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  • Treatment of Advanced Primary and Recurrent Diffuse Pigmented Villonodular Synovitis of the Kneeby Kingsley R. Chin, Stephen J. Barr, Carl Winalski, David Zurakowski, and Gregory W. BrickJ Bone Joint Surg AmVolume 84(12):2192-2202December 1, 20022002 by The Journal of Bone and Joint Surgery, Inc.

  • Figs. 1-A through 1-I Posterior approach to the left knee. Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • The fibular head is identified, and the peroneal nerve is protected. Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • The lateral head of the gastrocnemius muscle and the lateral superior genicular artery are identified. Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • The posterolateral aspect of the capsule is exposed.Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • Dissection proceeds between the medial head of the gastrocnemius and the semimembranosus muscle. Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • The medial and lateral exposures are joined by blunt dissection beneath the midline structures containing the tibial nerve and the popliteal vessels.Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • A T incision is made in the lateral aspect of the capsule, over the lateral femoral condyle, and the incision is continued to the level of the popliteus tendon and the posterior horn of the lateral meniscus.Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • All diffuse pigmented villonodular tissue is removed with careful dissection from the intercondylar region and laterally from the region of the popliteus sheath.Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • The same steps are performed on the medial side, starting with a T capsulotomy.Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • For the anterior approach to the knee, a standard anteromedial parapatellar incision is extended distal to the infrapatellar fat pad, passing lateral to the anterior horn of the medial meniscus. Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • Figs. 3-A through 3-D A twenty-two-year-old woman was referred with pain, swelling, and advanced pigmented villonodular synovitis of the left knee fifteen months after arthroscopic synovectomy. Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

  • Figs. 3-C and 3-D Postoperative sagittal (Fig. 3-C) and coronal (Fig. 3-D) T1-weighted magnetic resonance images of the knee, showing complete removal of pigmented villonodular tissue from the knee 7.5 years after combined posterior and anterior synovectom...Kingsley R. Chin et al. J Bone Joint Surg Am 2002;84:2192-22022002 by The Journal of Bone and Joint Surgery, Inc.

    Figs. 1-A through 1-I Posterior approach to the left knee. PVNS = pigmented villonodular synovitis. Fig. 1-A An s-shaped incision is made with the proximal limb lateral and the distal limb medial. Skin flaps are dissected, and then lateral and medial vertical fascial incisions are made.The fibular head is identified, and the peroneal nerve is protected. A plane is dissected between the medial border of the biceps femoris muscle and the peroneal nerve.The lateral head of the gastrocnemius muscle and the lateral superior genicular artery are identified. A clamp is placed under the tendinous portion to mobilize the gastrocnemius muscle.The posterolateral aspect of the capsule is exposed.Dissection proceeds between the medial head of the gastrocnemius and the semimembranosus muscle. The medial head of the gastrocnemius is tagged with a stay suture and divided. A Cobb elevator is used to expose the posteromedial aspect of the capsule. Both the medial inferior and the medial superior genicular arteries are identified.The medial and lateral exposures are joined by blunt dissection beneath the midline structures containing the tibial nerve and the popliteal vessels.A T incision is made in the lateral aspect of the capsule, over the lateral femoral condyle, and the incision is continued to the level of the popliteus tendon and the posterior horn of the lateral meniscus.All diffuse pigmented villonodular tissue is removed with careful dissection from the intercondylar region and laterally from the region of the popliteus sheath.The same steps are performed on the medial side, starting with a T capsulotomy.For the anterior approach to the knee, a standard anteromedial parapatellar incision is extended distal to the infrapatellar fat pad, passing lateral to the anterior horn of the medial meniscus. Both menisci are detached, and all pigmented villonodular tissue is removed.Figs. 3-A through 3-D A twenty-two-year-old woman was referred with pain, swelling, and advanced pigmented villonodular synovitis of the left knee fifteen months after arthroscopic synovectomy. Figs. 3-A and 3-B Preoperative sagittal (Fig. 3-A) and coronal (Fig. 3-B) T1-weighted magnetic resonance images of the knee, showing diffuse pigmented villonodular tissue anteriorly in the suprapatellar pouch and posteriorly around the femoral condyles, around both heads of the gastrocnemius and the posterior cruciate ligament, and extending posteriorly to the tibial plateau.Figs. 3-C and 3-D Postoperative sagittal (Fig. 3-C) and coronal (Fig. 3-D) T1-weighted magnetic resonance images of the knee, showing complete removal of pigmented villonodular tissue from the knee 7.5 years after combined posterior and anterior synovectomy and intra-articular radiation with dysprosium-165-ferric hydroxide macroaggregates. The patient was working full-time with no symptoms or residual knee stiffness.

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