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CASE REPORT
Year : 2015  |  Volume : 15  |  Issue : 2  |  Page : 204-206

Synovial chondromatosis of the knee joint in infant: A case report and literature review


Department of Orthopedic Surgery, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication6-May-2015

Correspondence Address:
Hazem Al-Khawashki
Department of Orthopedic Surgery, King Saud University, Riyadh
Saudi Arabia
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DOI: 10.4103/1319-6308.146353

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  Abstract 

Synovial chondromatosis is an uncommon benign disorder that is most often occurring in adults. It is an exceedingly rare condition in children. We are describing an unreported cause of knee swelling in an infant. Clinical and radiological evaluation revealed that the symptoms were due to a synovial chondromatosis of the knee joint. To the best of our knowledge, this is the first report describing a knee synovial chondromatosis in an infant patient. Synovial chondromatosis should be included in the differential diagnosis of knee swelling during infancy. Greater physician awareness of such condition together with a high index of suspicion is crucial for diagnosis.

  Abstract in Arabic 

عضرلا لافطلأا دنع ةبكرلا لصفم يف يليلزلا يفورضغلا مرولا
بيصي ام اردانو ,نيغلابلا بيصي ام ابلاغو عئاش ريغ ابارطضا يليلزلا يفورضغلا مرولا ّدعي فشكلا رهظأ دقو .عضرلا لافطلأا دحأ ىدل ةبكرل مروت ةلاح فصي ريرقتلا اذهو .لافطلأا بسحو ةبكرلا لصفمل يليلزلا يفورضغلا مرولا ببسب تناك ضارعلأا نأ يعاعشلإاو يريرسلا ىدل ةبكرلا لصفم يف يليلزلا يفورضغلا مرولا فصي يذلا ديحولا وه ريرقتلا اذه نأ ،انملع صيخشت يف يليلزلا يفورضغلا مرولا جردي نأ يغبني هنا ريرقتلا جئاتن نم تناك و .عضرلا ىضرملا ةجرد عافترا عم ةلاحلا هذهب جلاعملا بيبطلل ريبكلا يعولا دعيو .ةلوفطلا ةلحرم للاخ ةبكرلا مروتضرملا صيخشتل امساح ارمأ هابتشلاا

Keywords: Infant, knee, synovial chondromatosis


How to cite this article:
Al-Khawashki H. Synovial chondromatosis of the knee joint in infant: A case report and literature review. Saudi J Sports Med 2015;15:204-6

How to cite this URL:
Al-Khawashki H. Synovial chondromatosis of the knee joint in infant: A case report and literature review. Saudi J Sports Med [serial online] 2015 [cited 2021 Sep 17];15:204-6. Available from: https://www.sjosm.org/text.asp?2015/15/2/204/146353


  Introduction Top


Synovial chondromatosis (also known as synovial osteochondromatosis or synovial chondrometaplasia) is an uncommon benign disorder. It is marked by the metaplastic proliferation of multiple cartilaginous nodules in the synovial membrane of the joints, bursae, or tendon sheaths. [1] It, usually, occurs in patients between 30 and 50 years of age with a male to female ratio of 2:1. It is almost invariably monoarticular; rarely, multiple joints may be affected. Synovial chondromatosis is extremely rare in pediatric patients. [2],[3],[4],[5],[6],[7],[8],[9]

We are describing an unreported cause of knee swelling in an infant that turned out to be a synovial chondromatosis. To the best of our knowledge, this is the first report that describing a knee synovial chondromatosis in an infant. The patient's family agreed that the date concerning the case would be submitted for publication and was approved by the Institutional Review Board.


  Case report Top


A 16-month-old boy presented with left knee swelling. The swelling started 2 months prior to the presentation without history of antecedent trauma. Initially, the knee swelling coincides with an attack of fever for 2 days that resolved spontaneously with antipyretics prescribed by the general pediatrician. The family also noticed progressive limping while walking.

Clinical examination upon presentation revealed healthy and afebrile child who was walking on the tip toes of the left foot with a limping gait. Left knee examination revealed swollen knee with effusion, clicking sensation during motion,and flexion deformity of 20°; otherwise the knee flexes to full [Figure 1]. There were no palpable lymph nodes and examination of the hips; ankles and back was within normal.
Figure 1: Clinical photograph showing a left knee swelling (arrow)

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Laboratory workup revealed a normal white blood cell count: 7000/mm (normal; 4500-10,000/mm), a normal C-reactive protein: 1.0 mg/L (normal; 0-4 mg/L), and mildly elevated erythrocyte sedimentation rate count: 22 mm/h (normal; < 20 mm/h).

In view of the persistent patient symptoms and failure of medical treatment, we proceeded to radiological investigations. Plain radiographs of both knees showed a soft tissue swelling of the left knee. However, no calcified nodules identified [Figure 2]. To further delineate the swelling, a magnetic resonance imaging was also performed. It demonstrated a cartilaginous lobular appearance consistent with chondromatosis [Figure 2].
Figure 2: (a) Anteroposterior and lateral views of both knees plain radiographs showing the knee swelling on the left side (arrow). (b) Coronal and axial magnetic resonance imaging views demonstrating the left knee
synovial chondromatosis (arrow)


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Based on clinical and radiological findings, a provisional diagnosis of synovial chondromatosis versus a synovial tumor was suspected, and the decision was to proceed for excision and subtotal synovectomy. At the time of the procedure, a medial parapatellar arthrotomy was performed. On incision, a clear, straw-colored synovial fluid was obtained in addition to wondering grape-like grayish soft nodular masses [Figure 3]. Histopathological examination of the excised lesion confirmed the diagnosis of synovial chondromatosis.
Figure 3: Intraoperative photograph of the excised lesion

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Postoperatively, the patient had complete resolution of knee swelling within 3 months. At the most recent 1-year follow-up, the patient was doing well, and there were no signs of local recurrence.


  Discussion Top


The differential diagnosis of knee swelling in an infant is broad. Infection, inflammation, trauma, and child abuse are established, well-reported causes of such presentation. Keeping a high index of suspicion for synovial chondromatosis was mandatory for diagnosis in the presented case.

Synovial chondromatosis is, usually, symptomatic depending on its location and severity. Occasionally, it occurs in the bursa overlying an osteochondroma. Pain, clicking, swelling and limited range of motion are the mainstay symptoms. In our case, knee swelling was the presenting symptom. Natural history is, usually, self-limited, but the process can damage the joint if left untreated. Less than adequate removal of chondromatosis nodules should be avoided as it may increase the risk for local recurrence. [10]

In terms of radiological and pathological findings, conditions such as pigmented villonodular synovitis, synovial hemangioma, synovial chondrosarcoma, secondary chondromatosis, and lipoma arborescens can mimic synovial chondromatosis and should be differentiated. [11]

There are few reported cases of synovial chondromatosis in pediatrics. Most of the cases reported after the age of 10 years. Gottschalk et al. reported a case of synovial chodromatosis involving the thumb in a 13-year-old girl. [8] Similarly, Narasimhan et al. reported an elbow synovial chondromatosis in an 11-year-old girl. [7] Kirchhoff et al. described an extremely rare presentation of synovial chondromatosis in a child affecting the sheath of the long head of biceps tendon. [6]

Reports of knee synovial chondromatosis similar to the current case have been described, however; in these reports, it occurred during childhood beyond the infancy period. [3],[4],[9] Based on a literature search, only one case of synovial chondromatosis in a 2-year-old child has been reported. [2] In that report, it affected the hip joint. This contrasted with the synovial chondromatosis presented here, which affected the knee joint.


  Conclusion Top


Synovial chondromatosis could happen in infancy. It is rare and possibly misdiagnosed condition. Physicians should be aware of the possibility of this lesion in patients with unexplained symptoms. High index of suspicion together with a sufficient imaging work up are crucial for diagnosis.


  Acknowledgment Top


We would like to thank Professor Mamoun Kremli for allowing us to publish his case.

 
  References Top

1.
Mackenzie H, Gulati V, Tross S. A rare case of a swollen knee due to disseminated synovial chondromatosis:Acase report. J Med Case Rep 2010;4:113.  Back to cited text no. 1
    
2.
Cahuzac JP, Lebarbier P, Germaneau J, Pasquié M. Synovial chondromatosis in children (author's transl). Chir Pediatr 1979;20:89-93.  Back to cited text no. 2
    
3.
Carey RP. Synovial chondromatosis of the knee in childhood. A report of two cases. J Bone Joint Surg Br 1983;65:444-7.  Back to cited text no. 3
    
4.
Kistler W. Synovial chondromatosis of the knee joint: A rarity during childhood. Eur J Pediatr Surg 1991;1:237-9.  Back to cited text no. 4
    
5.
Nashi M, Manjunath B, Banerjee B, Muddu BN. Synovial chondromatosis in a child: An unusual cause of shoulder pain case report. J Shoulder Elbow Surg 1998;7:642-3.  Back to cited text no. 5
    
6.
Kirchhoff C, Buhmann S, Braunstein V, Weiler V, Mutschler W, Biberthaler P. Synovial chondromatosis of the long biceps tendon sheath in a child: A case report and review of the literature. J Shoulder Elbow Surg 2008;17:e6-10.  Back to cited text no. 6
    
7.
Narasimhan R, Kennedy S, Tewari S, Dhingra D, Zardawi I. Synovial chondromatosis of the elbow in a child. Indian J Orthop 2011;45:181-4.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Gottschalk HP, Newbury R, Wallace CD. Synovial chondromatosis in a child's thumb: A case report and review of the literature. Hand (N Y) 2012;7:98-102.  Back to cited text no. 8
    
9.
Giancane G, Tanturri de Horatio L, Buonuomo PS, Barbuti D, Lais G, Cortis E. Swollen knee due to primary synovial chondromatosis in pediatrics: A rare and possibly misdiagnosed condition. Rheumatol Int 2013;33:2183-5.  Back to cited text no. 9
[PUBMED]    
10.
Coolican MR, Dandy DJ. Arthroscopic management of synovial chondromatosis of the knee. Findings and results in 18 cases. J Bone Joint Surg Br 1989;71:498-500.  Back to cited text no. 10
    
11.
Ramsey SE, Cairns RA, Cabral DA, Malleson PN, Bray HJ, Petty RE. Knee magnetic resonance imaging in childhood chronic monarthritis. J Rheumatol 1999;26:2238-43.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Abstract
Introduction
Case report
Discussion
Conclusion
Acknowledgment
References
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