A comparison of open and arthroscopic surgery for treatment of diffuse pigmented villonodular synovitis of the knee.

PURPOSE: To compare the outcomes of diffuse pigmented villonodular synovitis (PVNS) of the knee treated with routine anteroposterior open surgery or modified multi-directional arthroscopy.

METHODS

Medical records of patients with diffuse PVNS who underwent surgery between 2002 and 2010 were reviewed. Patients were followed up at 3, 6, 12, 24, and 36 months. Operative time, blood loss, length of hospital stay, recurrence rate, and International Knee Documentation Committee (IKDC) scores and Lysholm knee scores at 1- and 3-year postoperatively were compared between the open surgery and arthroscopy groups.

RESULTS

A total of 41 patients with diffuse PVNS were included (20 in open surgery group and 21 in multi-directional arthroscopy group). There was no significant difference in the baseline characteristics between the two groups. Operation time, postoperative bleeding, and length of hospital stay were all significantly lower in the arthroscopy group than in the open surgery group (all, P < 0.05). There were four recurrences in the open surgery group and one in arthroscopy group. All five recurrences received a second surgery without any subsequent recurrences. At both 1- and 3-year postoperatively, IKDC and Lysholm scores were significantly greater in the arthroscopy group than the open surgery group (all P < 0.001).

CONCLUSIONS

The multi-directional arthroscopic technique was associated with significantly shorter operation time and hospital stay, less blood loss, and better postoperative IKDC and Lysholm scores than open surgery.

LEVEL OF EVIDENCE: Retrospective study with controls, Level III.