Arthroscopic Treatment of Diffuse Pigmented Villonodular Synovitis of the Knee: Complete Synovectomy and Septum Removal—Midterm ResultsFunding None.
15 January 2018
20 March 2018
04 May 2018 (eFirst)
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.
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.
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.
- 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
- 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
- 3 Jaffe HL, Lichtenstein L, Sutro CJ. Pigmented villonodular synovitis, bursitis, and tenosynovitis. Arch Pathol 1941; 31: 731-765
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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