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Lipoma arborescens of the knee

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Lipoma arborescens (LA) is a benign lesion described as replacement of mature fat cells with sub-synovial tissue, which causes the formation of villous projections. Underlying inflammatory conditions might predispose LA. This study demonstrates the treatment, post-operative survey and MRI demonstrations of this rare entity.

Methods

Five patients (6 knees) diagnosed and treated with arthroscopic (5/6) and open (1/6) synovectomy were reviewed retrospectively. An additional mini-transquadricipital incision is used for excision of the extensive suprapatellar lesions. The patients had post-operative follow-ups at first and sixth months and then yearly. Radiographs and MRI of the affected knees were taken at the final follow-up.

Results

The median follow-up was 59 (4–105) months. Major symptom was painless swelling of the joint. The presenting age was under 18 years in four patients. Recurrent lesions were detected in MRI scan of three patients with JRA, ARF and Tbc. Two out of three were located adjacent to the posterior capsule. The median of the Kujala questionnaire scores was 88 (74–95), and the median of the Knee Society Clinical Rating System scores was 95 (80–100) at the final follow-up.

Conclusions

Lipoma arborescens should be considered in the differential diagnosis of paediatric patients who have painless swelling of the knee joint. The lesion is totally curable. However, underlying persistent disease might aggravate the inflammatory process and might cause recurrent lesions. Although resecting the lesion adjacent to the posterior capsule of the knee joint is technically demanding, arthroscopic treatment is an effective procedure and transquadricipital approach may help resection of the extensive lesions in suprapatellar pouch.

Level of evidence

Case series, Level IV.

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References

  1. Al-Ismail K, Torreggiani WC, Al-Sheikh F, Keogh C, Munk PL (2002) Bilateral lipoma arborescens associated with early osteoarthritis. Eur Radiol 12(11):2799–2802

    PubMed  Google Scholar 

  2. Babar SA, Sandison A, Mitchell AW (2008) Synovial and tenosynovial lipoma arborescens of the ankle in an adult: a case report. Skelet Radiol 37(1):75–77

    Article  CAS  Google Scholar 

  3. Blais RE, LaPrade RF, Chaljub G, Adesokan A (1995) The arthroscopic appearance of lipoma arborescens of the knee. Arthroscopy 11(5):623–627

    Article  CAS  PubMed  Google Scholar 

  4. Cil A, Atay OA, Aydingoz U, Tetik O, Gedikoglu G, Doral MN (2005) Bilateral lipoma arborescens of the knee in a child: a case report. Knee Surg Sports Traumatol Arthrosc 13(6):463–467

    Article  PubMed  Google Scholar 

  5. Coll JP, Ragsdale BD, Chow B, Daughters TC (2011) Best cases from the AFIP: lipoma arborescens of the knees in a patient with rheumatoid arthritis. Radiographics 31(2):333–337

    Article  PubMed  Google Scholar 

  6. Donnelly LF, Bisset GS 3rd, Passo MH (1994) MRI findings of lipoma arborescens of the knee in a child: case report. Pediatr Radiol 24(4):258–259

    Article  CAS  PubMed  Google Scholar 

  7. Doyle AJ, Miller MV, French JG (2002) Lipoma arborescens in the bicipital bursa of the elbow: MRI findings in two cases. Skelet Radiol 31(11):656–660

    Article  Google Scholar 

  8. Feller JF, Rishi M, Hughes EC (1994) Lipoma arborescens of the knee: MR demonstration. AJR Am J Roentgenol 163(1):162–164

    Article  CAS  PubMed  Google Scholar 

  9. Franco M, Puch JM, Carayon MJ, Bortolotti D, Albano L, Lallemand A (2004) Lipoma arborescens of the knee: report of a case managed by arthroscopic synovectomy. Joint Bone Spine 71(1):73–75

    Article  PubMed  Google Scholar 

  10. Fraser AR, Perry ME, Crilly A, Reilly JH, Hueber AJ, McInnes IB (2010) Lipoma arborescens co-existing with psoriatic arthritis releases tumour necrosis factor alpha and matrix metalloproteinase 3. Ann Rheum Dis 69(4):776–777

    Article  PubMed  Google Scholar 

  11. Hallel T, Lew S, Bansal M (1988) Villous lipomatous proliferation of the synovial membrane (lipoma arborescens). J Bone Joint Surg Am 70(2):264–270

    CAS  PubMed  Google Scholar 

  12. Hill GN, Phyo N (2011) Extra-articular lipoma arborescens of the hand: an unusual case report. J Hand Surg Eur 36(5):422–423

    Article  CAS  Google Scholar 

  13. Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 248(248):13–14

    PubMed  Google Scholar 

  14. Kamaci S, Ergen FB, Leblebicioglu G (2014) Lipoma arborescens in the extensor tendon sheath of the hand secondary to foreign body reaction. J Hand Surg Eur. doi:10.1177/1753193414521131

    Google Scholar 

  15. Kloen P, Keel SB, Chandler HP, Geiger RH, Zarins B, Rosenberg AE (1998) Lipoma arborescens of the knee. J Bone Joint Surg Br 80(2):298–301

    Article  CAS  PubMed  Google Scholar 

  16. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163

    Article  CAS  PubMed  Google Scholar 

  17. Martin S, Hernandez L, Romero J, Lafuente J, Poza AI, Ruiz P, Jimeno M (1998) Diagnostic imaging of lipoma arborescens. Skelet Radiol 27(6):325–329

    Article  CAS  Google Scholar 

  18. Moukaddam H, Smitaman E, Haims AH (2011) Lipoma arborescens of the peroneal tendon sheath. J Magn Reson Imaging 33(1):221–224

    Article  PubMed  Google Scholar 

  19. Pandey T, Alkhulaifi Y (2006) Bilateral lipoma arborescens of the subdeltoid bursa. Australas Radiol 50(5):487–489

    Article  CAS  PubMed  Google Scholar 

  20. Ranganath K, Rao GB, Namitha (2010) Lipoma arborescens of the elbow. Indian J Radiol Imaging 20(1):50–52

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Rao S, Rajkumar A, Elizabeth MJ, Ganesan V, Kuruvilla S (2011) Pathology of synovial lipomatosis and its clinical significance. J Lab Physicians 3(2):84–88

    Article  PubMed Central  PubMed  Google Scholar 

  22. Senocak E, Gurel K, Gurel S, Ozturan KE, Cakici H, Yilmaz F, Boran C (2007) Lipoma arborescens of the suprapatellar bursa and extensor digitorum longus tendon sheath: report of 2 cases. J Ultrasound Med 26(10):1427–1433

    PubMed  Google Scholar 

  23. Sharma SD, Bagri DR, Gupta RK, Sarna A (2011) Lipoma arborescens. Indian J Pediatr 78(8):1016–1018

    Article  CAS  PubMed  Google Scholar 

  24. Sola JB, Wright RW (1998) Arthroscopic treatment for lipoma arborescens of the knee: a case report. J Bone Joint Surg Am 80(1):99–103

    CAS  PubMed  Google Scholar 

  25. Soler T, Rodriguez E, Bargiela A, Da Riba M (1998) Lipoma arborescens of the knee: MR characteristics in 13 joints. J Comput Assist Tomogr 22(4):605–609

    Article  CAS  PubMed  Google Scholar 

  26. Sumen Y, Ochi M, Soda Y, Ikuta Y (1998) Lipoma arborescens in bilateral knee joints. Arch Orthop Trauma Surg 117(1–2):105–107

    Article  CAS  PubMed  Google Scholar 

  27. Vilanova JC, Barcelo J, Villalon M, Aldoma J, Delgado E, Zapater I (2003) MR imaging of lipoma arborescens and the associated lesions. Skelet Radiol 32(9):504–509

    Article  Google Scholar 

  28. Xiao J, Xu Y, Wang J, Feng J, Shi Z (2011) Bilateral knee lipoma arborescens combined with osteoarthritis in elderly patients. J Int Med Res 39(4):1563–1569

    Article  CAS  PubMed  Google Scholar 

  29. Xue J, Alario AJ, Nelson SD, Wu H (2013) Progressive bilateral lipoma arborescens of the knee complicated by juvenile spondyloarthropathy: a case report and review of the literature. Semin Arthritis Rheum 43(2):259–263

    Article  PubMed  Google Scholar 

  30. Yacyshyn EA, Lambert RG (2010) Lipoma arborescens: recurrent knee effusions with positive cyclic citrillunated peptide. J Rheumatol 37(10):2188–2189

    Article  PubMed  Google Scholar 

  31. Yah CH, Wong JW, Yip DK (2008) Bilateral knee lipoma arborescens: a case report. J Orthop Surg (Hong Kong) 16(1):107–110

    Google Scholar 

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Acknowledgments

The authors would like to thank A. Ozgur Atay, M.D., for his help during the surgeries and Defne Kaya, PT, for managing the post-operative rehabilitation.

Conflict of interest

Authors declare no conflict of interest. Authors received no financial support for this study.

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Correspondence to M. Nedim Doral.

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Kamaci, S., Doral, M.N., Ergen, F.B. et al. Lipoma arborescens of the knee. Knee Surg Sports Traumatol Arthrosc 23, 2196–2201 (2015). https://doi.org/10.1007/s00167-014-2996-3

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  • DOI: https://doi.org/10.1007/s00167-014-2996-3

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