EFFECTIVENESS OF ARTHROSCOPY AND/OR ARTHROTOMY THERAPY FOR DIFFUSE PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Dong , LI Qi , JIANG Xie , TANG Xin , LI Jian

Department of Orthopaedics,West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.;

Corresponding author：

Keywords：

Knee, Diffuse pigmented villonodular synovitis, Arthroscopy

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Objective To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combined
with postoperative radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee. Methods Between
September 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 females
with a median age of 33 years (range, 8-75 years). The disease duration ranged from 1 week to 30 years, including 52 left knees
and 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were (1.9 ± 2.3)° and (122.9 ± 5.6)°,
respectively; the Lysholm score was 43.2 ± 6.7; and the International Knee Documentation Committee (IKDC) score was
53.2 ± 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posterior
synovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extraarticular
lesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, and
staging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy. Results Popliteal
artery was injuryed in 1 case and the branch of popl iteal veins were injuryed in 3 cases during operation. Intra-articular
hemorrhage occurred in 1 case at 3 days after operation. The other patients achieved heal ing of incision by first intention
without nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months
(median, 61 months) postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extention
and flexion of the knee joint were (0.2 ± 1.3)° and (135.9 ± 6.6)°, respectively; the Lysholm score was 89.8 ± 5.8; and the IKDC
score was 87.8 ± 5.8. All indexes were significantly improved when compared with the preoperative ones (P lt; 0.05). At 6 months
to 8 years postoperatively, 8 cases had occurrence, and they had sl ight limitation of the range of motion but had no pain and
swelling of the knees after reoperation. Conclusion According to the scope and degree of the knee joint lesions, arthroscopy
and/or arthrotomy combined with postoperative radiotherapy should be chosen for diffuse PVNS of the knee so as to obtain good effectiveness. Radiotherapy and enough total radiation dose are important factors to insure no recurrence.

Citation： LIU Dong,LI Qi,JIANG Xie,TANG Xin,LI Jian. EFFECTIVENESS OF ARTHROSCOPY AND/OR ARTHROTOMY THERAPY FOR DIFFUSE PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(5): 518-521. doi: Copy

1.	Ofluoglu O. Pigmented villonodular synovitis. Orthop Clin North Am, 2006, 37(1): 23-33.
2.	杨洪彬, 李忠, 张忠杰, 等. 膝关节色素沉着绒毛结节性滑膜炎的关节镜治疗探讨. 现代预防医学, 2009, 36(9): 1757-1759.
3.	Miquel A, Lesavre A, Menu Y, et al. Pigmented villonodular synovitis of the knee. Presse Med, 2006, 35(1 Pt 1): 67-68.
4.	Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis of the foot and ankle: Forty years of experience from the Scottish bone tumor registry. J Foot Ankle Surg, 2006, 45(5): 329-336.
5.	Rhee PC, Sassoon AA, Sayeed SA, et al. Arthroscopic treat ment of localized pigmented villonodular synovitis: long-term functional results. Am J Orthop (Belle Mead NJ), 2010, 39(9): E90-94.
6.	Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: Diagnostic pitfalls and management strategy. Cur Orthop, 2005, 19(3): 215-222.
7.	Murphey MD, Rhee JH, Lewis RB, et al. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics, 2008, 28(5): 1493-1518.
8.	Kramer DE, Frassica FJ, Frassica DA, et al. Pigmented villonodular synovitis of the knee: diagnosis and treatment. J Knee Surg, 2009, 22(3): 243-254.
9.	段小军, 杨柳, 陈光兴, 等. 膝关节色素沉着绒毛结节性滑膜炎的微创治疗. 中国微创外科杂志, 2008, 8(7): 648-650.
10.	孙笑非, 林建宁, 阮狄克, 等. 关节镜下诊治膝关节色素绒毛结节性滑膜炎. 中国微创外科杂志, 2009, 9(2): 128-130.
11.	Wu CC, Pritsch T, Bickels J, et al. Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee, 2007, 14(2): 99-106.
12.	Chen WM, Wu PK, Liu CL. Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis. Clin Orthop Relat Res, 2012. [Epub ahead of print].
13.	Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: diagnostic pitfalls and management strategy. Curr Orthop, 2005, 19: 215-222.
14.	Nishida Y, Tsukushi S, Nakashima H, et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol, 2012, 39(2): 345-351.
15.	Berger B, Ganswindt U, Bamberg M, et al. External beam radiotherapy as postoperative treatment of the diffuse pigmente villonodular synovitis. Int J Radiat Oncol Biol Phys, 2007, 67(4): 1130-1134.
16.	Ottaviani S, Ayral X, Dougados M, et al. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum, 2011, 40(6): 539-546.
17.	Nassar WA, Bassiony AA, Elghazaly HA. Treatment of diffuse pigmented villonodular of the knee with combined surgical and radiosynovectomy. HSS J, 2009, 5(1): 19-23.
18.	Horoschak M, Tran PT, Bachiredd P, et al. External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 2009, 75(1): 183-187.

1. Ofluoglu O. Pigmented villonodular synovitis. Orthop Clin North Am, 2006, 37(1): 23-33.
2. 杨洪彬, 李忠, 张忠杰, 等. 膝关节色素沉着绒毛结节性滑膜炎的关节镜治疗探讨. 现代预防医学, 2009, 36(9): 1757-1759.
3. Miquel A, Lesavre A, Menu Y, et al. Pigmented villonodular synovitis of the knee. Presse Med, 2006, 35(1 Pt 1): 67-68.
4. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis of the foot and ankle: Forty years of experience from the Scottish bone tumor registry. J Foot Ankle Surg, 2006, 45(5): 329-336.
5. Rhee PC, Sassoon AA, Sayeed SA, et al. Arthroscopic treat ment of localized pigmented villonodular synovitis: long-term functional results. Am J Orthop (Belle Mead NJ), 2010, 39(9): E90-94.
6. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: Diagnostic pitfalls and management strategy. Cur Orthop, 2005, 19(3): 215-222.
7. Murphey MD, Rhee JH, Lewis RB, et al. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics, 2008, 28(5): 1493-1518.
8. Kramer DE, Frassica FJ, Frassica DA, et al. Pigmented villonodular synovitis of the knee: diagnosis and treatment. J Knee Surg, 2009, 22(3): 243-254.
9. 段小军, 杨柳, 陈光兴, 等. 膝关节色素沉着绒毛结节性滑膜炎的微创治疗. 中国微创外科杂志, 2008, 8(7): 648-650.
10. 孙笑非, 林建宁, 阮狄克, 等. 关节镜下诊治膝关节色素绒毛结节性滑膜炎. 中国微创外科杂志, 2009, 9(2): 128-130.
11. Wu CC, Pritsch T, Bickels J, et al. Two incision synovectomy and radiation treatment for diffuse pigmented villonodular synovitis of the knee with extra-articular component. Knee, 2007, 14(2): 99-106.
12. Chen WM, Wu PK, Liu CL. Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis. Clin Orthop Relat Res, 2012. [Epub ahead of print].
13. Sharma H, Jane MJ, Reid R. Pigmented villonodular synovitis: diagnostic pitfalls and management strategy. Curr Orthop, 2005, 19: 215-222.
14. Nishida Y, Tsukushi S, Nakashima H, et al. Osteochondral destruction in pigmented villonodular synovitis during the clinical course. J Rheumatol, 2012, 39(2): 345-351.
15. Berger B, Ganswindt U, Bamberg M, et al. External beam radiotherapy as postoperative treatment of the diffuse pigmente villonodular synovitis. Int J Radiat Oncol Biol Phys, 2007, 67(4): 1130-1134.
16. Ottaviani S, Ayral X, Dougados M, et al. Pigmented villonodular synovitis: a retrospective single-center study of 122 cases and review of the literature. Semin Arthritis Rheum, 2011, 40(6): 539-546.
17. Nassar WA, Bassiony AA, Elghazaly HA. Treatment of diffuse pigmented villonodular of the knee with combined surgical and radiosynovectomy. HSS J, 2009, 5(1): 19-23.
18. Horoschak M, Tran PT, Bachiredd P, et al. External beam radiation therapy enhances local control in pigmented villonodular synovitis. Int J Radiat Oncol Biol Phys, 2009, 75(1): 183-187.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF ARTHROSCOPY AND/OR ARTHROTOMY THERAPY FOR DIFFUSE PIGMENTED VILLONODULAR SYNOVITIS OF THE KNEE

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