Treatment of Advanced Primary and Recurrent Diffuse Pigmented Villonodular Synovitis of the Knee by Kingsley R. Chin, Stephen J. Barr, Carl Winalski, David.

Treatment of Advanced Primary and Recurrent Diffuse Pigmented Villonodular Synovitis of the Knee

by Kingsley R. Chin, Stephen J. Barr, Carl Winalski, David Zurakowski, and Gregory W. Brick

J Bone Joint Surg AmVolume 84(12):2192-2202

December 1, 2002

©2002 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A through 1-I Posterior approach to the left knee.

Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-2202


The fibular head is identified, and the peroneal nerve is protected.



The lateral head of the gastrocnemius muscle and the lateral superior genicular artery are identified.



The posterolateral aspect of the capsule is exposed.



Dissection proceeds between the medial head of the gastrocnemius and the semimembranosus muscle.



The medial and lateral exposures are joined by blunt dissection beneath the midline structures containing the tibial nerve and the popliteal vessels.



A T incision is made in the lateral aspect of the capsule, over the lateral femoral condyle, and the incision is continued to the level of the popliteus tendon and the posterior horn of the lateral

meniscus.



All diffuse pigmented villonodular tissue is removed with careful dissection from the intercondylar region and laterally from the region of the popliteus sheath.



The same steps are performed on the medial side, starting with a T capsulotomy.



For the anterior approach to the knee, a standard anteromedial parapatellar incision is extended distal to the infrapatellar fat pad, passing lateral to the anterior horn of the medial meniscus.



Figs. 3-A through 3-D A twenty-two-year-old woman was referred with pain, swelling, and advanced pigmented villonodular synovitis of the left knee fifteen months after arthroscopic

synovectomy.



Figs. 3-C and 3-D Postoperative sagittal (Fig. 3-C) and coronal (Fig. 3-D) T1-weighted magnetic resonance images of the knee, showing complete removal of pigmented villonodular tissue from

the knee 7.5 years after combined posterior and anterior synovectom...



Treatment of Advanced Primary and Recurrent Diffuse Pigmented Villonodular Synovitis of the Knee by Kingsley R. Chin, Stephen J. Barr, Carl Winalski, David.

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