Kramer, Dennis E. MD; Frassica, Frank J. MD; Cosgarea, Andrew J. MD
Department of Orthopaedic Surgery
Johns Hopkins University
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ABSTRACT Pigmented villonodular synovitis of the knee is a rare and benign disease of synovial proliferation. It commonly occurs in 2 growth patterns: localized nodular and diffuse villous. Presenting clinically with joint pain and swelling, pigmented villonodular synovitis can be difficult to diagnose, as it mimics other more common knee ailments. Numerous treatment modalities for pigmented villonodular synovitis exist, including open and arthroscopic total or partial synovectomy, external beam radiation, and intraarticular injection of radioisotopes. While localized nodular pigmented villonodular synovitis responds well to primary excision, treatment of the diffuse pigmented villonodular synovitis of the knee with synovectomy has been associated with high recurrence rates. Total synovectomy (both arthroscopic and open) has a lower recurrence rate compared with partial synovectomy. Arthroscopic total synovectomy has lower operative morbidity, decreased risk of joint stiffness, lower risk of wound complications, and more rapid rehabilitation when compared with open synovectomy. However, arthroscopic total synovectomy is technically demanding due to difficulty visualizing the posterior synovium. With proper technique and appropriate use of posteromedial, posterolateral, and posterior trans-septal portals, adequate visualization and debridement of the posterior synovium can be achieved via arthroscopy. Using this technique, total 5-compartment arthroscopic synovectomy can be an effective primary treatment modality for diffuse pigmented villonodular synovitis of the knee.