Diffuse Pigmented Villonodular Synovitis of the Ankle With Severe Bony Destruction: Treatment of a Case by Surgical Excision With Limited Arthrodesis

Abstract not available. Introduction provided instead.

Pigmented villonodular synovitis (PVNS) is a relatively rare disease affecting the synovial-lined joints. It was first fully described in 1941, by Jaffe and colleagues,¹ as a benign inflammatory state of the synovium of unclear etiology and as a tumor-like aggression of synovial tissue involving joints. The disease can be diffuse or localized and either intra-articular or extra-articular.² Diffuse PVNS involves the entire joint synovium; localized PVNS involves a discrete nodular, lobulated mass.³ The disease commonly occurs in the knee joint, whereas involvement of the foot and ankle is rare⁴ (reported incidence, ~1.8/million⁵). Severity of bony involvement in PVNS of the ankle may be high, possibly because the pressure erosion easily occurs in the narrow joint space of the ankle joint.⁶ The recurrence rate for the diffuse type may be as high as 50%, whereas the rate for the localized type is considered low.^2,5,7 So, to avoid tumor spread, complete excision and careful tissue handling are essential. However, a more curative approach causes more structural morbidity to the joint, which may necessitate a more invasive procedure, such as talocrural arthrodesis, depending on location of the lesion. Thus, the surgeon faces a difficult choice between aggressive surgery and more conservative treatment. Here we report a case of diffuse PVNS of the ankle with severe bony destruction, most of which originated in the distal tibiofibular joint (DTFJ). As this rare location was accessible, complete resection and arthrodesis only of the DTFJ were sufficient for curative operation.