J Korean Orthop Assoc.  2014 Oct;49(5):389-393. 10.4055/jkoa.2014.49.5.389.

Ochronotic Arthropathy: Degenerative and Complex Tear of Black Meniscus

• Yoon JR
• Kim Y
• Yu J
• Yang JH

• KMID: 2185176
• DOI: http://doi.org/10.4055/jkoa.2014.49.5.389

Abstract

In this report, a case of a black meniscus with underlying ochronosis is described. Further analysis by laboratory findings showed that the patient had underlying alkaptonuria, which was previously undiagnosed. The patient's symptoms showed improvement after arthroscopic treatment.

Keyword

ochronosis; alkaptonuria; arthroscopy; knee

MeSH Terms

Alkaptonuria
Arthroscopy
Humans
Knee
Ochronosis

Figure

• 

  Figure 1 (A) Radiographs of the knee showing loss of joint space and subchondral sclerosis. (B) Magnetic resonance imaging with a complex tear of medial and lateral meniscus.

• 

  Figure 2 Arthroscopic findings. Brown pigmentation and hypertrophy of the synovium (white arrows) at medial knee compartment (A) and lateral knee compartment (B).

• 

  Figure 3 Arthroscopic findings after arthroscopic menisectomy. (A) Medial meniscus. The parenchymatous tissue of meniscus was uniformly black with sharply defined edges (arrow). (B) Lateral meniscus. Intrasubstance deposition of a grossly black substance (arrow) with yellowish-brown pigmentation of the cartilage was demonstrated.

• 

  Figure 4 The histopathology of the meniscus revealed degenerative fibrocartilage with nonspecific brownish shards (arrows) (H&E; A: ×200, B:×400).

Reference

1. Fernández-Cañón JM, Granadino B, Beltrán-Valero de Bernabé D, et al. The molecular basis of alkaptonuria. Nat Genet. 1996; 14:19–24.

2. Philippot R, Coste C, Lasseur E, Tramond P, Rollier JC, Moyen B. Ochronosis or black cartilage disease. Rev Chir Orthop Reparatrice Appar Mot. 2008; 94:693–696.

3. Raaijmaakers M, Steenbrugge F, Dierickx C. Ochronosis, arthroscopy of a black knee: a case report and review of the literature. Knee Surg Sports Traumatol Arthrosc. 2008; 16:182–184.

4. Keller JM, Macaulay W, Nercessian OA, Jaffe IA. New developments in ochronosis: review of the literature. Rheumatol Int. 2005; 25:81–85.

5. Iannuccelli C, Coari G, Mastantuono M, Osimani M, Valesini G, Di Franco M. Joint and tendineous involvement in ochronosis: clinical history and imaging of a case. Clin Exp Rheumatol. 2009; 27:696–697.

6. Zhao BH, Chen BC, Shao de C, Zhang Q. Osteoarthritis? Ochronotic arthritis! A case study and review of the literature. Knee Surg Sports Traumatol Arthrosc. 2009; 17:778–781.

7. Phornphutkul C, Introne WJ, Perry MB, et al. Natural history of alkaptonuria. N Engl J Med. 2002; 347:2111–2121.

8. Thacker M, Garude S, Puri A. Ochronotic arthropathy: arthroscopic findings in the shoulder and the knee. Arthroscopy. 2003; 19:E14–E17.

9. Chen AL, Rose DJ, Desai P. Arthroscopic diagnosis and management of ochronotic arthropathy of the knee. Arthroscopy. 2001; 17:869–873.