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Purpose To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy. Methods A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5 cm mass within the spinal canal at the C4–6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4–5 and C5–6 facet joints. Results After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3 months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4–5 and C5–6 intervertebral foramen 2 years postoperatively. Conclusions Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.

A man in his 30s presented with a progressively enlarging swelling over the lateral aspect of his right ankle for 8 months. The swelling was insidious in onset, gradually progressive and notably painless. Examination revealed a 6×4 cm lobulated mass over the lateral malleolus with preserved ankle motion. Ultrasonography showed a lobulated hypoechoic lesion with vascularity, and contrast-enhanced MRI revealed a multiloculated lesion with peripheral enhancement surrounding the peroneal tendons, suggestive of synovial chondromatosis (SC). Excisional biopsy demonstrated nodules of mature hyaline cartilage separated by fibrocollagenous septa, confirming SC. The patient recovered uneventfully after excision and remained asymptomatic at follow-up. This case highlights an unusual presentation of peroneal tendon sheath SC as a painless swelling, underscoring the importance of imaging and histopathology in diagnosis and the role of surgical excision as definitive treatment.

Background The coexistence of calcium pyrophosphate dihydrate crystal deposition (CPP) and synovial chondromatosis (SC) in the temporomandibular joint (TMJ) is rarely reported. CPP disease (CPPD) is complex arthritis synonymous with excessive pyrophosphate production and variable aberrations in mineral and organic phase metabolism of the joint cartilage, leading to local inundated CPP and crystal deposition of partially deciphered predispositions. Meanwhile, SC is a rare benign synovial joint proliferative disease of unclear etiology and has a low risk of malignant transformation. However, SC manifests severe joint disability and dysfunction because of connective tissue metaplasia of the synovial membrane, which forms cartilaginous nodules with or without calcifications or ossifications. These nodules often detach and form intra-articular loose bodies and very rarely within extraarticular spaces. Case presentation We report the case of a 61-year-old man to expand the body of literature on these unusual coexisting arthropathies of the TMJ. The patient presented to our hospital in 2020 with complaints of pain in the right TMJ and trismus for over 6 months. Radiographic assessments of the TMJ provided a preoperative provisional diagnosis of SC. However, the histopathology of the open biopsy revealed tumor-like lesions comprising several deposits of rhomboid and rod-shaped crystals that displayed positive birefringence in polarized light, confirming a coexistence of CPPD. A second-stage operation was performed for the complete removal of the loose bodies and chalk-like lesions including synovectomy. No evidence of recurrence was recorded after a follow-up of nearly 1.5 years. Conclusions Isolated CPPD and SC of the TMJ are prevalent in the literature however, monoarticular coexistence of these diseases is rare, due to the lack of consistency in the diagnostic criteria in clinical practice. Moreover, optimal treatment depends on several considerations. This report delineated the molecular etiopathology and underscored the need for continued deciphering of the causal mechanisms of coexisting CPPD and SC of the TMJ. In addition, the importance of confirmatory testing for accurate diagnosis, and appropriate management of these diseases were discussed.

Synovial osteochondromatosis is a rare benign disorder characterised by cartilaginous metaplasia of the synovium, most often affecting large joints. We describe an unusual case in the sternoclavicular joint of an adolescent, who presented with a localised swelling. Imaging demonstrated multiple calcified loose bodies, and the diagnosis was confirmed histologically following surgical excision. Management consisted of removal of the loose bodies with consideration of synovectomy to reduce recurrence. Early recognition is crucial to prevent progressive joint damage.

Introduction Synovial chondromatosis is a rare, benign condition characterized by the formation of multiple cartilaginous nodules within the synovial membrane of joints. Despite its rarity, there remains significant uncertainty regarding its optimal management. Early diagnosis and appropriate surgical intervention are essential, yet the literature on best practices remains limited. The anterior compartment of the knee is mostly affected, and widespread illness is quite uncommon. In severe cases, the most effective surgical approach for severe cases is still debated. This report presents a rare case of knee synovial chondromatosis with extensive involvement of both anterior and posterior compartments, treated with a staged surgical approach. Case presentation A 50-year-old Semitic male presented with a 15-year history of progressively worsening right knee pain and swelling. Physical examination revealed significant swelling, restricted range of motion, and a palpable mass in the anterior and posterior knee, prompting further imaging. Magnetic resonance imaging confirmed the presence of large loose bodies and extensive synovial hypertrophy, leading to the decision for surgical intervention. The patient underwent a staged open radical synovectomy, first targeting the anterior compartment followed by the posterior compartment. Two large loose bodies were removed, and histopathology confirmed synovial chondromatosis with synovial papillary hyperplasia. The patient responded well postoperatively, with improved range of motion following physiotherapy. Conclusion Generalized synovial chondromatosis of the knee is a rare but significant condition that requires early diagnosis and surgical intervention to prevent joint degeneration. A staged anterior and posterior synovectomy provides effective management of the disease with good clinical outcomes and reduced risk of recurrence.

Purpose The authors evaluated a cohort of 37 patients with histologically verified synovial chondromatosis (SC) between 2013 and 2022. Methods The cohort consisted of 37 patients (26 women, 11 men). 36 patients had unilateral involvement, while one patient had bilateral involvement. The average age of the patients was 54.77 years. The authors used the Milgram histopathological classification. They evaluated SC localisation, clinical symptoms, diagnostics and treatment (including recurrence incidence) in this cohort. Results In 31 patients (83.7%) SC affected only the upper joint space in one patient (2.7%) the lower space, and in five patients (13.6%) both spaces. 12 patients (32%) were Milgram Stage 1 (presence of synovial metaplasia without loose bodies), eight patients (22%) were Stage 2 (presence of synovial changes, loose bodies), and 17 patients (46%) were Stage 3 (presence of loose bodies, no synovial changes). Pain was the dominant clinical symptom (32 patients, 86.4%). Treatment consisted of arthroscopy and open surgery. Two patients underwent primary reconstruction and total TMJ replacement. Treatment was successful in 89.2% of cases (33 patients), with four (10.8%) patients suffering recurrence. Conclusion As this patient cohort shows, pain was the dominant symptom in patients with SC. Magnetic resonance imaging is fundamental in the diagnosis of SC, demonstrating pathological findings even in patients for whom an initial X-ray was negative. These were mainly patients with Milgram Stages 1 and 2 without calcification, loose bodies or pathological changes of the bone structures. This is why the authors recommend MRI for any patient experiencing pain for more than three months, and if this reveals an effusion, joint distension or intraarticular soft tissue mass, they will always indicate arthroscopy. Thorough follow-up of patients is recommended, although SC recurrence is not very frequent. The authors recommend follow-up one, three and six months after surgery, and then annually for the first five years after surgery. They recommend follow-up MRI one, two and five years after surgery.

Background Synovial chondromatosis is an uncommon metaplastic process of the synovial lining that results in the formation of cartilaginous nodules within joints or their associated bursae or tendon sheaths. Radiologic evidence of mineralized bodies within these structures is typically pathognomonic for this condition. Extraarticular chondromatosis is rarer than intraarticular chondromatosis, and the knee is affected less frequently than the smaller joints of the hands and feet. To our knowledge, no reports describing this condition in the semimembranosus-medial collateral ligament (SM-MCL) bursa have been published. Case presentation We describe a case of tenosynovial chondromatosis in a 37-year-old woman. The case was atypical for both the location within the SM-MCL bursa and the paucity of radiodense or hypointense changes to support a clinical suspicion of chondroid metaplasia on radiographs and T2-weighted MRI, respectively. Recreational weightlifting and swimming by the patient were impaired by chronic pain, and restricted range of motion of the ipsilateral knee persisted despite extensive skilled physical therapy and injections of both corticosteroids and platelet-rich plasma. Thirteen months after a diagnostic and therapeutic knee arthroscopy, open surgical excision of the SM-MCL bursal body was performed, and knee pain and range of motion improved by the 6-week postoperative reevaluation. Pathologic evaluation of the excised tissue was consistent with tenosynovial chondromatosis. Conclusions Synovial chondromatosis should be considered in the differential diagnosis for recalcitrant bursitis, even in the absence of classic imaging findings. Level of evidence 4.

Objective To investigate the diagnostic performance of ultrasound-guided synovial biopsy. Methods Clinical notes, pathology and microbiology reports, ultrasound and other imaging studies of 100 patients who underwent 111 ultrasound-guided synovial biopsies were reviewed. Biopsies were compared with the final clinical diagnosis established after synovectomy (n = 43) or clinical/imaging follow-up (n = 57) (mean 30 months). Results Other than a single vasovagal episode, no complication of synovial biopsy was encountered. One hundred and seven (96 %) of the 111 biopsies yielded synovium histologically. Pathology ± microbiology findings for these 107 conclusive biopsies comprised synovial tumour (n = 30, 28 %), synovial infection (n = 18, 17 %), synovial inflammation (n = 45, 42 %), including gouty arthritis (n = 3), and no abnormality (n = 14, 13 %). The accuracy, sensitivity, and specificity of synovial biopsy was 99 %, 97 %, and 100 % for synovial tumour; 100 %, 100 %, and 100 % for native joint infection; and 78 %, 45 %, and 100 % for prosthetic joint infection. False-negative synovial biopsy did not seem to be related to antibiotic therapy. Conclusion Ultrasound-guided Tru-cut synovial biopsy is a safe and reliable technique with a high diagnostic yield for diagnosing synovial tumour and also, most likely, for joint infection. Regarding joint infection, synovial biopsy of native joints seems to have a higher diagnostic yield than that for infected prosthetic joints. Key Points • Ultrasound-guided Tru-cut synovial biopsy has high accuracy (99 %) for diagnosing synovial tumour . • It has good accuracy, sensitivity, and high specificity for diagnosis of joint infection . • Synovial biopsy of native joints works better than biopsy of prosthetic joints . • A negative synovial biopsy culture from a native joint largely excludes septic arthritis . • Ultrasound-guided Tru-cut synovial biopsy is a safe and well-tolerated procedure .

Synovial chondromatosis (SC) is a benign condition characterized by the formation of metaplastic cartilage in the synovial membrane of the joint, resulting in numerous attached and unattached osteocartilaginous bodies. SC mostly affects the large synovial joints, especially the knee, hip, elbow, and ankle, whereas involvement of the temporomandibular joint (TMJ) is rare. Approximately 240 cases of SC of the TMJ have been reported in the English-language literature to date. The number of loose bodies varies among patients but usually ranges from the dozens to around 100. We herein report a case of SC of the TMJ accompanied by approximately 400 loose bodies in a healthy 53-year-old woman. Such a high number of loose bodies within a small space is extremely rare. We also include a brief discussion about the differential diagnoses and current diagnostic approaches to SC of the TMJ. Notably, delayed diagnosis or misdiagnosis is common because of the nonspecific nature of the presenting complaints.

Objective Arthroscopic surgery is recommended for the treatment of hip synovial chondromatosis, as it allows patients to resume daily activities quickly and requires only a short rehabilitation period. Despite its advantages, there is currently no standardized protocol for arthroscopic hip synovectomy, and complete removal of intra‐articular loose bodies remains challenging. The objective of this study is to evaluate long‐term clinical outcomes of arthroscopic treatment for hip synovial chondromatosis using a standardized protocol based on clock‐face‐guided, imaging‐based lesion localization. Methods A consecutive cohort of patients undergoing arthroscopic treatment and diagnosed with synovial chondromatosis between June 2016 and July 2019 was included in the study. All patients underwent preoperative imaging‐guided localization of loose bodies followed by arthroscopic removal performed by a single surgeon, with a minimum postoperative follow‐up of 30 months. Preoperative and postoperative assessments included standard radiographs (x‐ray), three‐dimensional computed tomography (3D‐CT), magnetic resonance imaging (MRI), intraoperative arthroscopic images, visual analog scale (VAS) for pain, range of motion (ROM), modified Harris Hip Score (mHHS), and International Hip Outcome Tool (iHOT‐12). The percentage of patients achieving the minimal clinically important difference (MCID) was calculated to summarize and compare differences in clinical outcomes. Results Seventeen patients were enrolled, with a mean postoperative follow‐up duration of 71 months. No major complications were observed. Patients achieved weight‐bearing ambulation at a mean of 7 days postoperatively and were discharged at a median of 2.5 days (range: 1–3 days). PROs demonstrated significant improvements: VAS for pain decreased from 7.6 to 2.1, mHHS increased from 54.6 preoperatively to 89.4 postoperatively, and iHOT‐12 improved from 38.1 to 75.2 (all p < 0.001). At long‐term follow‐up, all patients met MCID thresholds for both mHHS and iHOT‐12 scores. Conclusion Arthroscopic treatment using a standardized protocol can result in favorable long‐term clinical outcomes. A clock‐face‐guided, imaging‐based arthroscopic protocol improves surgical orientation and facilitates complete removal of loose bodies in hip synovial chondromatosis, leading to favorable long‐term outcomes.