Synovial osteochondromatosis (SOC) is a benign proliferation of the synovium. Etiology is unknown. In this condition, cartilaginous metaplasia takes place within the synovial membrane of the joint. Metaplastic synovium organizes into nodules. With minor trauma, nodules are shed as small bodies into the joint space. In some patients the disease process may involve tendon sheaths and bursal sacs.

Cartilaginous intra-articular bodies float freely within the synovial fluid, which they require for nutrition and growth. Progressive enlargement and ossification occur with time. If they remain free, they continue to grow larger and more calcified. In severe cases, they may occupy the entire joint space or penetrate to adjacent tissues. Alternately, they can deposit in the synovial lining, reestablish a blood supply, and become replaced by bone. On occasion, synovial reattachment can lead to complete reabsorption of the cartilage fragment.

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ARTHROSCOPIC TREATMENT OF ELBOW OSTEOCHONDROMATOSIS
From Journal of Bone and Joint Surgery, 1/1/04 by Dagher, E

Purpose: Removal of intra-articular foreign bodies (FB) constitues a major indication for elbow arthroscopy.The purpose of our study was to evalule our experience with arthroscopic treatment of elbow osteochondromatosis.

Material and methods: Between September 1988 and june 2001 we performed elbow arthroscopy in 25 active patients (15 manual workers, S athletes including 2 high-level) who presented intra-articular FB osteochondromatosis of the elbow. Male gender predominated (n=22). Mean age at intervention was 42 years (17-68). The right (n-21) and dominant (n=24) side predominated. The mean clinical course before arthroscopy was two years. Seven patients had had upper limb trauma (five with elbow injury) a mean 60 months (6-144) before arthroscopy. Clinical assessment before arthroscopy and at last follow-up (mean follow-up 60 months, 8-138) included pain score (visual analogue scale), the notion of blocking and joint effusion and joint motion, as well as index of functional impairment during occupational and recreational activities and a subjective satisfaction index. Standard x-rays and arthroscan were obtained before arthroscopy to identify and evaluate intra-arlicular foreign bodies. Cartilage damage and presence of synovial anomalies were evaluated on the preoperativc scan and during the intervention. Arthroscopy was performed according to the same procedure in all cases: lateral decubitus. arm cuff, anterior expoloration (anteromedial and anterolatcral access). Standard x-rays were also obtained after arthroscopy and at last follow-up.

Results: FB were found and extracted in all cases. Cartilage injury was associated in 14 cases. Synovectomy was performed systematically in case of synovitis, a macroscopic synovial anomaly, or to extract a FB trapped in the synovia! (n=18). Osteophytes were shaved in 12 cases. The post-arthroscopic period was uneventful with no complications (vascular, nervous, infectious). Clinical improvement was significant and sustained and the occupational and recreational function indexes improved. The subjective satisfaction index remained high five years after arthroscopy. We did not have any clinical recurcnce (blockage) or radiographically detectable anomaly at last follow-up. Less favourable results (persistent pain) were obtained in patients who had cartilage injury.

Discussion: Arthroscopy appears to be a safe treatment with long-term efficacy for osteochondromatosis of the elbow. Long-term prognosis is influenced most by presence of cartilage injury.

E. Dacher. F. Bonnomet. X. Chiffolot. Y. Lefebre, P. Clavert. J.Lano. J.F. Kempf

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