Systematic Arthroscopic Treatment of Synovial Chondromatosis of the Knee

Abstract

Synovial chondromatosis is a benign metaplastic disease of the synovial joints, characterized by the development of cartilaginous nodules in the synovium. Treatment generally includes open or arthroscopic loose body removal combined with a synovectomy. An all-arthroscopic approach has been described to minimize complications and reduce morbidity while providing adequate control of local disease. The purpose of this Technical Note is to describe our techniques and technical pearls that allow for adequate excision of disease while minimizing complications and disease recurrence. The combination of patient positioning, the establishment of multiple arthroscopic portals to ensure optimal visualization and freedom of instruments, the use of a leg holder, and the use of a variety of surgical instruments to facilitate loose body removal and synovectomy is critical to optimize clinical outcomes and minimize complications. Although technically demanding, our described technique can help facilitate extensive loose body removal and complete synovectomy.

Fig 1

Surface anatomy and portal placement in right knee. The patient is positioned supine with the use of a leg holder. Views from both the lateral and medial aspects of the right knee are shown. (AL, anterolateral; AM, anteromedial; APL, accessory posterolateral; APM, accessory posteromedial; BF, biceps femoris; CPN, common peroneal nerve; F, fibula; PL, posterolateral; PM, posteromedial; SL, superolateral; SM, superomedial; SN, saphenous nerve; TT, tibial tuberosity).

Fig 2

Multiple shavers are used to ensure adequacy of debridement: (1) Dyonics 5.5-mm Full Radius Blade, Platinum Series; (2) Dyonics 4.5-mm Incisor Plus Blade, Platinum Series; and (3) Dyonics 4.5-mm Curved Incisor Plus Elite Blade.

Fig 3

Arthroscopic view from standard anterolateral portal in right knee. Synovial tissue found within the suprapatellar pouch is often embedded with loose bodies. A combination of arthroscopic shavers and electrocautery can be used to release this tissue, which can then be removed with a Kelly forceps or Kocher grasper.

Fig 4

Arthroscopic view from posterolateral portal in right knee. A trans-septal approach is used by inserting the shaver through the posteromedial portal and debriding from medial to lateral.

Fig 5

A trans-septal approach can be used to debride the posterior aspect of the right knee. It is helpful to use the posteromedial portal for debridement and the posterolateral portal for viewing or vice versa.