Synovial Chondromatosis and Pigmented Villonodular Synovitis of the Elbow
Synovial chondromatosis and pigmented villonodular synovitis of the elbow are both rare conditions. While the aetiology of both is unclear, there is evidence supporting genetic factors in some cases of synovial chondromatosis. Both conditions cause swelling, pain, and decreased range of motion, with synovial chondromatosis also resulting in catching and locking. Recurrence has been observed after inadequate treatment of both conditions, as has been progression of benign synovial chondromatosis to malignant chondrosarcoma. Arthroscopic treatment of both conditions has advantages in decreasing the insult to the surrounding soft tissue and improving access to the gutters. Tips on how to perform the surgery are outlined in this chapter.
KeywordsSynovial chondromatosis Elbow Arthroscopy Open Synovectomy Loose body PVNS
Wet arthroscopy. The white loose bodies are all in similar size. Note how they are suspended in the irrigation fluid and are disturbed by movement of the arthroscope (MP4 12186 kb)
A curved artery clip has already been passed through the lateral capsule. A cannula is inserted over a switching stick. The loose bodies are swept from the joint, when the portal is opened. As the soft tissue is balloted, the capsule and synovium project into the joint cavity (MP4 16815 kb)
A grasper removes clumps of loose bodies, and a resector “vacuums” the remaining loose bodies. Resector for synovectomy, with suction off to avoid drawing the PIN into the aperture (MP4 16258 kb)
An arthroscopic punch is used to perform synovectomy in the anterior compartment and a resector anterolaterally. Note that adequate synovectomy has been performed, since the muscle is on view (MP4 3872 kb)