Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 72  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::Related articles
 ::  Article in PDF (11 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed7385    
    Printed149    
    Emailed4    
    PDF Downloaded108    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


 


 
CASE REPORT
Year : 1995  |  Volume : 41  |  Issue : 4  |  Page : 113-4

Solitary synovial osteochondroma of the knee.


Dept of Orthopaedics, Seth GS Medical College, Parel, Bombay.,

Correspondence Address:
V N Allahabadia
Dept of Orthopaedics, Seth GS Medical College, Parel, Bombay.

Login to access the Email id


PMID: 0010707736

Get Permissions


 :: Abstract 

A very rare case of solitary osteochondroma of the knee is reported. The patient presented with a slowly growing retropatellar bony tumour of 4 years duration following a minor trauma. An excisional biopsy with a total patellectomy was performed as the patellar articular surface was unsalvageable. A 20 month follow up revealed no recurrence and a functional knee. A brief review of literature is also presented.


Keywords: Adult, Bone Neoplasms, diagnosis,etiology,surgery,Case Report, Female, Human, Knee Injuries, complications,Knee Joint, Osteochondroma, diagnosis,etiology,surgery,Synovial Membrane, pathology,


How to cite this article:
Allahabadia V N, Kulkarni S S, Dogra A S, Bhosale P B. Solitary synovial osteochondroma of the knee. J Postgrad Med 1995;41:113

How to cite this URL:
Allahabadia V N, Kulkarni S S, Dogra A S, Bhosale P B. Solitary synovial osteochondroma of the knee. J Postgrad Med [serial online] 1995 [cited 2014 Nov 23];41:113. Available from: http://www.jpgmonline.com/text.asp?1995/41/4/113/507





  ::   Introduction Top


Synovial chondromatosis has been discussed widely in literature[1]. However solitary osteochondroma is an extremely uncommon entity and few reports are available in literature. This rare tumour is usually seen in the hands and feet. We present here an interesting case where it was found in the knee joint.


  ::   Case report Top


A 32 year old housewife, sustained a minor trauma to her left knee region 4 years ago which was treated by massage. She complained of a progressively increasing swelling with restriction of her range of motion over the 4 year period. There was no other significant contributory history. On examination there was a diffuse, solitary, bony hard swelling, anteromedial to the left patella, extending to the retro patellar region, with normal overlying skin. The range of movements at the left knee was 30? to 90?, and no patella femoral movement was detectable. There was minimal tenderness over the tibial tuberosity. There was no ligamentous laxity or distal neurovascular deficit. The swelling was not palpable in the popliteal fossa. There was quadriceps wasting and no palpable inguinal lymph nodes. All other joints were normal. Roentgenograms of the left knee, AP, lateral and skyline views [Figure - 1], showed a solitary, calcified, intra-articular, irregular, retro patellar mass with erosion of the articular surface of the patella.

99m Technetium bone scan revealed localised increased uptake. Rest of the scan was normal. Serum calcium was - 9.5 mg % (Normal 9-11 mg %) Serum inorganic phosphorus - 4 mg % (Normal 3-4.5 mg %) Serum alkaline phosphatase - 10 KA units (Normal 3-13 KA units) Rest of the biochemical investigations were unremarkable.

As the history, clinical findings and investigations were suggestive of a benign tumour, it was decided to perform an excisional biopsy through an anteromedial para patellar incision. On exploration, a solitary, gritty, bony hard tumour, 4 x 3 x 6 cms was found arising from the synovium and eroding the posterior and inferior surface of the patella. There was also some extension into the anterior cruciate ligament and the posterior aspect of the patellar tendon. The tumour along With its overlying folds of synovium was excised. Since the patellar articular surface was beyond salvage, a total patellectomy was performed, Intra and postoperative period was uneventful, the limb being immobilised in a cylinder cast for a period of 6 weeks. Gradual mobilisation was then started. Histopathologically, the tumour was proved to be an osteochondroma.

At a 20 month follow-up, the range of movement at the left knee was 0 to 100?, without any pain. There was no evidence of local recurrence. The patient could perform all daily activities without discomfort [Figure - 2]


  ::   Discussion Top


Solitary synovial osteochondroma is a rare variant of synovial osteochondromatosis. These tumours arise from the synovial cells themselves or the primitive cells lying within the synovium[1]. These tumours are formed probably by metaplasia of the synovial cells to chondrocytes, giving rise to islands of cartilage within the synovium, which then lead to multiple loose bodies within the joint cavity with secondary mineralization[2]. Solitary synovial osteochondroma is not connected to bone and occurs almost exclusively in the vicinity of the joints in hands and feet. There has been a single case report of a solitary synovial osteochondroma around the knee[3]. Other rare presentations include a carpal tunnel syndrome[4]. A review of literature failed to disclose a case with malignant transformation although local recurrence has been reported, in some, more than once[2], and hence a subtotal synovectomy has been advised. In our case, there has been no recurrence in a period of 20 months and the functional result is good following the local excision of the tumour.

 
 :: References Top

1. Fechner RE. Neoplasms and Neoplasm-like Lesions of the Synovium; in Tones and Joints", edited by Ackermann LLV, Spjut HJ, Abell MR, Williams and Wilkins Co., Baltimore: 1976; 157-1M  Back to cited text no. 1    
2.Minsinger WE, Balogh K, Millender LH. Tenosynovial Osteochondroma of the hand. A case report and brief review. Clin Orthop 1985; 196:248-52.  Back to cited text no. 2    
3.Shih WJ, Ryo UY. Synovial osteochondroma of the knee it Tc 99m HMDP Bone Imaging. Clin Nucl Med 1988; 13 (8):617-18.  Back to cited text no. 3    
4.Nather AA, Chong PY. A rare case of carpal tunnel syndrome due to tenosynovial osteochondroma. J Hand Surg (Br) 1986; 11 (3): 478-80.   Back to cited text no. 4    


    Figures

[Figure - 1], [Figure - 2]

This article has been cited by
1 Extra-osseous osteochondroma-like soft tissue mass of the patello-femoral space
Oliva F, Marconi A, Fratoni S, et al.
BMC MUSCULOSKELETAL DISORDERS. 2006; 7: Art.
[Pubmed]
2 Diagnosis and differential diagnosis of extraskeletal, para-articular chondroma of the knee
Schmidt-Rohlfing B, Staatz G, Tietze L, et al.
ZEITSCHRIFT FUR ORTHOPADIE UND IHRE GRENZGEBIETE. 2002; 140 (5): 544-547
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Medknow