Search Results (13)

Background/Objectives: Tenosynovial giant cell tumor (TGCT), historically referred to as pigmented villonodular synovitis (PVNS), is a rare proliferative synovial disorder that most commonly affects the knee and may lead to progressive joint damage. Surgical synovectomy remains the mainstay of treatment, although recurrence remains a concern, particularly in diffuse disease. The purpose of this study was to evaluate functional outcomes and recurrence following arthroscopic synovectomy with selective open excision for TGCT of the knee. Methods: This retrospective case series included patients treated surgically for TGCT of the knee at a single tertiary orthopaedic center between 2003 and 2023. The extended study period may have introduced variability in surgical technique and perioperative management due to evolving clinical practice. All patients underwent arthroscopic synovectomy, with open excision performed when necessary to address posterior or extra-articular disease not amenable to complete arthroscopic resection. Functional outcomes and knee range of motion were evaluated preoperatively and at final follow-up. Recurrence and complications were recorded. Results: A total of 43 patients were included with a mean follow-up of 8.1 years. Diffuse TGCT was present in 32 patients (74%), while 11 patients (26%) had localized disease. Arthroscopic synovectomy was performed in all cases, with additional open excision required in 10 patients. Functional scores and range of motion improved significantly at final follow-up (p < 0.001). Disease recurrence occurred in 8 patients (18.6%), all with diffuse disease, and was treated with revision arthroscopic synovectomy. Conclusions: Arthroscopic synovectomy with selective open excision when required was associated with significant improvement in functional outcomes and knee range of motion. Disease recurrence occurred in 18.6% of patients and exclusively in those with diffuse disease, emphasizing the need for careful postoperative surveillance. Full article

Background/Objectives: Tenosynovial giant cell tumours (TGCT) are a group of mesenchymal tumours involving the synovium, bursae, and tendon sheaths, comprising two subtypes: nodular and diffuse. Although predominantly benign, diffuse forms can be locally aggressive, resulting in bone destruction. The pathogenesis of TGCTs is still poorly understood. The aim of this study was to systematically review the current literature on the factors, mechanisms, and markers involved in TGCT disease, focussing on their potential role in bone destruction. Methods: This systematic review was conducted using the PRISMA guidelines. A search was performed using PubMed, Scopus, and Cochrane Library, and all original scientific research into mechanisms/pathways/signalling involving TGCTs was included. Results: After the review process, 51 studies were included for data extraction. Extracted data included authorship, publication year, patient numbers and aetiology (nTGCT/dTGCT), demographics, investigative methods, and studied biological factors, mechanisms, and markers. Cross-tabulation of reported elements revealed 159 unique factors, with most appearing only once. Eight elements were reported five or more times: CSF1, CD68, Ki-67, MMP9, CD163, TRAP, TNF-α, and IL-1β. Although representing just 5% of all identified factors, these appeared in 69% of the included studies, highlighting their prominence in the literature. Conclusions: Apart from the well-known osteoclastogenesis factor CSF1, inflammatory cytokines (TNF-α and IL-1β) and monocyte–macrophage lineage makers (CD68, CD163) are signalling pathways key to TGCT disease progression and associated bone destruction. Full article

Background: Pigmented villonodular synovitis (PVNS), also known as tenosynovial giant cell tumor, is a rare proliferative disorder of the synovial membrane that primarily affects the knee joint. Despite advances in imaging and surgical techniques, diagnosis is often delayed, and optimal treatment remains debated. Methods: A Narrative review was conducted according to PRISMA guidelines using PubMed, MEDLINE, and Scopus databases from January 2000 to December 2024. Studies reporting on epidemiology, clinical features, imaging, treatment, and outcomes of PVNS were included. Results: Sixty-six studies encompassing 120 patients were included. The majority of cases were diffuse PVNS. MRI was the most effective imaging tool. Arthroscopic synovectomy was the most common treatment, though recurrence rates remained high, particularly in diffuse forms. Adjuvant treatments, including radiosynoviorthesis and biologic therapies such as infliximab or pexidartinib, were employed in recurrent or unresectable cases. Conclusions: Early diagnosis and complete surgical excision remain the mainstay of treatment. Combined open and arthroscopic approaches are recommended in diffuse PVNS. Further prospective studies are needed to define optimal long-term management. Full article

Diffuse type tenosynovial giant cell tumor (D-TGCT) of the knee presents with stiffness, pain and swelling with surgery being the mainstay treatment. However, the literature lacks data on clinical course of range of motion, pain (ROM), and swelling after open synovectomy for D-TGCT. Therefore, this study aims to evaluate clinical course after open anterior synovectomy. A retrospective analysis was conducted on 214 patients treated for TGCT at our Institutions between 2010 and 2023. 51 patients with anterior knee D-TGCT who underwent open anterior synovectomy were included. Pre- and postoperative assessments included ROM, pain (VAS scale), and reported swelling. The mean knee flexion increased from 100° (SD 14.28) preoperatively to 131.8° (12.64) at 12 months post-surgery. Knee extension remained stable, ranging from 178.4° preoperatively to 179.2° at the final follow-up. Pain decreased from a mean of 5.0 (SD 2.8) preoperatively to 0.5 (SD 0.7) at 12 months. Swelling was initially reported in 90.4% of patients, with 95.74% of them showing improvement at six months, and 100% at 12 months. Open anterior synovectomy effectively improves knee function, pain, swelling in patients with anterior knee D-TGCT, although functional recovery may take up to 6–12 months. Full article

Osteoid osteoma is a benign tumor of the bone, which tends to occur in diaphysis or metaphysis of the long bones. The lesion is generally intraosseous with vague clinical symptoms, hence given the name great mimicker. When located subperiosteally and juxta-articulary, atypical clinical presentation and radiographs may lead to a delayed or missed diagnosis. Performing surgery with a misdiagnosis carries the risk of incomplete resection of the lesion and recurrence. We report the case of a 15-year-old male with a subperiosteal osteoid osteoma of the talus, who was misdiagnosed with pigmented villonodular synovitis (PVNS) and operated through anterior ankle arthrotomy. A nodular lesion, 1 cm in diameter, with a hard rubber consistency, was removed from the dorsal aspect of the talar neck. The pathologic specimens were consistent with subperiosteal osteoid osteoma. The patient’s symptoms resolved rapidly in the early postoperative period. The patient remained asymptomatic at the 20-month follow-up and the control magnetic resonance imaging revealed no signs of recurrence. Atypical radiographs and clinical presentation of juxta-articular subperiosteal osteoid osteomas cause misdiagnosis, delay in diagnosis, incomplete resection, and recurrence. It is important to keep in mind “juxta-articular subperiosteal osteoid osteoma” in the differential diagnosis of cases with suspected pigmented villonodular synovitis. Full article

Background: Pigmented villonodular synovitis (PVNS) is a rare, proliferative disorder of the synovium that predominantly affects the knee. Traditional treatment involves surgical resection; however, the high recurrence rates have prompted the exploration of alternative, minimally invasive treatments. This case report presents the novel use of genicular artery embolization (GAE) with imipenem/cilastatin as a therapeutic intervention. Case presentation: We present a case of a 52-year-old male with a 5-month history of progressive left-knee pain and swelling. Magnetic resonance imaging (MRI) suggested PVNS, which was confirmed through synovial biopsy. Because of concerns about surgical recovery and recurrence risk, the patient opted for GAE with imipenem/cilastatin over traditional synovectomy. This technique, employing the antibiotic’s anti-angiogenic and anti-inflammatory properties, was administered under local anesthesia without complications. Results: Post-procedural assessments demonstrated rapid and sustained symptom relief. At the 1-month follow-up, the patient’s Visual Analog Scale (VAS) pain score decreased from 7/10 to 3/10, and their Knee Injury and Osteoarthritis Outcome Score (KOOS) and SF-36 health survey scores indicated significant functional improvement. By the 6-month follow-up, the VAS had reached 0/10; the KOOS value reflected near-complete functional recovery; and MRI confirmed reduced synovial hypertrophy and absence of recurrence. No complications were observed. Discussion: GAE with imipenem/cilastatin shows potential as an effective alternative to surgery for PVNS, particularly in patients at risk of surgical complications or recurrence. While the preliminary findings are promising, the limitations include the case’s single-subject design and the need for extended follow-up to determine long-term outcomes and recurrence rates. Further studies comparing GAE with traditional surgical approaches are needed to assess its broader applicability in PVNS management. Conclusion: GAE with imipenem/cilastatin offers a promising, minimally invasive approach for PVNS, providing significant symptom relief and functional recovery with minimal complications. Although long-term studies are needed, this technique could serve as a viable alternative for patients with PVNS, especially those contraindicated for surgery. Full article

Background/Objectives: Pigmented villonodular synovitis (PVNS) is a benign proliferation of synovial tissue that can cause joint damage. The hip, although less commonly affected than the knee, presents a challenging diagnosis and treatment, with magnetic resonance imaging (MRI) as the gold standard for detection. Surgical excision, arthroscopic or open, is the main treatment approach, but there is no consensus on the best strategy for the hip. The aim of this systematic review is to evaluate the clinical outcomes, complications, and revision rates associated with arthroscopic hip surgery for PVNS. Methods: A systematic review was performed following the PRISMA guidelines. Relevant studies were identified by searching four databases: PubMed, Scopus, Embase, and Medline. Selected articles were evaluated according to the criteria of levels of evidence (LoE). For retrospective studies, the Coleman Methodology Score (mCMS) was used. This systematic review was registered with the International Prospective Register of Systematic Reviews. Results: Six studies satisfied the criteria; these involved 77 patients (48% male, 52% female) with a mean age of 26.4 years and a mean follow-up of 54.3 months. MRI and biopsy confirmed the diagnoses, and arthroscopic synovectomy was the primary treatment. Success rates ranged from 80% to 100%, with a recurrence rate of 7.8%, 1.3% requiring revision surgery, and eight (10.4%) patients in three studies reporting conversion to THA. Complications included mild effusions and residual synovitis. All patients who underwent a subsequent total hip arthroplasty were affected by advanced osteoarthritis. Conclusions: Our systematic review reveals that the use of hip arthroscopy in diagnosing and treating PVNS has shown satisfactory results without increasing the risk of recurrence or complications and can return patients to their former activity levels, provided their preoperative osteochondral status is good and there is early management of PVNS of the hip joint. Full article

Background: Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures to eliminate the actively inflamed synovial membrane. This study aims to investigate the recurrence-free survival and functional outcome after synovectomy and subsequent radiosynoviorthesis (RSO) in patients with knee synovitis. Methods: Thirty-seven knees diagnosed with pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), and peripheral spondyloarthritis underwent synovectomy and subsequent RSO between May 2005 and October 2016. The mean age was 34.9 ± 15.1 years, and the mean follow-up period was 84 ± 36.4 months. Clinical outcomes were assessed using the Oxford Knee Score and the presence of swelling and pain at the last follow-up. Recurrence-free survival denotes the duration from synovectomy to surgical re-synovectomy. Results: In general, twelve knees underwent re-synovectomy after a mean follow-up of 34.8 ± 24.9 months. The recurrence-free survival was 83.8% at two years, 71.3% at five years, and 61.7% at ten years. The subgroup analysis revealed recurrence-free survival at two years in 63.6% of patients with PVNS, 86.7% of those with RA, and 100% of individuals with peripheral spondyloarthritis. Conclusions: This study demonstrates that combined therapy for synovitis is an effective approach, significantly improving clinical outcomes. Full article

Pigmented villonodular synovitis (PVNS) of the ankle is a very rare, locally aggressive, proliferative disorder. Although surgical excision represents the standard curative treatment, the PVNS relapse rate is high. We present our study of five young athletes (range 20–36 years) with a histopathological diagnosis of PVNS of the ankle, who were treated by surgery and adjuvant radiosynoviorthesis (RSO). The operation involved either arthroscopic (four patients) or open (one patient) debridement, followed by intraarticular RSO with the radiopharmaceutical erbium-169 (¹⁶⁹Er). They were evaluated with the Foot Function Index (FFI) and a visual analog scale (VAS) for pain. At a median follow up period of 47 months (range 36–54 months), all five patients reported marked pain relief with improvements in their daily activities. In particular, the median FFI decreased from 77% (range 71.0%–84.5%) pre-treatment, to 0.5% (range 0%–6%) after treatment. The median VAS score decreased from 4 (range 3–7) to 0 (range 0–1), respectively. Throughout the follow-up period, there were no major complications regarding either therapeutic intervention (arthroscopic or open debridement, RSO). Based on these results, it can be concluded that adjuvant RSO with ¹⁶⁹Er following surgical excision is effective and safe in the treatment of PVNS of the ankle. Full article

Background: Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. Methods: Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2–4.6 years). Results: The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4–10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. Conclusions: Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity. Full article

Pigmented villonodular synovitis (PVNS) of the ankle is a rare benign proliferative growth of the synovium. Studies of the radiologic characteristics of ankle PVNS are sparse. To characterize the radiologic features of ankle PVNS, five patients with histologically proven ankle PVNS were retrospectively studied. The features of their radiographs, computed tomographic scans, and magnetic resonance images were reviewed, with emphasis on the morphological features, extension, margin, bone involvement, signal intensity, and degree of magnetic resonance enhancement. All five lesions were diffuse, affecting the ankle and distal tibiofibular joint; three lesions also involved the subtalar joint. Radiography demonstrated extrinsic bone erosions with marginal sclerosis of the involved joints in all of the patients, but computed tomography identified this much better than did radiography. Magnetic resonance imaging revealed multiple lobulated soft-tissue masses in all of the cases. These soft-tissue masses surrounded the flexor hallux longus tendon and were hypointense on T1-weighted images, with a heterogeneous signal in two cases and homogenous hypointensity in three cases on fat-suppressed T2-weighted images. In one patient who underwent gadolinium-enhanced imaging, the masses showed intense enhancement. Magnetic resonance imaging is the best way to reveal ankle PVNS. Magnetic resonance imaging findings of predominant hypointensity on all pulse sequences and standard radiography findings of bone erosion with marginal sclerosis are characteristic. (J Am Podiatr Med Assoc 101(3): 252–258, 2011). Full article

Pigmented villonodular synovitis, a rare proliferative disease of unknown etiology, is rare in the foot (2% of these lesions). A retrospective review was undertaken of the case histories, radiographs, and imaging results of eight patients treated for pigmented villonodular synovitis of the foot. Pigmented villonodular synovitis was located in the rearfoot in five patients and in the forefoot in the other three. Radiographs in six patients showed bone involvement. Affected bones included the talus, first cuneiform, first and fifth metatarsals, and second phalanx. Treatment was surgical, and only one recurrence was recorded after 24 months. Pigmented villonodular synovitis should be considered in the differential diagnosis of foot tumors. Full article

Pigmented villonodular synovitis is nonmalignant and nonmetastasizing, but it is locally destructive and can result in considerable disability through infiltration and involvement of surrounding soft tissues and bone. This article briefly describes the clinical picture of the diffuse form of pigmented villonodular synovitis and reports on two cases involving juxta-articular erosions of the calcaneocuboid joint. Treatment involved substantial curettage of bone and resection of infiltrated intrinsic musculature. Full article