synovial chondromatosis is a disease with unknown etiology , originating from synovia and characterized by the presence of metaplastic cartilaginous nodules in the synovial cavities , bursa or tendon sheaths .
the disease is commonly seen in men and between the 3rd and 5th decades of life . although the exact etiology is not known
the knee , hip and elbow joints are frequently reported to be involved by the condition . however , shoulder and ankle joints are involved extremely rarely .
the disease is classified in 3 stages and evaluated according to following criteria : the early stage with intrasynovial differentiation without loose bodies , the transitional stage by intrasynovial cartilaginous nodules with loose bodies and late stage with multiple loose bodies .
the treatment decision is made according to the patient 's age , symptoms and the disease stage .
the main advantages of the arthroscopic approaches are decreased morbidity , synchronous visualization and treatment feature for intra and extra articular pathologies .
the hypertrophic synovia and multiple loose bodies are typical arthroscopic findings . in this case report
, we presented an arthroscopically managed adult patient with anteriorly localized right ankle chondromatosis and discussed the potential benefits of arthroscopic surgery .
a twenty - eight year old male patient was admitted to our hospital with decreased range of motion , swelling and increased pain during movement in the right ankle joint .
he had no history of trauma , systemic inflammatory disease or family history of bone or joint diseases .
the physical examination revealed that he had mild tenderness around the anterior ankle joint on palpation with palpable loose bodies .
multiple nodules 39  mm in diameter with calcifications were located at the anterior aspect of the right ankle on the plain anteroposterior and lateral x - ray images ( fig .
1 ) . magnetic resonance imaging ( mri ) revealed multiple calcified well - circumscribed loose bodies at the same location and synovitis in the ankle joint ( fig .
the laboratory tests were within the normal limits and the patient was scheduled for arthroscopic surgery with the diagnosis of anterior impingement syndrome due to right ankle synovial chondromatosis .
the ankle joint was entered via anteromedial and anterolateral arthroscopic portals during spinal anesthesia and tourniquet application .
multiple loose bodies and hypertrophic synovia around the anterior ankle joint were seen ( fig .
3 ) . arthroscopic partial synovectomy and excision of loose bodies were performed ( fig .
the drain was removed in the 1st postoperative day and the active and passive range of motion exercises was started .
the patient was allowed partial weight bearing with crutches and at the 2nd week he was mobilized with full weight .
there were multiple cartilaginous loose bodies , with the biggest and smallest dimensions of 0.9  cm    0.7  cm    0.5  cm and 0.4  cm    0.3  cm    0.2  cm in the permanent pathology report respectively ( fig .
the patient 's dorsiflexion and plantar flexion degrees were 25 and 30 , respectively , at the end of the 11th postoperative month .
no complications were diagnosed in the follow - up period with no recurrence on the plain x - ray images and mri .
trauma , degenerating joint diseases , osteochondritis dissecans , rhomatoid arthritis and tuberculosis arthritis are examples of the secondary form .
our case was evaluated in the primary synovial osteochondromatosis group due to the absence of previous trauma or inflammatory pathologies .
complaints of pain , swelling of the joint ( especially after physical activity ) with or without accompanying pain , decreased range of motion , palpable mass , locking paresthesias and joint clicking are main symptoms and signs in patients with synovial chondromatosis .
the suspected diagnosis was confirmed by the appropriate radiologic investigations and pathologic examination after history taking and physical evaluation .
the calcified form synovial osteochondromatosis could be seen in the anteroposterior and lateral plain x - ray images .
mri investigation enabled the diagnosis of the disease in the early stage , the exact localization of the disease and intrinsic property of chondroid tissue .
the tenosynovial giant cell tumor , calcifying aponeurotic fibroma , periosteal chondroma , osteocartilaginous loose bodies and soft tissue chondrosarcoma must be kept in mind in the differential diagnosis . the disease is slowly progressive and is considered to be a self - limiting condition . in the early stages of the disease and in asymptomatic patients , treatment can be planned conservatively with frequent follow - up visits .
degenerative changes could occur in the later stages of the disease in patients without appropriate therapy .
although the classical treatment approach for ankle joint chondromatosis is open surgery , arthroscopic surgery is rarely encountered in the literature .
some important advantages of arthroscopic surgery are wide visualization areas , easy access to difficult to reach areas , lower morbidity , no need for casting and immobilization , early rehabilitation and quick recovery period . however , there is the possibility of limited synovectomy and residual loose bodies .
arthroscopic surgery enables wide regional visualization , lowers morbidity , promotes early rehabilitation , shortens the recovery period and decreases the immobilization period .
written informed consent was obtained from the patient for publication of this case report and accompanying images .
a copy of the written consent is available for review by the editor - in - chief of this journal upon request .
nevres hurriyet aydogan , ahmet ozmeric , onur kocadal , murad pepe , talip kara took part in surgical procedure , literature search , preparation of the paper and review .
serap gozel took part in pathological investigation.key learning pointssynovial chondromatosis is a disease originating from synovia and characterized by the presence of metaplastic cartilaginous nodules.pain , swelling of the joint especially after physical activity and decreased range of motion are main symptoms.treatment is arranged according to the patient 's complaints , age and disease stage.there are many advantages of arthroscopic surgery in selected patients .
synovial chondromatosis is a disease originating from synovia and characterized by the presence of metaplastic cartilaginous nodules.pain , swelling of the joint especially after physical activity and decreased range of motion are main symptoms.treatment is arranged according to the patient 's complaints , age and disease stage.there are many advantages of arthroscopic surgery in selected patients .
synovial chondromatosis is a disease originating from synovia and characterized by the presence of metaplastic cartilaginous nodules .
pain , swelling of the joint especially after physical activity and decreased range of motion are main symptoms .
 introductionsynovial chondromatosis is characterized by the presence of metaplastic cartilage nodules originating from the synovia , bursa and tendon sheaths . 
 although it is extremely rare in the ankle joint , malignant transformation is possible . 
 the choice of treatment is usually open surgery for excision of loose bodies and synovectomy . 
 limited data is available concerning arthroscopic approaches.presentation of casea 28-year - old male patient was evaluated for pain and swelling of the right ankle joint . based on the findings of physical examination and radiographic investigations 
 , arthroscopic surgery was performed due to ankle impingement syndrome . 
 a diagnosis of synovial osteochondromatosis was made following the pathological survey.discussionsynovial chondromatosis is slowly progressive and is considered to be a self - limiting situation . 
 treatment strategies are decided on according to the patient 's complaints , age and disease stage . 
 open or arthroscopic surgery . can be performed . 
 some advantages of arthroscopic surgery are wide visualization areas , easy access to areas difficult to reach , lower morbidity , no necessity for casting and immobilization , early rehabilitation and quick recovery period.conclusionin conclusion , arthroscopic management can be successful in selected patients with synovial osteochondromatosis localized to the ankle joint . 