Module 60, Pediatric Orthopaedist Level
The patient is an 8 year and 7 month old white male who reported that
he injured his left knee about two weeks ago when he fell off his bicycle.
The child complained of pain and swelling and difficulty moving his left
knee. He has been able to bear weight and ambulate with a limp. On ambulation
the left knee was held in mild flexion. The left knee lacked full range
of motion. Extension was approximately 10 degrees short of full. Flexion
was to approximately 120 degrees, about 20 degrees less than the opposite
side. There was a moderate effusion evident by blotting of the patella.
There were no specific areas of tenderness although ranging the knee was
bothersome with mild apprehension. No ligamentous instability was noted
during the exam. Exams of the hip and ankle were normal bilaterally as
was the right knee. AP, lateral and oblique radiographs of the left knee
showed an effusion with multiple radiodense bodies that were felt to be
intra-articular. No fractures or dislocations were evident. The patient
underwent left knee arthroscopy with removal of loose bodies and extensive
synovectomy. Posteromedial and posterolateral portals as well as standard
anteromedial and anterolateral portals were used. Multiple loose bodies
were found on the order of 15- 25. They measured approximately 4-6mm x
3-4mm. They resembled the so called rice bodies. Synovial reaction was
also evident in the areas where these loose bodies seemed to be developing.
The articular surfaces appeared to be affected with grades I - II chondromalacia.
The menisci and ligaments were in good condition.
Question 60A
The arthroscopy should include a complete synovectomy as a treatment of
this process.
Question 60B
Post-operatively
the child should be kept non-weight bearing in a cast for 6 weeks.
Question 60C
After
14 months the effusion and pain reoccurred. repeat arthroscopy is indicated.
Question 60D
The
etiology of the cartilage is direct growth on the synovium.
Question 60E
This
process may lead to synovial chondrosarcoma.
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