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Der Orthopäde

, Volume 38, Issue 6, pp 511–519 | Cite as

Synoviale Chondromatose

  • M. FuerstEmail author
  • J. Zustin
  • C. Lohmann
  • W. Rüther
Leitthema

Zusammenfassung

Die primäre artikuläre synoviale Chondromatose ist eine monoartikuläre, gutartige, neoplastische und selbstlimitierende Erkrankung der Synovialis mit metaplastischer Transformation subsynovialer Zellen in Knorpelzellen. Am häufigsten tritt die Erkrankung am Kniegelenk auf, gefolgt von dem Befall des Ellenbogengelenks. Männer sind häufiger betroffen als Frauen. Die transformierten synovialen Chondroblasten bilden kleine Inseln und Knoten aus Knorpel, die sich kontinuierlich vergrößern und im weiteren Verlauf in die Gelenkhöhle geboren werden. Dort können die multiplen freien Gelenkkörper, ernährt durch die Synovia, weiter wachsen, verkalken oder auch im Sinne einer enchondralen Ossifikation verknöchern. Die operative Therapie richtet sich nach dem Stadium der Erkrankung: Besteht Aktivität in der Synovialis mit persistierender Knorpelbildung ist eine Gelenkkörperentfernung mit radikaler Synovektomie erforderlich, in späten inaktiven Stadien ohne pathologische Veränderungen in der Synovialis ist die Entfernung der freien Gelenkkörper ausreichend. Die maligne sarkomatöse Transformation ist selten, bereitet aber unter Umständen Schwierigkeiten in der Abgrenzung zu einem benignen Verlauf.

Schlüsselwörter

Synoviale Chondromatose Osteochondromatose Freie Gelenkkörper Synovektomie Arthrose 

Synovial chondromatosis

Abstract

Primary articular synovial chondromatosis is a benign, self-limiting neoplastic process in which hyaline cartilage nodules form in the synovial tissue. The disease most frequently affects the knee in men, followed by the elbow. The basic feature of this disease is a metaplastic maturation of the mesenchymal cells in the synovial membrane of a joint into cartilage. These cells mature into chondroblasts and form small nodules of cartilage in the synovial membrane. These nodules subsequently enlarge and detach to lie within the joint space. They become free within the joint as multiple small cartilaginous loose bodies nourished by the synovial fluid. The chondrocytes in the loose bodies continue to multiply, and the loose bodies grow in diameter. Calcification appears in the central zone of the loose bodies, and in some cases, enchondral ossification takes place. The operative therapy depends on the stage of the disease: synovectomy with removal of chondral fragments if active intrasynovial disease is present, and removal of the multiple chondral bodies alone in cases of late inactive disease with no synovial abnormalities. Malignant transformation is unusual and can be difficult to distinguish from benign disease.

Keywords

Synovial chondromatosis Osteochondromatosis Loose bodies Synovectomy Arthritis 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Lehrstuhl für Orthopädie, Klinikum Bad BramstedtUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland
  2. 2.Diagnostikzentrum, Institut für PathologieUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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