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Pigmented villonodular synovitis (PVNS)

Definition

Pigmented villonodular synovitis (PVNS) is a disease affecting the synovial lining the tendon seath and the bursa and may present in the local (figure 1) or the diffuse type.  Knee PVNS is usually diffuse. It is considered a benign disease. Repeated microtrauma and bleeding have been implicated as potential causes. In severe cases, the subchondral bone is also affected with cyst formation.

 
Εικόνα 1. Αρθροσκοπική εικόνα εντοπισμένης μορφής λαχνοοζώδους υμενίτιδας
Figure 1. Arthroscopic view of localized PVNS.
Figure 1. Arthroscopic view of localized PVNS.
 

Clinical presentationDiagnosis

Knee PVNS affects equally men and women aged between 20-45 years old. It presents with knee joint effusion and synovial thickening. Decreased knee range of motion and diffuse pain may also appear.

 
Εικόνα 2. Σχηματική παράσταση υγράθρου γόνατος.
Figure 2. Schematic presentation of knee joint effusion.
Figure 2. Schematic presentation of knee joint effusion.
 

Clinical diagnosis requires high index of suspicious, while radiographs are usually normal. MRI is useful and definite diagnosis is accomplished after arthroscopy and synovial biopsy.

Treatment

Conservative treatment with anti-inflammatory drugs offers temporary symptoms relief. Arthroscopic synovectomy is the recommended treatment (video 1 and 2). Total synovectomy is not feasible (part of the posterior synovium is not approached) and PVNS may recur. 

 

Video 1. Arthroscopic treatment of localized PVNS.

Video 2. Arthroscopic treatment of diffused PVNS.