Combined anterior and posterior arthroscopic portals for loose body removal and synovectomy for synovial chondromatosis.

BACKGROUND: Synovial chondromatosis is a rare disorder characterized by formation of cartilaginous bodies within the synovia of joints, tendon sheaths, and bursae secondary to a synovial metaplastic process. Recent literature has described using only an anterior approach to the ankle for these patients. It is unclear how well, if at all, synovectomy of the posterior part of the ankle joint was performed. Most recurrences occur years after surgery, as a result of incomplete synovectomy.

MATERIALS AND METHODS: We treated five patients (mean age 31.6 years; range, 21 to 63; four male, one female) with synovial chondromatosis of the ankle. We performed arthroscopic loose body removal and total synovectomy using both posterior and anterior ankle arthroscopic portals. At latest followup of a mean of 34.2 (range, 13 to 58) months, the functional result was assessed with the AOFAS score.

RESULTS: The AOFAS score improved from a mean of 67 (range, 58 to 77) points to a mean of 94 (range, 77 to 100) points. Overall patient satisfaction was good to excellent. We noted only one minor complication when a loose body was lost in the subcutaneous tissue, and was removed two weeks after the arthroscopy.

CONCLUSION: Our experience in this small group of patients seems to indicate that a 2 portal approach with total synovectomy and removal of loose bodies gives the best result and minimizes the risk of recurrence.