Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive knee pain, swelling, and intermittent mechanical symptoms (locking/catching). Reports recurrent joint effusions, often disproportionate to activity level. No history of acute trauma. Symptoms are refractory to conservative management, including NSAIDs and physical therapy.
Clinical Examination Findings
Knee examination reveals diffuse synovial thickening and palpable boggy swelling, most prominent in the suprapatellar pouch and parapatellar gutters. Joint effusion is present (positive bulge sign/ballottement). Range of motion is limited by pain and mechanical obstruction. Tenderness noted along the joint line. No ligamentous instability or neurovascular deficits.
Treatment Protocol
Recommended management includes surgical synovectomy (arthroscopic or open, depending on disease extent) to excise the proliferative synovial tissue. Post-operative MRI surveillance is required to monitor for local recurrence. Consider adjuvant radiotherapy or systemic therapy (e.g., CSF1R inhibitors) for diffuse or recurrent cases.