Concurrent arboreal lipoma and synovial chondromatosis in an osteoarthritic knee: Insights from a rare case study - A surgical case report.

INTRODUCTION AND IMPORTANCE: Conditions mimicking tumors within the knee, such as arborescent lipoma and synovial chondromatosis, are generally benign yet closely linked to inflammatory or degenerative joint diseases. While each condition is commonly documented individually with osteoarthritis, their concurrent presentation within the same knee is extremely rare. This case report adheres to the SCARE 2023 guidelines (Sohrabi et al., 2023) and aims to shed light on the diagnostic and therapeutic challenges posed by the rare coexistence of these conditions, presenting unique management challenges. CASE PRESENTATION: We detail the case of a 67-year-old woman who has been suffering from progressively worsening bilateral osteoarthritis for over five years, with significant impairment in her right knee. Symptoms included persistent pain unresponsive to standard treatments, reduced mobility, and recurrent swelling. A comprehensive diagnostic evaluation through clinical examination, radiography, and magnetic resonance imaging (MRI) suggested tricompartmental osteoarthritis complicated by suspected arborescent lipoma. Surgical exploration not only confirmed the presence of arborescent lipoma but also revealed synovial chondromatosis. Both conditions were validated during total knee arthroplasty via histopathological examination, and the patient demonstrated significant functional recovery 18 months postoperatively. CLINICAL DISCUSSION: The simultaneous occurrence of arborescent lipoma and synovial chondromatosis within an osteoarthritic knee emphasizes the complex nature of diagnosing and managing advanced joint pathologies. This case highlights the critical need for thorough diagnostic processes to differentiate between multiple potential diagnoses and the vital role of surgical intervention in managing such intricate conditions effectively. CONCLUSION: The rare coexistence of arborescent lipoma and synovial chondromatosis in an osteoarthritic knee underlines the complexities of diagnosing and managing joint diseases. It accentuates the necessity of an exhaustive diagnostic approach and demonstrates the efficacy of surgical management in achieving favorable outcomes. This case supports the need for maintaining a broad differential diagnosis and underscores the value of interdisciplinary collaboration in managing complex joint pathologies.

Rare case of chondrosarcoma of the manubrium sterni: Management challenges and insights (a surgical case report).

INTRODUCTION AND IMPORTANCE: Chondrosarcoma of the manubrium sterni is an exceedingly rare localization of chondrosarcoma. Its treatment poses a significant therapeutic challenge due to the tumor's proximity to the mediastinal organs and the clavicles. This challenge is magnified when the inner ends need to be resected due to tumor contact with the sternoclavicular joints and, more critically, during the reconstruction of the thoracic wall. CASE PRESENTATION: We present the case of a 71-year-old female with a 45x42x51 mm chondrosarcoma of the manubrium sterni, extending to both sternoclavicular joints. The diagnosis was confirmed cytologically and histologically after an ultrasound-guided biopsy. A surgical strategy involving en bloc resection of the manubrium sterni, the internal ends of both clavicles, and the first two ribs, followed by sternal reconstruction using a synthetic manubrial plate and titanium costal staples without clavicular bridging, was indicated and executed. CLINICAL DISCUSSION: This case outlines the surgical considerations and techniques adopted for this complex procedure, emphasizing the operative planning and interdisciplinary collaboration required for a successful outcome. CONCLUSION: At 18 months post-surgery, the patient demonstrated favorable clinical and radiological progress, indicating a positive response to the treatment strategy employed.

Floating patella: Ipsilateral and simultaneous rupture of the quadriceps and patellar tendons in a young individual (a surgical case report).

INTRODUCTION AND IMPORTANCE: The phenomenon of a floating patella or ipsilateral bifocal rupture of the extensor apparatus is an extremely rare injury, with few cases reported in the literature. The aim of this case study is to report an unprecedented event: the simultaneous trans-tendinous rupture of both quadriceps and patellar tendons in a young adult without predisposing factors, emphasizing the need for awareness in diagnosis and management, and suggesting a new avenue for research in prevention and rehabilitation. CASE PRESENTATION: We report the case of a 35-year-old patient with no significant medical history, who experienced this injury following a sudden start in a sprint without prior warm-up. The clinical examination revealed a swollen, painful knee with active extension deficit, patellar ascent, and a sub patellar hiatus. Magnetic Resonance Imaging (MRI) confirmed a trans-tendinous rupture of both the patellar and quadriceps tendons. CLINICAL DISCUSSION: Tendon repair was performed using end-to-end sutures and a figure-8 reinforcement with the semitendinosus tendon, along with gracilis plastie to strengthen the patellar tendon repair. This methodological approach is discussed in the context of its effectiveness and potential implications for future surgical management of similar injuries. CONCLUSION: After a 12-month follow-up, the patient exhibited highly satisfactory results, resuming both professional and sporting activities. To our knowledge, this is the first published case of a trans-tendinous rupture of the extensor apparatus tendons. This observation serves as a reference in understanding the mechanism and surgical management of such lesions, emphasizing the need for further research and clinical vigilance in similar cases.