Arthroscopy: The Journal of Arthroscopic & Related Surgery
International Section: CubaCombined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee*
Section snippets
Methods
Forty-three of all referred patients during the time of the study with clinical symptoms of villonodular synovitis were evaluated arthroscopically. All had a history of atraumatic symptoms of knee pain, local hyperthermia, swelling, and loss of range of motion, and all had failed treatment including at least 6 months of nonsteroidal anti-inflammatory drugs, physical therapy with anti-inflammatory modalities, and avoidance of perpetuating activities. Arthroscopic evaluation was suggestive of
Results
Criteria for determining outcomes at follow-up were primarily patient-reported symptoms. Three patients reported stiffness and swelling, and 2 of these reported pain at follow-up. No patient had erythema. Three patients experienced recurrence of PVNS within 1 year as determined by ultrasonic confirmation of synovial hypertrophy, pain, inflammation, and hyperemia. These recurrences were treated with repeat anterior arthroscopic synovectomy. No further recurrences have occurred. A comparison of
Discussion
Motorized arthroscopic synovectomy is an effective tool in treating PVNS, but when used alone it may be insufficient in eliminating all affected tissue. Flandry et al.14 reported a recurrence rate of 8% of diffuse PVNS of the knee in 23 patients treated by total synovectomy with good to excellent results in all patients, but with 8 patients who required closed manipulation. This may be due to the extensor realignment necessary in patients with redundancy secondary to chronic distention. Zvijac
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Address correspondence and reprint requests to Todd B. Guthrie, M.D., Park Ridge Orthopedics P.A., 27 Doctor’s Dr, Fletcher, NC 28732, U.S.A. E-mail: [email protected]