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Arch Pediatr Adolesc Med. 2001;155(9):1069-1070. doi:10.1001/archpedi.155.9.1069.
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DENOUEMENT AND DISCUSSION: SYNOVIAL CHONDROMATOSIS

Figure 1. The radiograph of the shoulder demonstrates multiple densely calcified masses throughout the shoulder joint bursa.

In the embryo, tissue differentiates into synovium and articular cartilage. If hyaline cartilage develops within the synovial membrane at points of reflection, cartilaginous bodies are nourished through the synovial pedicle and deposited into the joint space where they obtain nutrition via synovial fluid. These cartilaginous bodies undergo endochondral ossification. The presence of intra-articular bodies may damage the joint's articular cartilage. Considerable controversy exits as to the nature of these chondral bodies. Apte and Athanasou1 reported the presence of a different antigenic phenotype, while de-Bont et al2 found mature chondrocytes by electron microscopy. Leu et al3 observed an independent chondroid matrix and found basal lamina-like material not found in mature chondrocytes, which they postulated as a prechondroblastic precursor cell responsible for formation of chondromatosis.

Synovial chondromatosis is rarely seen in young people, although isolated cases in the knee4 and the hip5 have been reported. Reports involving the wrist69 and elbow10 appear in the literature with a prevalence in the 40- to 50-year age group. In affected individuals, recurrent effusions limit the range of movement, and chondral fragments cause joint locking. The involved joints are warm and painful. Radiography is usually sufficient to make the diagnosis, but air arthrogram has been reported as contributory in confirming the diagnosis.11,12

There is no consensus as to the management of synovial chondromatosis. Maurice et al13 reported an 11.5% recurrence rate after synovectomy or the simple removal of loose bodies.

Ogilvie-Harris and Saleh14 reported that synovectomy lowers the recurrence, but others found no difference between removal of loose bodies and synovectomy.15 Dorfmann et al16 reported good results in 78% of patients with a single arthroscopic procedure where the loose masses were removed without a synovectomy. Understanding of the etiology underlies treatment. Those believing that this condition is benign remove the loose bodies, while those whose concept encompasses pathological synovium favor eradication of that tissue. Chondrosarcoma has been reported in conjunction with chondromatosis.1720 Whether this is a separate entity or a form of chondral metaplasia remains unclear. The usual general approach to management is removal of loose bodies, with synovectomy reserved for progressive (recurrent) chondromatosis, a more radical approach.

These intra-articular free bodies are usually numerous within the shoulder bursa, and excessive physical activity may cause the condition to become symptomatic and potentially cause degenerative arthropathy of the shoulder. Regardless of an asymptomatic history, the potential for deterioration exists, and the individual requires protection from overuse of the affected joint.

Accepted for publication May 22, 2000.

Reprints: Michael Heim, Department of Orthopedic Rehabilitation, Tel Hashomer Hospital, Tel Hashomer, Israel 52621.

Apte  SSAthanasou  NA An immunohistological study of cartilage and synovium in primary synovial chondromatosis. J Pathol. 1992;166277- 281
de-Bont  LGLiem  RSBoering  G Synovial chondromatosis in the temporomandibular joint: a light and electron microscopic study. Oral Surg Oral Med Oral Pathol. 1988;66593- 598
Leu  JZMatsubara  THirohata  K Ultrastructural morphology of early cellular changes in the synovium of primary synovial chondromatosis. Clin Orthop. 1992;276299- 306
Carey  RP Synovial chondromatosis of the knee in childhood: a report of two cases. J Bone Joint Surg Br. 1983;65444- 447
Pelker  RRDrennan  JCOzonoff  MB Juvenile synovial chondromatosis of the hip: a case report. J Bone Joint Surg Am. 1983;65552- 554
De Smet  LVan-Wetter  P Synovial chondromatosis of the distal radio-ulnar joint. Acta Orthop Belg. 1987;54106- 108
Pope  TLKeats  TEde Lange  EEFechner  REHarvey  JW Idiopathic synovial chondromatosis in two unusual sites: inferior radioulnar joint and ischial bursa. Skeletal Radiol. 1987;16205- 208
Jones  JREvans  DMKaushik  A Synovial chondromatosis presenting with peripheral nerve compression: a report of two cases. J Hand Surg Br. 1987;1225- 27
Ballet  FLWatson  HKRyu  J Synovial chondromatosis of the distal radioulnar joint. J Hand Surg Am. 1984;9590- 592
Dufour  JPHamels  JMaldague  BNoel  HRestiaux  B Unusual aspects of synovial chondromatosis of the elbow. Clin Reumatol. 1984;3247- 251
Blacksin  MFGhelman  BFreiberger  RHSalvati  E Synovial chondromatosis of the hip: evaluation with air computed arthrotomography. Clin Imaging. 1990;14315- 318
Wilson  WJParr  TJ Synovial chondromatosis. Orthopedics. 1988;111179- 1183
Maurice  HCrone  MWatt  I Synovial chondromatosis. J Bone Joint Surg Br. 1988;70807- 811
Ogilvie-Harris  DJSaleh  K Generalized synovial chondromatosis of the knee: a comparison of removal of the loose bodies alone with arthroscopic synovectomy. Arthroscopy. 1994;10166- 170
Shpitzer  TGanel  AAngelberg  S Surgery for synovial chondromatosis: 26 cases followed up for 6 years. Acta Orthop Scand. 1990;61567- 569
Dorfmann  HDe-Bie  BBonvarlet  JPBoyer  T Arthroscopic treatment of synovial chondromatosis of the knee. Arthroscopy. 1989;548- 51
Hamilton  ADavis  RJNixon  JR Synvial chondrosarcoma complicating synovial chondromatosis: report of a case and review of the literature. J Bone Joint Surg Am. 1987;691084- 1088
Hamilton  ADavis  RIHayes  DMollan  PA Chondrosarcoma developing in synovial chondromatosis: a case report. J Bone Joint Surg Br. 1987;69137- 140
Laus  MCapanna  R Synovial chondromatosis and chondrosarcoma of the hip: indications for surgical treatment. Ital J Orthop Traumatol. 1982;8193- 198
Perry  BEMcQueen  DALin  JJ Synovial chondromatosis with malignant degeneration to chondrosarcoma: report of a case. J Bone Joint Surg Am. 1988;701259- 1261

Tables

References

Apte  SSAthanasou  NA An immunohistological study of cartilage and synovium in primary synovial chondromatosis. J Pathol. 1992;166277- 281
de-Bont  LGLiem  RSBoering  G Synovial chondromatosis in the temporomandibular joint: a light and electron microscopic study. Oral Surg Oral Med Oral Pathol. 1988;66593- 598
Leu  JZMatsubara  THirohata  K Ultrastructural morphology of early cellular changes in the synovium of primary synovial chondromatosis. Clin Orthop. 1992;276299- 306
Carey  RP Synovial chondromatosis of the knee in childhood: a report of two cases. J Bone Joint Surg Br. 1983;65444- 447
Pelker  RRDrennan  JCOzonoff  MB Juvenile synovial chondromatosis of the hip: a case report. J Bone Joint Surg Am. 1983;65552- 554
De Smet  LVan-Wetter  P Synovial chondromatosis of the distal radio-ulnar joint. Acta Orthop Belg. 1987;54106- 108
Pope  TLKeats  TEde Lange  EEFechner  REHarvey  JW Idiopathic synovial chondromatosis in two unusual sites: inferior radioulnar joint and ischial bursa. Skeletal Radiol. 1987;16205- 208
Jones  JREvans  DMKaushik  A Synovial chondromatosis presenting with peripheral nerve compression: a report of two cases. J Hand Surg Br. 1987;1225- 27
Ballet  FLWatson  HKRyu  J Synovial chondromatosis of the distal radioulnar joint. J Hand Surg Am. 1984;9590- 592
Dufour  JPHamels  JMaldague  BNoel  HRestiaux  B Unusual aspects of synovial chondromatosis of the elbow. Clin Reumatol. 1984;3247- 251
Blacksin  MFGhelman  BFreiberger  RHSalvati  E Synovial chondromatosis of the hip: evaluation with air computed arthrotomography. Clin Imaging. 1990;14315- 318
Wilson  WJParr  TJ Synovial chondromatosis. Orthopedics. 1988;111179- 1183
Maurice  HCrone  MWatt  I Synovial chondromatosis. J Bone Joint Surg Br. 1988;70807- 811
Ogilvie-Harris  DJSaleh  K Generalized synovial chondromatosis of the knee: a comparison of removal of the loose bodies alone with arthroscopic synovectomy. Arthroscopy. 1994;10166- 170
Shpitzer  TGanel  AAngelberg  S Surgery for synovial chondromatosis: 26 cases followed up for 6 years. Acta Orthop Scand. 1990;61567- 569
Dorfmann  HDe-Bie  BBonvarlet  JPBoyer  T Arthroscopic treatment of synovial chondromatosis of the knee. Arthroscopy. 1989;548- 51
Hamilton  ADavis  RJNixon  JR Synvial chondrosarcoma complicating synovial chondromatosis: report of a case and review of the literature. J Bone Joint Surg Am. 1987;691084- 1088
Hamilton  ADavis  RIHayes  DMollan  PA Chondrosarcoma developing in synovial chondromatosis: a case report. J Bone Joint Surg Br. 1987;69137- 140
Laus  MCapanna  R Synovial chondromatosis and chondrosarcoma of the hip: indications for surgical treatment. Ital J Orthop Traumatol. 1982;8193- 198
Perry  BEMcQueen  DALin  JJ Synovial chondromatosis with malignant degeneration to chondrosarcoma: report of a case. J Bone Joint Surg Am. 1988;701259- 1261

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