From the Research
Synovial chondromatosis should be treated with arthroscopic management, focusing on loose body removal and synovectomy, as it has been shown to be a safe and effective treatment option with a recurrence rate of 22.6% 1.
Overview of Synovial Chondromatosis
Synovial chondromatosis is a rare benign condition where the synovial lining of joints, tendon sheaths, or bursa produces multiple cartilaginous nodules that can detach and form loose bodies within the joint space. It typically affects a single joint, most commonly the knee, hip, or elbow, and occurs more frequently in men between 30-50 years old. Patients usually present with pain, swelling, limited range of motion, and locking or catching sensations in the affected joint.
Diagnosis and Treatment
Diagnosis involves imaging studies such as X-rays, which may show calcified loose bodies, and MRI for better visualization of non-calcified bodies and synovial involvement. Treatment depends on symptom severity. For mild cases, conservative management including NSAIDs (like ibuprofen 400-800mg three times daily or naproxen 500mg twice daily), activity modification, and physical therapy may be sufficient. However, definitive treatment typically requires surgical intervention, either through arthroscopic or open synovectomy with removal of loose bodies. The goal is to relieve symptoms and prevent joint damage.
Recent Evidence
A recent systematic review of arthroscopic management of knee synovial chondromatosis found that loose body removal alone was performed in 57.8% of cases, partial synovectomy in 30.9%, and total synovectomy in 13% 1. The review also found that recurrence occurred in 22.6% of cases, predominantly after loose body removal alone. Another study found that synovectomy alone may have slightly better outcomes compared to synovectomy with total knee replacement 2.
Recommendation
Based on the most recent and highest quality study, arthroscopic management with loose body removal and synovectomy is the recommended treatment for synovial chondromatosis 1. This approach has been shown to be safe and effective, with a recurrence rate of 22.6%. Patients should be monitored with follow-up imaging to detect any signs of recurrence or disease progression. Early intervention is important to prevent chronic cases from leading to secondary osteoarthritis due to mechanical damage to the joint surfaces.
Key Points
- Synovial chondromatosis is a rare benign condition that affects the synovial lining of joints, tendon sheaths, or bursa.
- Arthroscopic management with loose body removal and synovectomy is the recommended treatment.
- Recurrence rates range from 10-25%, and patients should be monitored with follow-up imaging.
- Early intervention is important to prevent chronic cases from leading to secondary osteoarthritis.