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Distinct extra-articular invasion patterns of diffuse pigmented villonodular synovitis/tenosynovial giant cell tumor in the knee joints

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

Abstract

Purpose

Pigmented villonodular synovitis (PVNS)/tenosynovial giant cell tumor (TGCT) is a benign, proliferative lesion of the synovium, the bursa, and the tendon sheath. Little is known about the anatomical distribution pattern of diffuse extra-articular PVNS/TGCT around the knee joint. In this retrospective study, anatomical distribution of PVNS/TGCT using magnetic resonance imaging (MRI) and arthroscopy was analyzed.

Methods

This study was designed as a retrospective, observational cross-sectional study based on MRI and arthroscopy. Twenty-four PVNS/TGCT patients (24 knees) who underwent arthroscopic or posterior open surgery between 2009 and 2016 were enrolled. Of these, eight intra-articular and 16 diffuse extra-articular PVNS/TGCT of the knee were classified. The anatomical locations of the PVNS/TGCT masses were determined with a newly devised mapping scheme. Analysis was performed on the prevalence of each compartment and agreement rates between each compartment.

Results

The point prevalence of intra-articular posterior compartment was higher in diffuse extra-articular PVNS/TGCT group compared with intra-articular PVNS/TGCT group. The point prevalence of diffuse PVNS/TGCT was most prevalent in the extra-articular posterolateral compartment (12 out of 16 diffuse extra-articular PVNS/TGCT patients, 75%) and second most common in the below to joint capsule compartment (11 out of 16, 68.8%). The agreement rate was the highest between intra-articular posterolateral and extra-articular posterolateral compartments (75%).

Conclusion

Extra-articular invasion of diffuse PVNS/TGCT occurred in specific patterns in the knee joint. Extra-articular lesions were always accompanied by lesions in intra-articular compartments. In particular, lesions in the intra-articular posterior compartments were observed in all of the diffuse extra-articular PVNS/TGCT patients. The point prevalence of diffuse extra-articular PVNS/TGCT for each compartment was the highest [12 out of 16 (75%)] in extra-articular posterolateral compartment. In contrast, invasion to the extra-articular posteromedial side was less frequent [5 out of 16 (31.3%)] than to the extra-articular posterolateral side. Knowing where the lesions frequently occur may provide important information for deciding the timing, method, and extent of surgery.

Level of evidence

Level IV.

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References

  1. Akgun I, Ogut T, Kesmezacar H, Dervisoglu S (2003) Localized pigmented villonodular synovitis of the knee. Orthopedics 26(11):1131–1135

    PubMed  Google Scholar 

  2. Auregan JC, Klouche S, Bohu Y et al (2014) Treatment of pigmented villonodular synovitis of the knee. Arthroscopy 30(10):1327–1341

    Article  Google Scholar 

  3. Blanco CE, Leon HO, Guthrie TB (2001) Combined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee. Arthroscopy 17(5):527–531

    Article  CAS  Google Scholar 

  4. Chiari C, Pirich C, Brannath W, Kotz R, Trieb K (2006) What affects the recurrence and clinical outcome of pigmented villonodular synovitis? Clin Orthop Relat Res 450:172–178

    Article  Google Scholar 

  5. Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW (2002) Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Jt Surg Am 84-A(12):2192–2202

    Article  Google Scholar 

  6. Colman MW, Ye J, Weiss KR, Goodman MA et al (2013) Does combined open and arthroscopic synovectomy for diffuse PVNS of the knee improve recurrence rates? Clin Orthop Relat Res 471(3):883–890

    Article  Google Scholar 

  7. De Maeseneer M, Van Roy P, Shahabpour M, Gosselin R et al (2004) Normal anatomy and pathology of the posterior capsular area of the knee: findings in cadaveric specimens and in patients. AJR Am J Roentgenol 182(4):955–962

    Article  Google Scholar 

  8. De Ponti A, Sansone V, Malchere M (2003) Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy 19(6):602–607

    Article  Google Scholar 

  9. Fiocco U, Sfriso P, Lunardi F, Pagnin E et al (2010) Molecular pathways involved in synovial cell inflammation and tumoral proliferation in diffuse pigmented villonodular synovitis. Autoimmun Rev 9(11):780–784

    Article  CAS  Google Scholar 

  10. Flandry F, Hughston JC, McCann SB, Kurtz DM (1994) Diagnostic features of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 298:212–220

    Google Scholar 

  11. Kwon JH, Han JH, Almeida VR et al (2014) Localized pigmented villonodular synovitis of the proximal tibiofibular joint. Knee Surg Relat Res 26(4):249–252

    Article  Google Scholar 

  12. Lindgren PG (1978) Gastrocnemio-semimembranosus bursa and its relation to the knee joint. III. Pressure measurements in joint and bursa. Acta Radiol Diagn (Stockh) 19(2):377–388

    Article  CAS  Google Scholar 

  13. Loriaut P, Djian P, Boyer T, Bonvarlet JP et al (2012) Arthroscopic treatment of localized pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc 20(8):1550–1553

    Article  Google Scholar 

  14. Mollon B, Lee A, Busse JW, Griffin AM et al (2015) The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis. Bone Jt J 97-B(4):550–557

    Article  CAS  Google Scholar 

  15. Mollon B, Griffin AM, Ferguson PC, Wunder JS et al (2016) Combined arthroscopic and open synovectomy for diffuse pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc 24(1):260–266

    Article  Google Scholar 

  16. Ofluoglu O (2006) Pigmented villonodular synovitis. Orthop Clin N Am 37(1):23–33

    Article  Google Scholar 

  17. Rauschning W (1980) Anatomy and function of the communication between knee joint and popliteal bursae. Ann Rheum Dis 39(4):354–358

    Article  CAS  Google Scholar 

  18. Rodriguez-Merchan EC (2014) Review article: open versus arthroscopic synovectomy for pigmented villonodular synovitis of the knee. J Orthop Surg (Hong Kong) 22(3):406–408

    Article  Google Scholar 

  19. Schwartz HS, Unni KK, Pritchard DJ (1989) Pigmented villonodular synovitis. A retrospective review of affected large joints. Clin Orthop Relat Res 247:243–255

    Google Scholar 

  20. Shabat S, Kollender Y, Merimsky O, Isakov J et al (2002) The use of surgery and yttrium 90 in the management of extensive and diffuse pigmented villonodular synovitis of large joints. Rheumatology 41(10):1113–1118

    Article  CAS  Google Scholar 

  21. Sharma V, Cheng EY (2009) Outcomes after excision of pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 467(11):2852–2858

    Article  Google Scholar 

  22. Sun J, Xiong Y, Lei G (2013) Anatomic features of posterior septum of knee joint and its application in posterior trans-septal portal for arthroscopic surgery. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 27(2):233–235

    PubMed  Google Scholar 

  23. Tyler WK, Vidal AF, Williams RJ, Healey JH (2006) Pigmented villonodular synovitis. J Am Acad Orthop Surg 14(6):376–385

    Article  Google Scholar 

  24. Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37(5):360–363

    PubMed  Google Scholar 

  25. West RB, Rubin BP, Miller MA, Subramanian S et al (2006) A landscape effect in tenosynovial giant-cell tumor from activation of CSF1 expression by a translocation in a minority of tumor cells. Proc Natl Acad Sci USA 103(3):690–695

    Article  CAS  Google Scholar 

  26. Yang B, Liu D, Lin J, Jin J et al (2015) Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 37(2):234–239

    PubMed  Google Scholar 

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Acknowledgements

We thank Dr. Joon Seo Lim from the Scientific Publications Team at Asan Medical Center for his editorial assistance in preparing this manuscript.

Funding

No external funds were received in support of this work. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Investigation Performed at the University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Jong-Min Kim, Bum-Sik Lee, Sang-Hoon Lee & Seong-Il Bin

  2. Hospital RUN, Seoul, South Korea

    Dong-Eun Kim

  3. Incheon Red Cross Hospital, Incheon, South Korea

    Nam-Ki Kim

  4. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Jong-Min Kim

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  1. Dong-Eun Kim
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Correspondence to Jong-Min Kim.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

Institutional review board (IRB)/Ethics committee approval was obtained (IRB No. S2016-1529-0001) from Asan Medical Center (Seoul, South Korea).

Informed consent

Institutional review board (IRB)/Ethics committee waived the need for patients’ informed consent based on the retrospective nature of the study.

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Kim, DE., Kim, JM., Lee, BS. et al. Distinct extra-articular invasion patterns of diffuse pigmented villonodular synovitis/tenosynovial giant cell tumor in the knee joints. Knee Surg Sports Traumatol Arthrosc 26, 3508–3514 (2018). https://doi.org/10.1007/s00167-018-4942-2

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  • DOI: https://doi.org/10.1007/s00167-018-4942-2

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