1/22. Open synovectomy with cryosurgical adjuvant for treatment of diffuse pigmented villonodular synovitis of the knee.Pigmented villonodular synovitis (PVNS) is an uncommon, benign disorder usually affecting the synovial membrane of large joints. The diffuse form of PVNS is extremely difficult to control, and long-term recurrence inevitably results in arthrodesis or arthroplasty. Current treatments include surgical, chemical, and radiation synovectomy, but all have significant failure rates. In hope of obtaining a more complete synovectomy, we used cryosurgery as an adjuvant to open synovectomy in three patients. Two patients presented with multiple failed arthroscopic synovectomies, and one patient presented with arthroscopically unresectable PVNS. The surgical approach involved take down and repair of the anterior meniscal attachments, and direct entry into the posterior space through medial and lateral femoral capsular attachments. Cryosurgical surface spray was used on all non-cartilaginous surfaces. At follow-up of 14, 30, and 31 months, all three patients remained symptom-free and there were no indications of clinical recurrence. There were no obvious complications or morbidity from the cryosurgical procedure and all patients had excellent functional recovery. All patients returned to sports and their jobs without restrictions. In the past, it has been shown that cryosurgery is a safe and effective treatment modality for proliferative joint disease. We propose the use of adjuvant cryosurgery for PVNS patients selected for open synovectomy.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/22. Giant-cell tumor of the synovial membrane: localized nodular synovitis in the knee joint.Giant-cell tumor of the synovia is a benign neoplasm characterized histologically by proliferating histiocytes bearing lipids and hemosiderin intermingled with a variable number of multinuclear giant cells. Areas of predilection are the hand, and in the case of synovial joints, the knee joint is particularly affected. Clinically, patients have signs of mechanical derangement and, with the knee joint, meniscal symptoms and locking are often present. Joint effusion without previous trauma is another typical finding. diagnosis is carried out by radiographic tools and has to be confirmed histologically. Giant-cell tumor of the synovia is treated by local excision either by arthroscopy or by arthrotomy. To our knowledge, the case we present is the largest giant-cell tumor of the synovia in the knee joint ever described in literature.- - - - - - - - - - ranking = 4keywords = membrane (Clic here for more details about this article) |
3/22. Successful arthroscopic treatment of pigmented villonodular synovitis of the knee in a patient with congenital deficiency of plasminogen activator inhibitor-1 and recurrent haemarthrosis.We report the arthroscopic treatment of pigmented villonodular synovitis (PVNS) in a 13-year-old Japanese boy with congenital partial deficiency of plasminogen activator inhibitor-1 (PAI-1). He was admitted to our hospital with recurrent haemarthrosis of his right knee. Characteristic abnormalities of fibrinolysis included shortened euglobulin lysis time, low PAI-1 activity and low PAI-1 antigen levels. In addition, levels of "active PAI" in the plasma, which is a measure of total PAI bound to exogenous plasminogen activator, were very low. These parameters remained low after venous occlusion. The diagnosis of PVNS was established by synovial membrane biopsy, and arthroscopic synovectomy was performed with adjuvant administration of intravenous tranexamic acid. Subsequent bleeding episodes have been well controlled by oral administration of tranexamic acid on demand.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
4/22. Localized pigmented villonodular synovitis of the knee: diagnostic challenge and arthroscopic treatment: a report of three cases.The localized form of pigmented villonodular synovitis (LPVS) is a lesion characterized by focal involvement of the synovial membrane. The knee is the most commonly affected joint. We report three cases of LPVS of the knee which were not diagnosed upon clinical evaluation. The aim is to bring the attention of clinicians to this pathological entity, which is often regarded as extremely rare and is therefore not considered in the early differential diagnosis of various knee derangements. Diagnostic and therapeutic arthroscopy was performed. The lesions were completely resected and patohistological findings confirmed the diagnosis of LPVS. All of our three patients have remained asymptomatic at 8, 10, and 12-month follow-ups.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/22. Localized pigmented villonodular synovitis attached to the posterior cruciate ligament of the knee.Localized pigmented villonodular synovitis (PVNS) of the knee joint is a rare pathological entity characterized by a limited involvement of the synovium. We report on a case of localized PVNS which was attached to the posterior cruciate ligament and presented pain without mechanical symptoms. The lesion did not reach dimensions sufficient to interfere with joint function. After arthroscopic removal of the tumor, the patient has maintained asymptomatic status during the 2 year follow-up period.- - - - - - - - - - ranking = 167.87937566052keywords = ligament (Clic here for more details about this article) |
6/22. Pigmented villonodular synovitis of the temporomandibular joint: a report of two cases.Pigmented villonodular synovitis is a benign but locally destructive disease that originates in the synovial membranes of the joints. It is a proliferative disorder of unknown etiology, and it is usually monarthric. Approximately 80% of cases involve the knee; the hip, ankle, foot, hand, elbow, and shoulder account for most other cases. Pigmented villonodular synovitis in the temporomandibular joint is rare. When it does occur, its features include preauricular swelling, trismus, and symptoms of temporomandibular joint dysfunction. It can be diagnosed by a combination of the history, clinical examination, characteristic radiologic findings, and fine-needle aspiration or biopsy results. Wide local excision, including the involved bone, and a total synovectomy are advocated because the lesion can recur if it is not adequately excised. We report two new cases of pigmented villonodular synovitis of the temporomandibular joint, and we review the literature on this subject.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
7/22. Pigmented villonodular synovitis of the temporomandibular joint: an extensive case with skull-base involvement.Pigmented villonodular synovitis (PVNS) is a benign lesion of unclear etiology involving the synovial membranes of joints, bursae, and tendon sheaths. Its occurrence in temporomandibular joint (TMJ) is distinctly rare. Despite its benign nature, PVNS is locally destructive to the surrounding structures. Misdiagnosis and delay in diagnosis contribute to the frequency of tumors presenting at an advanced stage at the time of treatment. Thus, PVNS often requires extensive surgery. A case of PVNS of the left TMJ, involving the left infratemporal fossa and subtemporal cranial base, is presented herein. Preoperative computerized tomography, magnetic resonance imaging, and fine-needle aspiration biopsy were used to establish a presumptive diagnosis and to determine the extent of the lesion. Complete excision of the lesion through an infratemporal fossa approach has provided 7 years of a disease-free period with adequate preservation of function.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
8/22. Pigmented villonodular synovitis: a disease in evolution.Pigmented villonodular synovitis (PVNS) is a rare, benign, proliferative disease of the synovial membrane of joints, tendon sheaths, and bursas. Joint aspiration typically yields hemorrhagic or xanthochromic/serosanguinous (brown, murky) fluid. We describe a case of PVNS that presented as an acute, painless, nontraumatic right knee effusion with clear synovial fluid on arthrocentesis. Initial magnetic resonance imaging of the knee revealed no evidence for hemosiderin. A diagnostic arthroscopy and surgical arthrotomy revealed a unique case of PVNS evolving from local to diffuse involvement of the synovium.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
9/22. Pigmented villonodular synovitis of flexor tendon sheath at wrist causing pseudo-carpal-tunnel syndrome: report of a case.A 27-year-old male patient, a machinist, had median neuropathy after a minor contusion on his right wrist and underwent carpal tunnel release under the impression of carpal tunnel syndrome five years ago. However, symptoms persisted and a small palmar nodule was found one year later. This slow-growing palmar nodule was locking the flexor tendon and the carpal tunnel was re-explored. At the second operation, the nodule was found to be a pigmented villonodular synovitis of the flexor tendon sheath at the palm. After excision of the lesion, the patient became symptom free. After three years, no recurrence was noted. Exploration of the carpal tunnel is recommended when median neuropathy of the wrist responds poorly to conservative treatment or to previous surgical release of the transverse carpal ligament. Although carpal tunnel release is not a difficult procedure, the pathology has to be checked carefully, so that even a small nodule within or near the carpal tunnel is not neglected, as in this case.- - - - - - - - - - ranking = 33.575875132105keywords = ligament (Clic here for more details about this article) |
10/22. The use of MRI to assist in diagnosis of pigmented villonodular synovitis of the knee joint.Pigmented villonodular synovitis (PVNS) of the knee joint remains a difficult and elusive entity to define and characterize. This entity most often appears in the young adult knee with nonspecific clinical features, including a painful range of motion and perhaps a sensation of locking. Detection and diagnosis of this localized soft-tissue mass are difficult because plain roentgenograms may be totally within normal limits. The case of a 21-year-old woman illustrates the use of magnetic resonance imaging (MRI) as an effective technique to define and characterize PVNS. Advantages of MRI include high-resolution/high-contrast multiplanar sections that depict bone, marrow, ligaments and tendons, fat, menisci, and articular cartilage in one image. In addition, MRI is noninvasive and requires no ionized radiation. MRI is an excellent clinical tool for the evaluation of intraarticular tumors of the knee joint.- - - - - - - - - - ranking = 33.575875132105keywords = ligament (Clic here for more details about this article) |
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