Arthroscopy in the Treatment of Pigmented Villonodular Synovitis of the Ankle and Subtalar Joints

A Technique Guide and Case Series

Kyle R. Sweeney, MD; Harris S. Slone, MD; Sameh A. Labib, MD

Disclosures

Curr Orthop Pract. 2017;28(5):499-502. 

In This Article

Discussion

Most of the literature regarding surgical treatment of PVNS in the ankle are small case series reporting recurrence rates ranging from 0–40%.[2,9–15,17] The most recent article by Korim et al.[9] compiled the data from previous case series to report a recurrence rate of 12.2%. Only two studies reported results on arthroscopic management of DPVNS. Stevenson et al.[10] reported two cases while Rochweger et al.[13] included one case. None of the three patients in these series had disease recurrence.

Adjuvant radiation therapy is occasionally used to treat PVNS after surgical excision. There are a small number of case series in the literature that report postoperative radiation after open synovectomy.[14,18] The overall recurrence rate in these series is 8.7% as compared to the previously mentioned 12.2%.[9] Bickels et al.,[18] in a case series of seven patients receiving postoperative radiation therapy for DPVNS, reported that two developed full-thickness skin necrosis that required soft-tissue flaps.[18] Considering the near equivalent efficacy between surgery alone and surgery with postoperative radiation as well as the reported risk of soft-tissue complications with adjuvant radiation, we recommend exercising caution when considering adjuvant radiotherapy.

Arthroscopic management can be used for patients with PVNS of the ankle and hindfoot, either as an adjunctive procedure for open surgery or primary treatment alone. Although we believe arthroscopy can be used in either LPVNS or DPVNS within the tibiotalar or subtalar joints to minimize complications related to larger surgical exposures, further research is needed to compare it with open debridement.

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