Evgeny Naryshkin

Title: Arthroscopic synovectomy for diffuse-type tenosynovial giant cell tumor of the knee joint

Abstract

Diffuse-type tenosynovial giant cell tumor (DT-TGCT) is a rare but locally aggressive synovial disease frequently affecting the knee joint. Patients often present with chronic pain, joint effusion, restricted motion, and recurrent synovitis, which significantly impairs quality of life. Complete surgical removal of pathological synovium remains the primary treatment option; however, achieving radical excision is technically demanding, especially in the posterior compartments of the knee.

This presentation describes the clinical outcomes and surgical considerations of arthroscopic synovectomy in patients with diffuse-type TGCT of the knee joint. A total of 27 patients with histologically confirmed DT-TGCT underwent arthroscopic synovectomy using a systematic multi-portal approach. In addition to standard anterior portals, modified posterior portals were employed, including upper and lower posteromedial and posterolateral portals. In cases with popliteal cyst involvement, an additional portal was created in the projection of the cyst to allow complete tumor removal.

Clinical outcomes were evaluated using the Visual Analog Scale (VAS) for pain, recurrence rate, and postoperative complications. The follow-up period ranged from 1 to 4 years. All patients were referred for adjuvant radiotherapy following surgery.

The mean VAS pain score improved significantly from 7.0 preoperatively to 2.2 postoperatively. Local recurrence occurred in two patients and was associated with residual tumor tissue located in anatomically challenging areas. Both patients underwent successful revision arthroscopic surgery. One patient developed a postoperative popliteal artery aneurysm requiring surgical intervention.

Arthroscopic synovectomy with extended posterior access allows effective tumor removal, significant pain relief, and acceptable mid-term outcomes. Careful preoperative planning and thorough assessment of posterior compartments are critical to minimize recurrence.

What will the audience take away from presentation:

• Practical arthroscopic strategies for managing DT-TGCT of the knee


• Safe use of modified posterior portals


• Key causes of recurrence and how to avoid them


• Role of adjuvant radiotherapy in treatment planning


• Participants will be able to apply the described portal configuration and surgical sequence in daily arthroscopic practice, improving access to posterior knee compartments.


• This presentation offers a practical solution for managing a rare but challenging condition, helping surgeons reduce recurrence rates and improve patient outcomes in both orthopedic and rheumatologic practice.