Introduction
Pigmented Villonodular Synovitis (PVNS) is a rare, benign proliferative disorder affecting the synovial membranes of joints, bursae, and tendon sheaths. Characterised by joint swelling, pain, and reduced mobility, PVNS predominantly impacts the knee and ankle joints.
Understanding PVNS
PVNS manifests in two forms: localised and diffuse. The diffuse type is more aggressive, leading to joint destruction if not addressed promptly. Symptoms include joint pain, swelling, stiffness, and sometimes joint locking. Magnetic Resonance Imaging (MRI) is the gold standard for diagnosis, revealing characteristic hemosiderin deposits (Slater & Bachmid, 2024).
Minimally Invasive Surgical Approaches
Advancements in arthroscopic techniques have revolutionised the management of PVNS. Arthroscopic synovectomy allows for the removal of affected synovial tissue with minimal disruption to surrounding structures. This approach reduces postoperative pain, shortens hospital stays, and accelerates rehabilitation compared to open procedures (Slater & Bachmid, 2024). As the disease progresses, the joint can collapse and require fusion surgery.
Case Study: Medial Malleolar Osteotomy and Distraction Arthroplasty
A case involved a patient with diffuse PVNS of the ankle joint, however, the patient did not want an ankle fusion. The surgical team performed an ankle arthroscopy combined with a medial malleolar osteotomy to access and excise the diseased synovium thoroughly. Postoperative distraction arthroplasty was employed to promote joint space restoration and cartilage healing. At the five-year follow-up, the patient exhibited significant improvement in joint function and no recurrence of PVNS (Slater & Bachmid, 2024).
Conclusion
The integration of minimally invasive techniques, such as arthroscopic synovectomy and distraction arthroplasty, was used successfully in the case above. Ongoing research and clinical experience continue to refine these approaches, promising improved outcomes for patients afflicted with this challenging condition.
Disclaimer: This blog is for informational purposes only and should not be considered medical advice. Please consult with your healthcare provider for any questions or concerns regarding your individual health.
References
- Slater, G., & Bachmid, Z. (2024). Ankle Arthroscopy Medial Malleolar Osteotomy followed by Distraction Arthroplasty in Treating PVNS: A 5-Year Follow Up. Journal of Regenerative Biology and Medicine, 6(1), 389–400. https://www.researchgate.net/publication/379051037_Ankle_Arthroscopy_Medial_Malleolar_Osteotomy_followed_by_Distraction_Arthroplasty_in_Treating_PVNS_A_5-Year_Follow_Up