografía Computarizada por Rayos X , Articulación Temporomandibular/patología , Base del Cráneo/patología , Base del Cráneo/cirugíaRESUMEN
Background: Synovial osteochondromatosis (SOC) of the shoulder is a rare condition with unclear characteristics. This study evaluated the clinical features and postoperative functional outcomes of SOC of the shoulder that are distinct from SOC of other joints. Methods: The characteristics of 28 shoulders with SOC that underwent arthroscopy were retrospectively assessed. Ten shoulders (35.7%) had rotator cuff tears (RCTs) and underwent concomitant arthroscopic rotator cuff repair. The mean follow-up period was 83.6 months (range, 24-154 months). Demographic characteristics and loose bodies localized under arthroscopy were compared between cases with and without concomitant RCTs. Radiography, ultrasonography, or magnetic resonance imaging were performed preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and satisfaction were evaluated for all cases, and functional scores were assessed in shoulders with concomitant RCTs. Results: The average age was 36.2 ± 15.6 years among patients without RCTs and 58.3 ± 7.2 years among patients with RCTs. Seven shoulders (7%) had osteoarthritis. Arthroscopy revealed loose bodies in multiple spaces, including the glenohumeral joint, subacromial (SA) space, and biceps tendon sheath. Overall, loose bodies were found in multiple spaces in 12 shoulders (42.9%). Loose bodies were found in the SA space only in 4 shoulders (22.2%) without RCTs and in 7 shoulders (70.0%) with RCTs. VAS for pain decreased significantly from 3.9 ± 2.3 to 1.1 ± 1.3 (p < 0.001). The functional scores increased significantly after arthroscopic management for patients with concurrent RCTs (all p < 0.05). Recurrence of SOC occurred in 3 of the 22 shoulders (13.6%) who underwent postoperative imaging, but no patient had a recurrent RCT. Conclusions: Pain relief and patient satisfaction were achieved via arthroscopic management. Unlike in other joints, loose bodies can occur simultaneously in several spaces in the shoulder, including the glenohumeral joint, SA space, and biceps tendon sheath. Early diagnosis of SOC of the SA space can help prevent osteoarthritis and RCT progression.
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Condromatosis Sinovial , Osteoartritis , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Hombro/cirugía , Manguito de los Rotadores/cirugía , Condromatosis Sinovial/diagnóstico por imagen , Condromatosis Sinovial/cirugía , Resultado del Tratamiento , Lesiones del Manguito de los Rotadores/cirugía , Articulación del Hombro/cirugía , Artroscopía/métodos , DolorRESUMEN
Synovial chondromatosis of the temporomandibular joint (TMJ) is a rare disease characterized by cartilaginous metaplasia of the mesenchymal remnants of the synovial membrane with formation of loose cartilaginous nodules. It is prevalent in middle-aged women and the main clinical characteristics are swelling, pain, and limited jaw movements. Diagnosis is difficult, especially in the early stages, because the signs and symptoms are like other TMJ diseases such as internal derangements and tumors. Imaging exams are fundamental in differential diagnosis for detection of synovitis and free cartilaginous bodies. Magnetic resonance imaging with a gadolinium contrast would be of particular interest for this purpose. Treatment involves the removal of the cartilaginous nodules and synovectomy. It can be performed by arthroscopy or arthrotomy depending on the size of the lesion, the number of corpuscles, and the need for auxiliary surgical procedures. Final diagnosis is anatomopathologic. Postoperative follow-up is necessary due to the risk of recurrence.