Die offene dorsale Synovektomie des Kniegelenks

Summary

Goal of surgery

Removal of inflamed synovial tissue from the posterior part of the knee with the aim of reestablishing a normal knee function.

Indications

Unsuccessful conservative treatment.

Popliteal cyst accompanied by synovitis.

Synovial chondromatosis.

Contraindications

Acute, bacterial joint infection.

Burnt-out synovitis causing minimal symptoms.

Preoperative work up

Radiographs of knee.

In the presence of rheumatoid processes: continuation of drug therapy.

If on corticotherapy: perioperative increase of dosage.

Positioning and anaesthesia

Prone. Tourniquet.

General anaesthesia.

Surgical technique

The operation usually precedes the anterior synovectomy.

Complete removal of synovial tissue from the posteromedial and posterolateral parts through 2 approaches. Simultaneous removal of a popliteal cyst, torn menisci and/or joint mice. Debridement of the recessus and the articula surfaces can be performed as well. In the presence of flexion contracture relaxation of capsule or fascia and/or lengthening of tendons can be carried out.

Postoperative management

Alternate positioning of knee between flexion and extension.

Early active exercises. Quadriceps strengthening exercises. Full weight bearing after 1 to 2 weeks.

Possible complications

Injury to nerves and/or vessels. Division of popliteus tendon. Flexion contracture. Recurrence.

Results

An assessment is only possible when an anterior synovectomy or other procedures have also been carried out.

In 149 patients we performed 212 posterior synovectomies. At the moment of follow-up, 4 and 10 years postoperatively, 14 patients had passed away and 18 had either undergone a total knee replacement or an arthrodesis. Of the remaining 117 patients 98 could be assessed (116 knees). An isolated anterior synovectomy was done in 52 knees and the superiority of the 64 combined, anterior and posterior, synovectomies was discernible. The activity state of the disease was assessed using the Laurin score: The incidence of recurrence was clearly lower when the combined approach was used—in spite of higher activity in this group.