Synovial Chondromatosis of Knee

Synovial chondromatosis (also synovial osteochondromatosis) is a type of non-cancerous tumor that arises in the lining of a joint. It has


Introduction
The exact prevalence of synovial chondromatosis is unknown, but the disorder is rare worldwide. Most reported series indicate a male-to-female ratio of 2:1. In addition, most cases are reported in patients aged 20-50 years; only a few case reports have described the condition occurring in children. Synovial chondromatosis usually affects the larger diarthroidal joints of the axial skeleton, typically the knee 35%, elbow 22%, wrist 11% and hip 4% (Jeyaraj and Vineet, 2017).
Synovial chondromatosis is a benign monoarticular disorder condition that involves the synovium, which is the thin layer of tissue that lines the joints. Synovial osteochondromatosis is Synovial chondromatosis (also called synovial osteochondromatosis) is a type of non-cancerous tumor that arises in the lining of a joint. It has been divided into primary and secondary forms. Primary synovial chondromatosis was originally considered to represent chondroid metaplasia in the synovium of a joint with resultant formation of multiple intraarticular chondral bodies. Secondary synovial chondromatosis is associated with joint abnormalities, such as mechanical or arthritic conditions, that cause intraarticular chondral bodies. Primary synovial chondromatosis typically affects adults, predominantly men, in the third to fifth decades of life. Synovial osteochondromatosis manifests clinically with joint pain, swelling, and limitation of motion. Although the condition is not cancerous, it can severely damage the affected joint and, eventually, lead to osteoarthritis. As conclusion, this case is typical of secondary synovial chondromatosis that is the result of a degenerative change in the joint. E-ISSN 2774-3837 in painful joint effusions and, on the generation of loose bodies, mechanical symptoms. The synovial lining of a joint, bursa, or tendon sheath undergoes nodular proliferation, and fragments may break off from the synovial surface into the joint. There, nourished by synovial fluid, the fragments may grow, calcify, or ossify. The intra-articular fragment may vary in size from a few millimeters to a few centimeters.
Plain radiographs frequently show characteristic feature including multiple (usually>5) calcified or osseous bodies within the joint or bursa. When fragments are not calcified, intrasynovial fragments may not be seen on plain images, and arthrographic studies are required to demonstrate the bodies. The differential diagnosis includes degenerative joint disease in which osteophytes have broken off into the joint. However, synovial chondromatosis tends to have a larger number of bodies in the joint. Other differential diagnoses include soft tissue and intraarticular chondromas. In advanced stages of synovial chondromatosis, secondary degenerative changes are often observed. For early diagnosis, plain radiographs help the doctor to makes next examination and treatment plan.

Case Presentation
We present a 52-years-old woman with main complain of pain dan swelling at right knee 1 day before. No traumatic history. Blood pressure was 160/100 and pulse was 80 x / mnt, temperature 40 C. Plain x-ray examination revealed irregular amorph cartilage lesion in bursal tissue and/or in tenosynovial tissue in proximity to an involved join. It was also revealed sclerotic and irregular facies articular, also narrow joint space.
Physical examination will be looking for swelling, tenderness, limited range of motion, and creaking or grinding noises during movement, an indication of bone-on-bone friction. Imaging studies will help differentiate synovial chondromatosis from osteoarthritis. X-rays provide images of dense structures, such as bone. Large loose bodies are usually calcified or ossified and can be seen on x-ray. Smaller loose bodies and those that are not calcified or ossified may not show up. If the loose bodies are not visible on x-ray, the doctor may suggest a magnetic resonance imaging (MRI) scan or computerized tomography (CT) scan to better evaluate the joint. Loose bodies can typically be seen on both MRI and CT scans.
Depending on the symptoms, simple observation can sometimes be a treatment option. The doctor will carefully consider a number of factors in determining whether observation is appropriate in your case. Treatment for synovial chondromatosis typically involves surgery to remove the lose bodies of cartilage. In some cases, the synovium is also partially or fully removed (synovectomy) during surgery.

Discussion
This study reports a case of synovial chondromatosis is unknown. Some research suggests that trauma may play a role in its development because the condition primarily occurs in weightbearing joints. Infection has also been considered as a contributing factor. The condition is not inherited. 1 Synovial chondromatosis is a benign condition that can result in severe disability and dysfunction of an involved synovial joint. Observation of involved cases indicates that this benign condition rarely undergoes malignant degeneration (Olufemi, 2020; Health Jade Team,2019). The typical history of a patient with primary synovial chondromatosis of the knee is that of a middle-aged man with monoarticular pain, swelling, and stiffness with or without mechanical symptoms in the knee. No history of acute trauma is usually reported, but the patient may have a distant history of knee injury. No systemic signs of infection or illness are apparent (Baecher NB,2020). Primary synovial chondromatosis represents as a benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa and as loose bodies in the joint cavity with or without calcification and without an identifiable joint pathology (Murphey 2007, Baecher NB, 2020 The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis (Murphey, 2007). Secondary synovial osteochondromatosis is seen with coexistent osteoarthosis. A general distinction in the secondary form is multiple bodies of differing sizes with concentric rings of growth.
The primary form of synovial chondromatosis is characterized by numerous small, round loose bodies that are uniform in size. It is not precipitated by any identifiable joint pathology and likely occurs secondary to metaplasia. Lesions are often aggressive and are associated with a high incidence of recurrence (Olufemi, 2020;Dutt, 2020). Secondary form ( The disease progresses from an active initial phase, with synovial proliferation and formation of intrasynovial cartilaginous nodules, to a final phase, which is characterized by inactive synovial disease and persistent nodules, which may break off into the joint space (Baecher, NB, 2020 1. Initial phase: metaplastic formation of cartilaginous nodules in the synovium 2. Transitional phase: detachment of those nodules and formation of free intra-articular bodies 3. Inactive phase: resolution of synovial proliferation, but loose bodies remain in the joint, and may increase in size obtaining nourishment from the joint fluid by diffusion (Olufemi, 2020;Dutt, 2020)

Conclusion
Radiographic findings enable differentiation of primary from secondary types. If radiographs indicate no underlying joint pathology, the primary type can be diagnosed. Secondary synovial chondromatosis is felt to occur as a result of mechanical changes in a joint due to arthropathy. The formation of loose chondral bodies is thought to be part of the degenerative process in these joints. MRI and MRI arthrography are also helpful in making the diagnosis. MRI can help differentiate and diagnose bursal extension of the disease process. An evaluation of patients with findings that suggest secondary synovial chondromatosis should include an attempt to identify underlying arthritic processes.