Dines Joshua S, DeBerardino Thomas M, Wells Jason L, Dodson Christopher C, Shindle Michael, DiCarlo Edward F, Warren Russell F
Hospital for Special Surgery, New York, New York 10021, USA.
Arthroscopy. 2007 Sep;23(9):930-7. doi: 10.1016/j.arthro.2007.03.012.
The purpose of this study was to review a single institution's large consecutive series of localized pigmented villonodular synovitis (PVNS) of the knee.
Cases for review were identified by a search of our institution's pathology records for definitive diagnoses of monoarticular localized PVNS (LPVNS) of the knee between 1970 and 1996. Patients' presenting symptoms and examination were recorded, as were the preoperative diagnosis and documentation of the PVNS nodule's location in the knee at surgery. Eighty-four patients were diagnosed with localized PVNS of the knee during the study period. Twenty-nine of these cases were incidental findings associated with planned total knee replacement and were excluded from the study. Of the remaining 55 patients constituting the study subgroup, 26 have been reviewed in detail.
There were 15 males and 11 females, and the mean age at presentation was 36.7 years. Patients presented for evaluation at an average of 15 months after the onset of symptoms. Pain was the most common complaint, reported by 24 of the 26. Locking and giving way were reported by 10 and 5 patients, respectively. On examination, 13 patients had an effusion, 11 had joint line tenderness, and 10 had a palpable mass. The most common preoperative diagnosis was a meniscus tear (10 of the 26), followed by PVNS (4), "mass" (4), and anterior cruciate ligament injury (3). At surgery, the nodule of PVNS was found most frequently in the suprapatellar pouch (6 cases), followed by the femoral notch (4), lateral synovium/gutter (4), popliteal fossa (3), lateral compartment (3), and medial compartment (2). Fourteen of the procedures performed were open, and 12 were performed by arthroscopy. Ten of the 26 patients participated in a long-term follow-up via the Lysholm Knee Scoring Scale questionnaire (average, 65.8 months postoperatively; average score, 95.4/100). Of these 10, 7 returned for follow-up clinical examinations (6 excellent results and 1 good). All 10 patients were operated on arthroscopically, and none required repeat surgery.
This review represents the largest series of localized PVNS of the knee to date. Echoing the findings of other PVNS studies, patients presented, on average, in their fourth decade. The common preoperative diagnosis of a meniscal tear is not surprising given the frequent presentation of a painful and, typically, locking knee with joint line tenderness and effusion. Interestingly, what is perhaps the most diagnostic finding on examination, a palpable mass, was present in only 1 of the 6 patients who had PVNS in the most common location, the suprapatellar pouch. With the ease and utility of modern arthroscopy, however, PVNS is an easily treatable condition that can be diagnosed at the time of surgery.
Level IV, therapeutic case series.
本研究旨在回顾一家机构中膝关节局限性色素沉着绒毛结节性滑膜炎（PVNS）的大量连续病例系列。
通过检索本机构的病理记录，确定1970年至1996年间确诊为膝关节单关节局限性PVNS（LPVNS）的病例以供回顾。记录患者的症状表现和检查情况，以及术前诊断和手术时PVNS结节在膝关节中的位置记录。在研究期间，84例患者被诊断为膝关节局限性PVNS。其中29例是与计划中的全膝关节置换相关的偶然发现，被排除在研究之外。构成研究亚组的其余55例患者中，26例已进行详细回顾。
男性15例，女性11例，就诊时的平均年龄为36.7岁。患者平均在症状出现后15个月前来评估。疼痛是最常见的主诉，26例中有24例报告疼痛。分别有10例和5例患者报告有绞锁和打软腿症状。检查时，13例患者有积液，11例有关节线压痛，10例可触及肿块。最常见的术前诊断是半月板撕裂（26例中有10例），其次是PVNS（4例）、“肿块”（4例）和前交叉韧带损伤（3例）。手术时，PVNS结节最常出现在髌上囊（6例），其次是股骨切迹（4例）、外侧滑膜/沟（4例）、腘窝（3例）、外侧间室（3例）和内侧间室（2例）。所进行的手术中有14例为开放手术，12例为关节镜手术。26例患者中有10例通过Lysholm膝关节评分量表问卷参与了长期随访（平均术后65.8个月；平均得分95.4/100）。在这10例患者中，7例返回进行随访临床检查（6例结果优秀，1例良好）。所有10例患者均接受关节镜手术，无一例需要再次手术。
本回顾是迄今为止最大规模的膝关节局限性PVNS病例系列。与其他PVNS研究结果一致，患者平均在第四个十年就诊。鉴于膝关节疼痛且通常伴有绞锁、关节线压痛和积液的常见表现，术前常见的半月板撕裂诊断并不令人意外。有趣的是，也许检查中最具诊断意义的发现——可触及肿块，在最常见部位髌上囊的6例PVNS患者中仅有1例出现。然而，随着现代关节镜技术的简便性和实用性，PVNS是一种易于治疗的疾病，可在手术时确诊。
IV级治疗性病例系列。
