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
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Localized pigmented villonodular synovitis of the knee: Arthroscopic treatment.Arthroscopy. 1998; 14: 764-768
- Localized pigmented villonodular synovitis of the knee.Arthroscopy. 1998; 14: 532-536
- Localized pigmented villonodular synovitis of the posterior compartment of the knee: Diagnosis with magnetic resonance imaging.Arthroscopy. 1995; 11: 482-485
- Cell populations involved in pigmented villonodular synovitis of the knee.J Rheumatol. 2000; 27: 463-470
- The use of MRI to assist in diagnosis of pigmented villonodular synovitis of the knee.Clin Orthop. 1988; 231: 135-139
- Pigmented villonodular synovitis.Arch Orthop Trauma Surg. 1990; 109: 205-210
- Pigmented villonodular synovitis of the knee. The results of total arthroscopic synovectomy, partial arthroscopic synovectomy and arthroscopic local excision.J Bone Joint Surg Am. 1992; 74: 119-123
- Treatment of pigmented villonodular synovitis with yttrium-90: Changes in immunologic features, Tc-99m uptake measurements, and MR imaging of one case.Clin Rheumatol. 1992; 11: 280-285
- [Combined treatment of the diffuse form of pigmented villonodular synovitis].Med Radiol (Mosk). 1986; 31: 27-31
- Arthroscopic synovectomy. When, which diseases and which joints.Z Rhematol. 1996; 55: 394-400
- Arthroscopic treatment of pigmented villonodular synovitis of the knee.Arthroscopy. 1999; 15: 613-617
- Diffuse and localized pigmented villonodular synovitis: Evaluation of treatment of 38 patients.Arch Orthop Trauma Surg. 1999; 119: 401-404
- Giant cell tumor of tendon sheath, tenosynovial giant cell tumor, and pigmented villonodular synovitis: Defining the presentation, surgical therapy and recurrence.Oncol Rep. 2000; 7: 413-419
- Surgical treatment of diffuse villonodular synovitis of the knee.Clin Orthop. 1994; 300: 183-192
- Diffuse pigmented villonodular synovitis of the shoulder.Skeletal Radiol. 1995; 24: 311-313
- Is there a place for chemical and radiation synovectomy in rheumatic diseases?.Rheumatol Rehabil. 1979; 18: 65-77
- Development of a patient-reported measure of function of the knee.J Bone Joint Surg Am. 1998; 80: 1132-1145
- Recurrence of pigmented villonodular synovitis of the knee 17 years after the initial treatment. A case report.Clin Orthop. 1993; 295: 179-182
*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]
© 2001 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.