Arthroscopic Synovectomy

• Chronic synovitis not responding to maximal medical therapy
  • Rheumatoid arthritis
  • Recurrent hemarthrosis
  • Hemophilia
  • Pigmented villonodular synovitis

• Degenerative joint disease
• Active infection

• Standard knee arthroscopy set
• 70-degree viewing arthroscope

• The synovial membrane attaches to:
  • Margins of the articular surfaces
  • Superior and inferior outer margins of the menisci
• Anteriorly, the synovial membrane forms a large suprapatellar bursa.
• More laterally, it then extends beneath the aponeuroses of the vasti muscles.
• Distally, it is separated from the patellar ligament by the infrapatellar fat pad, which it covers.
• Moving posteriorly, the membrane folds then converge to form the infrapatellar fold or plica (ligamentum mucosum).
  • This then attaches in the femoral intercondylar fossa.

The full content of this section includes:

• Step-by-step text instructions for performing the procedure
  
• Clinical pearls providing practical clinical tips from medical experts
• Patient safety guidelines consistent with Joint Commission and OHSA standards
• Links to medical evidence and related procedures

Figure 1 :  A, Localized nodular synovitis of posteromedial compartment of knee. B, Arthroscopic excision of localized nodular synovitis with arthroscope in posteromedial portal and probe through intercondylar notch to palpate posterior cruciate ligament. Synovial attachment of nodular synovitis is just superior and posterior to probe. From Canale ST, Beaty JH (eds): Campbell's Operative Orthopaedics, 11th ed. Philadelphia, Elsevier (2008).

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• Remove the drain before patient discharge.
• Weight-bearing to tolerance with crutches is allowed.
• Range of motion and quadriceps-strengthening exercises are begun immediately.

• Recurrent hemarthrosis
• Joint stiffness and loss of extension
• Infection and neurovascular injury

• Synovectomy significantly decreases pain and synovitis in patients with rheumatoid arthritis at 2-4 years of follow-up.
• Range of motion following arthroscopic synovectomy in patients with rheumatoid arthritis has been shown to improve 73% with 8 years of follow-up.