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J Knee Surg 2019; 32(05): 427-433
DOI: 10.1055/s-0038-1646929
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee: Complete Synovectomy and Septum Removal—Midterm Results

Sohrab Keyhani
1   Department of Orthopedic Surgery, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Seyyed Morteza Kazemi
2   Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Jin Hwan Ahn
3   Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
,
René Verdonk
4   Department of Orthopedics and Traumatology, Ghent University, Ghent, Belgium
,
Mehran Soleymanha
5   Department of Orthopaedics, Orthopaedic Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
› Author Affiliations
Funding None.
Further Information

Publication History

15 January 2018

20 March 2018

Publication Date:
04 May 2018 (online)

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Abstract

The purpose of this study was to evaluate and describe the clinical results of complete arthroscopic synovectomy through the four arthroscopic portals in the knees affected by diffuse pigmented villonodular synovitis (DPVNS). Between 2009 and 2012, 21 patients (15 men and 6 women) with the diffuse form of PVNS of the knee were enrolled in the study after qualification. The clinical diagnosis was confirmed by magnetic resonance imaging and postsurgical pathologic examination. All patients underwent complete synovectomy through posteromedial, posterolateral, anteromedial, and anterolateral portals. Each patient was evaluated before treatment and followed up for a minimum of 5 years (range: 60–79 months) using the Lysholm score and International Knee Documentation Committee (IKDC) score. Both Lysholm score and IKDC scores were significantly improved in all study participants. No cases of clinical recurrence, infection, joint stiffness, or neurovascular lesions were observed. This study showed that an attentive arthroscopic synovectomy is a safer alternative with better clinical outcomes, with no clinical recurrences.

Keywords

knee - pigmented villonodular synovitis - arthroscopic synovectomy

Authors' Contributions

S.K.: Developing the original idea and the protocol, and definition of intellectual content; R.V. and J.H.A.: Study supervision; M.S. and S.M.K.: Contribution to the development of the protocol; M.S.: Preparation and drafting of the article. All authors read and approved the final article.


Note

This study was approved by the Akhtar Hospital Research Ethic Committee in Tehran, Iran (No. 9820). Informed consent was obtained from all individual participants included in the study.


 

  • References

  • 1 Schiller AL. Tumors and tumor like lesions involving joints. In: Kelley WN, Harris ED, Ruddy S, Sledge CB. , eds. Textbook of Rheumatology. Philadelphia: WB Saunders; 1989: 1783-1789
    Search in Google Scholar
  • 2 Myers BW, Masi AT. Pigmented villonodular synovitis and tenosynovitis: a clinical epidemiologic study of 166 cases and literature review. Medicine (Baltimore) 1980; 59 (03) 223-238
    PubMedSearch in Google Scholar
  • 3 Jaffe HL, Lichtenstein L, Sutro CJ. Pigmented villonodular synovitis, bursitis, and tenosynovitis. Arch Pathol 1941; 31: 731-765
    PubMedSearch in Google Scholar
  • 4 Kanamori M, Matsushita I, Yasuda T, Kimura T. Cytogenetic findings in a case of pigmented villonodular synovitis and a review of the literature. Toyama Med J 2008; 19 (01) 31-34
    PubMedSearch in Google Scholar
  • 5 Granowitz SP, D'Antonio J, Mankin HL. The pathogenesis and long-term end results of pigmented villonodular synovitis. Clin Orthop Relat Res 1976; (114) 335-351
    PubMedSearch in Google Scholar
  • 6 Chiari C, Pirich C, Brannath W, Kotz R, Trieb K. What affects the recurrence and clinical outcome of pigmented villonodular synovitis?. Clin Orthop Relat Res 2006; 450 (450) 172-178
    CrossrefPubMedSearch in Google Scholar
  • 7 Rauh PB, Bernard J, Craig DM. Pigmented villonodular synovitis of the knee: average five-year follow-up of arthroscopic treatment. J South Orthop Assoc 2002; 11 (02) 88-92
    PubMedSearch in Google Scholar
  • 8 Rodriguez-Merchan EC. Review article: open versus arthroscopic synovectomy for pigmented villonodular synovitis of the knee. J Orthop Surg (Hong Kong) 2014; 22 (03) 406-408
    CrossrefPubMedSearch in Google Scholar
  • 9 Dines JS, DeBerardino TM, Wells JL. , et al. Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee. Arthroscopy 2007; 23 (09) 930-937
    CrossrefPubMedSearch in Google Scholar
  • 10 Flandry F, Hughston JC, McCann SB, Kurtz DM. Diagnostic features of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 1994; (298) 212-220
    PubMedSearch in Google Scholar
  • 11 Kubat O, Mahnik A, Smoljanović T, Bojanić I. Arthroscopic treatment of localized and diffuse pigmented villonodular synovitis of the knee. Coll Antropol 2010; 34 (04) 1467-1472
    PubMedSearch in Google Scholar
  • 12 Akinci O, Akalin Y, İncesu M, Eren A. Long-term results of surgical treatment of pigmented villonodular synovitis of the knee. Acta Orthop Traumatol Turc 2011; 45 (03) 149-155
    CrossrefPubMedSearch in Google Scholar
  • 13 Nakahara H, Matsuda S, Harimaya K. , et al. Clinical results of open synovectomy for treatment of diffuse pigmented villonodular synovitis of the knee: case series and review of literature. Knee 2012; 19 (05) 684-687
    CrossrefPubMedSearch in Google Scholar
  • 14 Aurégan JC, Klouche S, Bohu Y, Lefèvre N, Herman S, Hardy P. Treatment of pigmented villonodular synovitis of the knee. Arthroscopy 2014; 30 (10) 1327-1341
    CrossrefPubMedSearch in Google Scholar
  • 15 Colman MW, Ye J, Weiss KR, Goodman MA, McGough III RL. Does combined open and arthroscopic synovectomy for diffuse PVNS of the knee improve recurrence rates?. Clin Orthop Relat Res 2013; 471 (03) 883-890
    CrossrefPubMedSearch in Google Scholar
  • 16 Jabalameli M, Jamshidi K, Radi M, Hadi H, Bagherifard A. Surgical outcomes of 26 patients with pigmented villonodular synovitis (PVNS) of the knee at a mean follow-up of 4 years: introducing a novel technique. Med J Islam Repub Iran 2014; 28: 123
    PubMedSearch in Google Scholar
  • 17 Rao AS, Vigorita VJ. Pigmented villonodular synovitis (giant-cell tumor of the tendon sheath and synovial membrane). A review of eighty-one cases. J Bone Joint Surg Am 1984; 66 (01) 76-94
    CrossrefPubMedSearch in Google Scholar
  • 18 Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW. Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am 2002; 84-A (12) 2192-2202
    PubMedSearch in Google Scholar
  • 19 Kim SJ, Song HT, Moon HK, Chun YM, Chang WH. The safe establishment of a transseptal portal in the posterior knee. Knee Surg Sports Traumatol Arthrosc 2011; 19 (08) 1320-1325
    CrossrefPubMedSearch in Google Scholar
  • 20 Gu HF, Zhang SJ, Zhao C, Chen Y, Bi Q. A comparison of open and arthroscopic surgery for treatment of diffuse pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc 2014; 22 (11) 2830-2836
    CrossrefPubMedSearch in Google Scholar
  • 21 Johansson JE, Ajjoub S, Coughlin LP, Wener JA, Cruess RL. Pigmented villonodular synovitis of joints. Clin Orthop Relat Res 1982; 163 (163) 159-166
    PubMedSearch in Google Scholar
  • 22 Schwartz HS, Unni KK, Pritchard DJ. Pigmented villonodular synovitis. A retrospective review of affected large joints. Clin Orthop Relat Res 1989; 247 (247) 243-255
    PubMedSearch in Google Scholar
  • 23 Flandry FC, Hughston JC, Jacobson KE, Barrack RL, McCann SB, Kurtz DM. Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 1994; 300 (300) 183-192
    PubMedSearch in Google Scholar
  • 24 Zvijac JE, Lau AC, Hechtman KS, Uribe JW, Tjin-A-Tsoi EW. Arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy 1999; 15 (06) 613-617
    CrossrefPubMedSearch in Google Scholar
  • 25 de Visser E, Veth RP, Pruszczynski M, Wobbes T, Van de Putte LB. Diffuse and localized pigmented villonodular synovitis: evaluation of treatment of 38 patients. Arch Orthop Trauma Surg 1999; 119 (7-8): 401-404
    CrossrefPubMedSearch in Google Scholar
  • 26 Ushijima M, Hashimoto H, Tsuneyoshi M, Enjoji M. Giant cell tumor of the tendon sheath (nodular tenosynovitis). A study of 207 cases to compare the large joint group with the common digit group. Cancer 1986; 57 (04) 875-884
    CrossrefPubMedSearch in Google Scholar