J Korean Foot Ankle Soc.  2016 Dec;20(4):192-195. 10.14193/jkfas.2016.20.4.192.

Pigmented Villonodular Synovitis of the Ankle and Subtalar Joint Treated by Surgical Excision and Ligament Reconstructions: A Case Report

• Shin JH
• Lee BH
• Kim GL
• Kim K

• KMID: 2362769
• DOI: http://doi.org/10.14193/jkfas.2016.20.4.192

Abstract

Diffuse pigmented villonodular synovitis (PVNS) involving ankle joint needs complete mass excision and total synovectomy to reduce recurrence rate, while surrounding ligaments can be easily damaged. So the concurrent ligament reconstruction should be considered for post-excisional instability in subtalar joint as well as lateral ankle joint. We describe our experience in the management of a diffuse type PVNS, invades lateral talocrural joint extended to subtalar joint and introduce a new technique of all-in-one reconstruction for anterior talofibular,calcaneofibular and cervical ligament. Our new reconstruction technique applying modified Chrisman and Snook technique is useful in stabilization for deficiencies of the ligament complexafter PVNS excisionat lateral ankle and subtalar joint.

Keyword

Pigmented villonodular synovitis; Subtalar instability; Ligament reconstruction; Cervical ligament

MeSH Terms

Ankle Joint
Ankle*
Joints
Ligaments*
Recurrence
Subtalar Joint*
Synovitis, Pigmented Villonodular*

Figure

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  Figure 1. Preoperative plain anterior-posterior radiograph of left ankle shows diffuse soft tissue swelling, joint capsule distension without bony erosion.

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  Figure 2. (A) These are magnetic resonance imaging of left ankle. T1- and T2-weighted fat suppressed sagittal images show large sized mass of low signal intensity in posterior aspect of ankle surrounding high signal intensity with focal intermediate signal intensity (arrows). (B) Coronal images show mass (arrows) involved into subtalar joint.

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  Figure 3. (A) Curvilinear incision was done on lateral side of ankle. (B) Yellowish-brown color mass with localized dark brownish portion involves overall capsular structures in the lateral talocrural joint, and cervical and interosseous ligament into subtalar joint. (C) Widening of subtalar joint space in supination-adduction motion and abnormal increased talar motion in anterior draw and adduction of ankle joint was identified after mass excision.

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  Figure 4. Microscopic finding shows proliferation of fibrous matrix, mononuclear histiocytes, multinucleated giant cells, hemosiderin-laden cells (H&E stain, ×100).

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  Figure 5. This drawing shows anterior talofibular, calcaneofibular, and cervical ligament reconstruction technique.

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