Synovial osteochondromatosis is a benign metoplastic disease that primarily affects the knee. Histologic analysis has divided the disease in to primary and secondary forms. The treatment of osteochondromatosis about the elbow has received little attention in the literature. This report consists of 12 patients with synovial osteochondromatosis treated by surgical intervention. Pain was the predominant symptom in eleven patients and limitation of movement was present in seven. Catching and locking were also common symptoms. Preoperative x-rays showed loose bodies in either the anterior or posterior compartment. Degenerative joint disease was also prevalent in eight patients. The surgical procedure was not uniform. Patients underwent either arthroscopic or open surgery. Additional procedures were also variable, including capsulotomy, cheilectomy, ulnohumeral arthroplasty, and ulnar nerve transposition. This lack of uniformity diminishes the overall message of the manuscript. In general, all patients improved in their range of motion, both in flexion-extension and pronation and supination. Patients with primary disease had a mean improvement in the flexion arc from a preoperative average of 40- 123° to 5-128°. The secondary group had a mean improvement in the flexion arc from a preoperative value of 21-90° to 4-130°. Patients were followed for a mean of 6.8 years after the operation. Recurrence occurred in five patients. Progressive osteoarthritis was noted in nine individuals.
Synovial osteochondomatosis presents with or without pain about the elbow. Symptoms are often related to a contracture or loose body formation. Those with loose bodies and acceptable range of motion can be treated by arthroscopic methods. Individuals with loose body formation and unacceptable range of motion require an elbow release to regain adequate motion. Surgical intervention appears to be beneficial in regaining range of motion and alleviating the symptoms related to the the condition. The remaining question is whether or not early surgery will change the natural history of the disease and prevent progressive arthritic changes in the elbow.
J Bone Joint Surg