Simultaneous anterior and posterior synovectomies for treating diffuse pigmented villonodular synovitis

Abstract

Background: The current treatment methods for diffuse intraarticular or extraarticular type pigmented villonodular synovitis (PVNS) include arthroscopic synovectomy or staged anterior and posterior open synovectomies. However, it is unclear whether simultaneous anterior and posterior synovectomies achieve local control and recovery of function.

Questions/purposes: We therefore determined the recurrence rate and function in patients with diffuse PVNS treated with anterior and posterior synovectomies and adjuvant radiotherapy.

Methods: We retrospectively reviewed all 19 patients with diffuse PVNS involving the knee treated with anterior and posterior synovectomies and adjuvant radiotherapy between January 2001 and November 2007. From the records, we determined local recurrence and Tegner-Lysholm scores. The minimum followup was 42 months (median, 98 months; range, 42-143 months).

Results: Postoperative MRI revealed residual tumor in five of the 19 patients, although three had no disease progression during followup and had knee scores of 86 to 90. Two patients had recurrences at 6 and 9 months with knee scores of 88 at 42 months and 90 at 68 months. The mean Tegner-Lysholm knee score improved from 59 to 93 points. Mean maximum extension and flexion angles improved from 11° to 2° and from 76° to 127°, respectively.

Conclusions: Compared with the literature, simultaneous anterior and posterior synovectomies associated with postoperative radiotherapy provided rates of residual or recurrent tumor and knee function recovery comparable to that with staged synovectomies reported in the literature.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–C

A 34-year-old man (Patient 6) who underwent anterior cruciate ligament reconstruction at another hospital presented with persistent knee pain and instability. (A) A sagittal T2-weighted MR image shows diffuse PVNS of the left knee after anterior cruciate ligament reconstruction, with wearing and loosening of the graft. The black arrow indicates intact bone proximal to the PVNS, and the white arrow indicates PVNS over the posterior aspect of the distal femur. (B) A sagittal T2-weighted MR image was obtained 3 months after simultaneous anterior and posterior synovectomies. The black and white arrows indicate recurrent and residual PVNS, respectively. (C) This sagittal T2-weighted MR image was taken 9 months after simultaneous anterior and posterior synovectomies. The black and white arrows show recurrent and residual PVNS, respectively. The tumor has decreased in size compared with the tumor seen on the MR image taken 3 months postoperatively.