Synovial haemangioma of the knee joint: diagnosis by arthroscopy

Synovial haemangiomas are a rare cause of recurrent knee effusions. The problem usually presents in childhood, but the diagnosis is often not made for many years. Clinical, laboratory, and radiographic diagnosis is often non-specific, leading to prolonged diagnostic uncertainty. Arteriography, venography, thermography, and computer tomography may be useful once the diagnosis is made. Arthroscopy should be considered early on to make the diagnosis and biopsy the tumor so that further surgery, studies, and treatment can be carried out.     

Synovial entrapment: a complication of posterior stabilized total knee arthroplasty

BACKGROUND: We observed a complication of posterior stabilized total knee arthroplasty involving hypertrophy of tissue proximal to the patella associated with pain during active knee extension from 90 degrees of flexion. The purpose of this paper was to describe synovial entrapment and to determine if design features of the prosthesis predispose patients to the complication. METHODS: Between April 1990 and June 1999, we performed 459 consecutive posterior stabilized primary total knee arthroplasties using three prosthetic designs with different femoral intercondylar geometries. We identified twenty-six patients (twenty-seven knees) in whom arthroscopic débridement of the knee or open arthrotomy with débridement of the knee had been subsequently performed because of a diagnosis of synovial entrapment. We reviewed the records of these patients to identify the knee components that had been used and the symptoms and conditions that necessitated additional treatment. RESULTS: Symptoms (grating, crepitation, and pain with active knee extension from 90 degrees) necessitating subsequent débridement occurred in 13.5% (nineteen) of 141 knees treated with the Anatomic Modular Knee-Congruency implant, 3.8% (eight) of 212 treated with the Anatomic Modular Knee-Posterior Stabilized implant, and none of the 106 treated with the Press Fit Condylar Sigma-Posterior Stabilized implant. All patients had difficulty rising from a chair and climbing stairs; however, none had symptoms when standing or walking. No patient had a patellar clunk. The symptoms occurred at a mean of seven months after the arthroplasty in the patients with an Anatomic Modular Knee-Congruency implant and at a mean of twenty months after the arthroplasty in those with an Anatomic Modular Knee-Posterior Stabilized implant. Débridement of the frond-like hypertrophic synovial tissue at the distal aspect of the quadriceps tendon alleviated symptoms in all patients. No nodules were identified during the arthroscopy. CONCLUSIONS: Synovial entrapment is characterized by hypertrophic synovial tissue at the superior pole of the patella. Use of a posterior stabilized femoral component with a proximally positioned or wide femoral box is more likely to result in this complication.     

Synovial knee fistula: A cause of prolonged morbidity

Postarthroscopy knee fistulae may lead to prolonged morbidity. A 62-year-old man presented with a synovial knee fistula 4 weeks after knee arthroscopy, which was confirmed by magnetic resonance imaging. He was treated with antibiotics and knee immobilization that resulted in closure of the fistula. He then developed recurrent septic knee effusion that required arthroscopic washout, further antibiotic treatment, and physiotherapy. The patient’s clinical condition resolved after a further 6 weeks. This case shows that not all fistulae resolve spontaneously; they may lead to prolonged morbidity and necessitate further treatment. We also wish to note that magnetic resonance imaging is a useful diagnostic tool in place of the traditional sinogram.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 640–641     

A false aneurysm as a rare complication of knee arthroscopy

We present the rare case of a false aneurysm of the genus lat which occurred after knee arthroscopy. Apart from a pulse-synchronic swelling in close proximity to the former anterolateral portal there were no complaints and no pain. The diagnostic and therapeutic strategies - in this case performed with coiling of the involved vessel - are presented and discussed.     

Synovial fistula as a complication of recurrent dorsal wrist ganglion excision: case report

A wrist synovial fistula is rare. The author reports a patient who developed a synovial fistula following excision of a recurrent dorsal wrist ganglion.     

A broken scalpel blade tip: an unusual complication of knee arthroscopy

The case of a patient is presented in whom a No. 11 scalpel blade was inadvertently broken and embedded within the lateral femoral condyle during initial arthroscopic portal creation. After a thorough diagnostic arthroscopy and synovectomy to expose the distal femoral articular surface was unsuccessful, luoroscopy was performed to localize the blade fragment in orthogonal planes. The blade tip was eventually retrieved from its position below the surface of the cartilage. The details of the loss and recovery of the blade fragment reinforce that exceptional care must be taken and attention given during the creation of portals, particularly when resistance is encountered. Additionally, all instruments, especially scalpel blades, should be exam- ined carefully when removed from the knee joint.     

An unusual complication of knee arthroscopy: an extra-articular migrated asymptomatic broken probe from the knee joint

In large knee arthroscopy series, the complication rate has been reported to be between 2% and 8%. Although preventable in most cases, the incidence of instrument breakage remains approximately 3%. Despite this relatively frequent occurrence, few case reports have been published regarding these complications. In this case report, a patient carried a broken probe tip in her popliteal muscle belly for 5 years without symptoms. During arthroscopy, when the C-arm was temporarily not available, a probe tip had broken off and was left behind in the knee joint. It migrated through a popliteal hiatus into the popliteal fossa, and lodged in the medial head of the gastrocnemius muscle. When knee pain occurred 5 years later, the piece was located with fluoroscopy and was recovered without complications. This is the first such case reported in the English medical literature.     

Massive intraperitoneal and extraperitoneal accumulation of irrigation fluid as a complication during knee arthroscopy

A case of uncommon fluid extravasation during knee arthroscopy leading to a swelling of the groin, scrotum, and penis, with massive intraperitoneal and retroperitoneal fluid accumulation is reported. A defective pump pressure sensor relay was found to be the cause of uncontrolled fluid delivery with excessive intra-articular pressure increase. The literature reports several cases of extravasation of irrigation fluid into the calf without any sequelae. Our patient experienced proximal expansion of the fluid that expanded along the vastus intermedius and shunted into the retroperitoneal and intraperitoneal space. There was no clinical evidence of compartment syndrome despite the excessive amount of extravasation in the thigh. Diuretics were administrated, and the fluid was excreted within 36 hours. The patient suffered of no further sequelae.Arthroscopy 1998 May-Jun;14(4):401-4     

Traumatic arteriovenous fistula: a complication of amniocentesis.

Fetal injury is a potential complication of amniocentesis. We report the case of an infant who had an isolated arteriovenous fistula between the popliteal artery and vein that resulted from amniocentesis. Unlike the usual congenital arteriovenous communications that are multiple and difficult to treat, this case was completely cured by division of the fistula and vascular repair. This case emphasizes that newborns and infants who have had invasive prenatal interventions such as amniocentesis should be identified and the possibility of fetal injury be considered when evaluating their clinical signs and symptoms.     

Negative-pressure pulmonary edema: a complication of shoulder arthroscopy

Negative-pressure pulmonary edema has been increasingly reported in surgical literature since 1977, yet there are no references to this condition in current orthopedic textbooks. We report a case of negative-pressure pulmonary edema occurring during arthroscopic surgery of the shoulder. The patient required reintubation for 5 days and hospitalization for 1 week. Because arthroscopic surgery is widely believed to be without complications, we want to make orthopedic surgeons aware of the possibility of negative-pressure pulmonary edema.     

Vesico-diverticular fistula: a rare complication of Meckel's diverticulum.

Enterovesical fistulas usually result from diverticulitis, Crohn's disease, or colorectal cancer. A perforated Meckel's diverticulum can also result in an vesico-diverticulum fistula, as noted in three previously reported cases. In all three cases, bladder or bowel disease was associated with the fistula. Herein, the authors describe a previously healthy, 23-year-old man who presented with an enterovesical fistula. Exploratory laparotomy revealed a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum. Pathologic examination revealed that the diverticulum did not contain ectopic gastric or pancreatic tissue and that the perforation was secondary to an enterolith. The patient underwent a diverticulectomy and had an uneventful postoperative course. Unlike any of the three previously reported cases, the authors' patient had no coexisting bowel or bladder disease occurring with his vesico-diverticular fistula. To the authors' knowledge, this is only the third reported case of a vesico-diverticular fistula resulting from a perforated Meckel's diverticulum that did not contain ectopic tissue. It represents the first case where the perforation was secondary to an enterolith.     

Pseudoaneurysm as a complication of ankle arthroscopy

We present a case of a pseudoaneurysm of the anterior tibial artery following ankle arthroscopy with synovectomy, an extremely rare complication when standard anteromedial and anterolateral portals are used. The patient was diagnosed and treated with appropriate interventions which led to an uneventful recovery. Nevertheless, the potential sequelae of delayed diagnosis or misdiagnosis of the complication are dangerous; therefore, a high index of suspicion for a pseudoaneurysm must be maintained in the postoperative period.     

Pseudoaneurysm as a complication of ankle arthroscopy

We describe a case of pseudoaneurysm of the anterior tibial artery as a complication after arthroscopic ankle synovectomy, in which standard anterolateral and anteromedial portals were used. Pseudoaneurysm has been previously reported as a complication in ankle arthroscopy with the use of the anterocentral portal. Previously described anatomic variations of the tibial artery and its close relationship with the anterior ankle capsule may complicate arthroscopic surgery, especially when aggressive synovectomy is performed. Anterior tibial artery aneurysm is a rare complication of ankle arthroscopy, but its potential catastrophic sequelae must not be underestimated.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 4 (April), 2001: pp 400–402     

Debris observed by arthroscopy of the knee.

In examination of 732 knee joints through the arthroscope since 1961, various types of debris were observed in 47. The debris was classified into four groups: precipitation of fibrin, degeneration and necrosis of villi, desquamation of articular cartilage, and metaplasia of villi. Diseases of the knee joint and their pathogenesis are discussed in the light of these findings.