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Synovial osteochondromatosis (SOC) is a rare disease that creates a benign change or proliferation in the synovium or joint lining tissue which changes to form bone forming cartilage. Commonly there is only one joint affected, mostly either the knee, hip, or elbow.
The etiology or cause is unknown.
In this condition, cartilaginous metaplasia takes place within the synovial membrane of the joint. Metaplastic synovium organizes into nodules. With minor trauma, nodules are shed as small bodies into the joint space. In some patients the disease process may involve tendon sheaths and bursal sacs.
Cartilaginous intra-articular bodies float freely within the synovial fluid, which they require for nutrition and growth. Progressive enlargement and ossification occur with time. If they remain free, they continue to grow larger and more calcified. In severe cases, they may occupy the entire joint space or penetrate to adjacent tissues. Alternately, they can deposit in the synovial lining, reestablish a blood supply, and become replaced by bone. On occasion, synovial reattachment can lead to complete reabsorption of the cartilage fragment.
Classification is divided into primary versus secondary SOC. Primary SOC occurs in an otherwise normal joint. It is suggested by monoarticular involvement in a patient in the third to fifth decades of life. Secondary SOC occurs in older patients in joints previously affected by joint disease such as osteoarthritis. This pattern is suggested by bilateral involvement with multiple joint intra-articular bodies.
Cartilaginous bodies or osteocartilaginous bodies with central ossification may be noted. They are typically spherical in shape. Sizes range from several millimeters to several centimeters in diameter. The synovium of the involved joint demonstrates villous hyperplasia, which imparts a wrinkled appearance on gross examination. There may be cartilaginous bodies attached to the synovium. Synovial involvement may be focal or diffuse in nature.
Chronic, progressive pain and swelling of affected joint, exacerbated by physical activity. Joint effusion and limited range of motion are common associated features. It primarily affects large joints, including knee (>50% of cases), elbow, hip, and shoulder. SOC is twice as common in men as women. Some patients have intra-articular bodies resting in stable positions within joint recesses or bursae. These patients may be asymptomatic, with SOC merely as an incidental finding at imaging.
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