Basic Sciences 2023, Nov, 27 | 12:00 am

Synovial Chondromatosis: A Guide to Epidemiology, Etiology, Presentation, Imaging, and Treatment

Synovial Chondromatosis is a proliferative disease of the synovium associated with cartilage metaplasia that results in multiple intra-articular loose bodies. It predominantly affects young adults between the ages of 30 and 50, with a higher prevalence in males compared to females. The knee joint is the most common location for this condition. Understanding the epidemiology, etiology, presentation, imaging, and treatment options for Synovial Chondromatosis is crucial for proper diagnosis and management.

Epidemiology:

Synovial Chondromatosis typically affects individuals between 30 and 50 years old. The male to female ratio is approximately 2:1. Although it can occur in any joint, the knee joint is the most frequently affected site.

Etiology:

The exact mechanism of Synovial Chondromatosis is not fully understood. However, it is associated with cartilage metaplasia, leading to the development of multiple loose bodies within the joint space. These loose bodies can range from synovial tissue to firm nodules of cartilage.

Genetics may play a role in some cases, as occasional chromosome 6 abnormalities have been found in affected individuals.

Synovial Chondromatosis knee

Presentation:

The symptoms of Synovial Chondromatosis usually progress slowly over time. Patients may experience pain, swelling, and stiffness in the affected joint. The pain is typically worse with activity, and mechanical symptoms, such as decreased range of motion, can also be present. In some cases, Synovial Chondromatosis can occur in the bursa overlying an osteochondroma.

During a physical examination, healthcare providers may find decreased range of motion in the affected joint and observe warmth, erythema, or tenderness.

Imaging:

Radiographs, such as standard AP/lateral views of the affected joint, are recommended for diagnosing Synovial Chondromatosis. The radiographic findings can vary depending on the stage of the disease but may include stippled calcification.

Magnetic Resonance Imaging (MRI) is particularly useful in early-stage disease, as it can identify cartilage nodules that are not visible on radiographs. These nodules have a lobular appearance. In later stages, MRI may also show signal drop out consistent with calcification.

Studies:

Histology plays a crucial role in confirming the diagnosis of Synovial Chondromatosis. It involves examining the synovial tissue and loose bodies obtained during surgery. Histological analysis reveals discrete hyaline cartilage nodules in various stages of calcification and ossification. Chondrocytes can exhibit mild atypia, binucleate cells, and occasional mitoses.

Synovial Chondromatosis hip

Treatment:

The treatment of Synovial Chondromatosis can be either nonoperative or operative, depending on the severity of the symptoms and their impact on range of motion.

Nonoperative treatment involves observation and is suitable for patients with mild symptoms that do not significantly affect their range of motion.

Operative treatment options include open or arthroscopic synovectomy and loose body resection. This approach is indicated for patients experiencing severe symptoms that significantly limit their range of motion. Although treatment for Synovial Chondromatosis is primarily symptomatic, surgical intervention can help prevent degenerative joint changes.

Conclusion:

Synovial Chondromatosis is a proliferative disease of the synovium that presents with localized joint pain, stiffness, and swelling. It predominantly affects young adults, with the knee joint being the most commonly involved site. Proper diagnosis involves a combination of clinical evaluation, imaging studies such as radiographs and MRI, and histopathological examination. Treatment options range from observation for mild symptoms to operative synovectomy and loose body resection for severe cases. Early intervention can help alleviate symptoms and prevent further joint damage.