A synovial osteochondroma replacing the anterior cruciate ligament at the intercondylar notch

Jong Won Chung, Soon-Hyuck Lee, Seung Beom Han, Hyun Jung Hwang, Dae Hee Lee

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

A woman presented with knee pain and locking. Pain was exacerbated at the end of the range of motion, especially during extension, with locking symptoms similar to those associated with a meniscus bucket handle tear. Ligamentous laxity was not definite. Plain radiographs showed multiple calcified loose bodies. Magnetic resonance imaging (MRI) showed a lobulated mass that was hypointense to muscle on T1-weighted sequences and hyperintense to muscle on T2-weighted sequences in the anterior cruciate ligament (ACL). Arthroscopically, multiple loose bodies were observed in the intercondylar notch and posterolateral compartment. A huge mass replaced the normal ACL and was caught in the intercondylar notch. The mass in the intercondylar notch caused loss of extension range of motion (ROM) because the piece caused a mechanical blockage. However, the loss of flexion ROM was likely caused by a loss of elasticity of the ligament rather than mechanical blockage. We resected the ACL mass, and removed the free bodies from the posterolateral corner. It was not possible to preserve the ACL fibers. Histological examination confirmed a diagnosis of osteochondromatosis. All symptoms resolved postoperatively. At 20 months postoperatively, the patient was pain free and had regained full knee motion without recurrence evidenced by follow-up MRI. However, ACL removal caused the knee instability. To date the patient has not undergone ACL reconstruction because she prefers conservative treatment and has experienced little discomfort in activities of daily living. To our knowledge, this is the first report to describe synovial osteochondromatosis wholly replacing the ACL fibers and causing mechanical blocking of both extension and flexion.

Original languageEnglish
JournalOrthopedics
Volume34
Issue number2
Publication statusPublished - 2011 Feb 1
Externally publishedYes

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Osteochondroma
Anterior Cruciate Ligament
Articular Range of Motion
Knee
Osteochondromatosis
Synovial Chondromatosis
Magnetic Resonance Imaging
Pain
Muscles
Anterior Cruciate Ligament Reconstruction
Elasticity
Activities of Daily Living
Ligaments
Recurrence

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

A synovial osteochondroma replacing the anterior cruciate ligament at the intercondylar notch. / Chung, Jong Won; Lee, Soon-Hyuck; Han, Seung Beom; Hwang, Hyun Jung; Lee, Dae Hee.

In: Orthopedics, Vol. 34, No. 2, 01.02.2011.

Research output: Contribution to journalArticle

Chung, Jong Won ; Lee, Soon-Hyuck ; Han, Seung Beom ; Hwang, Hyun Jung ; Lee, Dae Hee. / A synovial osteochondroma replacing the anterior cruciate ligament at the intercondylar notch. In: Orthopedics. 2011 ; Vol. 34, No. 2.
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