Abstract
We present the results of combined partial arthroscopic synovectomy and low-dose external-beam
radiation therapy (RT) in the treatment of diffuse pigmented villonodular synovitis
(PVNS) of the knee. Mechanical synovectomy is an effective tool in treating PVNS of
the knee, but when used alone it may be insufficient to eliminate all affected tissue.
Intra-articular radiation or external-beam radiation may be added to mechanical synovectomy
to treat recurrence but is not routinely done at the time of initial synovectomy.
Combining intra-articular synovectomy with RT at the initial treatment for PVNS of
the knee may reduce the recurrence rate. We present a prospective study of the treatment
of 22 patients with clinical, ultrasonic, and histologically confirmed findings of
diffuse PVNS of the knee. Characteristic clinical findings included pain, swelling,
and erythema. These patients were treated by the Arthroscopic Surgery Group of the
Orthopaedic Service at the Hospital “Hermanos Ameijeiras” in Havana, Cuba from 1990
to 1998. The protocol included anterior (patellofemoral, medial, and lateral) arthroscopic
synovectomy and postoperative RT with a total dose of 2,600 cGy. This combination
therapy was effective in reducing symptoms of pain and edema, and in improving overall
function of patients. Nineteen patients (86%) had good or excellent results at an
average follow-up of 33 months (range, 26 to 76 months). Three patients had residual
stiffness and swelling, 2 of whom also had pain. Three had clinically and ultrasonically
confirmed recurrence of disease and were treated with repeat arthroscopic synovectomy
without harmful effects from RT. In all of the cases requiring repeat arthroscopic
synovectomy, we observed fibrous bands secondary to reorganization of synovial inflamed
tissue, meniscal retraction, and microscopic findings of fibrosis and cellular paucity.
Partial arthroscopic synovectomy combined with low-dose RT in anti-inflammatory doses
produced good results in the treatment of PVNS without significant complications in
our patient series. Partial arthroscopic synovectomy of the knee for PVNS may be combined
with RT to reduce the risk of disease recurrence. Adjuvant RT should also be considered
for patients receiving a radical synovectomy to treat inaccessible or hidden disease
sites. Rates of recurrence with combined partial (anterior) synovectomy and RT approach
that of complete synovectomy in this series. Combining RT with radical arthroscopic
synovectomy might further reduce recurrence rates.
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June),
2001: pp 527–531
Keywords
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Article info
Footnotes
*Address correspondence and reprint requests to Todd B. Guthrie, M.D., Park Ridge Orthopedics P.A., 27 Doctor’s Dr, Fletcher, NC 28732, U.S.A. E-mail: [email protected]
Identification
Copyright
© 2001 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
