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Updated: Jun 22 2021

Synovial Chondromatosis

  • summary
    • Synovial Chondromatosis is a proliferative disease of the synovium associated with cartilage metaplasia that results in multiple intra-articular loose bodies.
    • The condition usually presents in patients between 30 and 50 years of age with localized joint pain, stiffness, and swelling.  
    • Diagnosis is made on radiographs in late disease but MRI studies may be required in early disease to show cartilage nodules throughout the joint space.
    • Treatment is usually observation for mild symptoms without restriction in motion. Open or arthroscopic synovectomy and loose body resection is indicated for patients with progressive pain, loss of motion, and reduced function. 
  • Epidemiology
    • Demographics
      • usually affects young adults 30-50 years of age
      • 2:1 male to female ratio
    • Anatomic location
      • knee is most common location
  • Etiology
    • Mechanism
      • associated with cartilage metaplasia
      • results in multiple intra-articular loose bodies
      • ranges from synovial tissue to firm nodules of cartilage 
    • Genetics
      • occasional chromosome 6 abnormalities have been found
  • Presentation
    • Symptoms
      • slow progression of symptoms
      • pain and swelling
        • pain worse with activity
      • mechanical symptoms including stiffness
      • can occur in the bursa overlying an osteochondroma
    • Physical exam
      • decreased range of motion
      • can have warmth, erythema, or tenderness
  • Imaging
    • Radiographs
      • recommended views
        • standard AP/lateral of affected joint
      • findings
        • variable depending on stage of disease
        • may show stippled calcification
    • MRI
      • initially cartilage nodules are only visible on MRI
      • lobular appearance
      • in later stage, signal drop out consistent with calcification
  • Studies
    • Histology
      • discrete hyaline cartilage nodules in various stages of calcification and ossification
      • chondrocytes
        • mild atypia
        • binucleate cells
        • occasional mitoses
  • Treatment
    • Nonoperative
      • observation
        • indications
          • mild symptoms not affecting range of motion
    • Operative
      • open or arthroscopic synovectomy and loose body resection
        • indications
          • severe symptoms affecting range of motion
        • outcomes
          • treatment is symptomatic but may help prevent degenerative joint changes
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