Distinct extra-articular invasion patterns of diffuse pigmented villonodular synovitis/tenosynovial giant cell tumor in the knee joints

  • Dong-Eun Kim
  • Jong-Min Kim
  • Bum-Sik Lee
  • Nam-Ki Kim
  • Sang-Hoon Lee
  • Seong-Il Bin



Pigmented villonodular synovitis (PVNS)/tenosynovial giant cell tumor (TGCT) is a benign, proliferative lesion of the synovium, the bursa, and the tendon sheath. Little is known about the anatomical distribution pattern of diffuse extra-articular PVNS/TGCT around the knee joint. In this retrospective study, anatomical distribution of PVNS/TGCT using magnetic resonance imaging (MRI) and arthroscopy was analyzed.


This study was designed as a retrospective, observational cross-sectional study based on MRI and arthroscopy. Twenty-four PVNS/TGCT patients (24 knees) who underwent arthroscopic or posterior open surgery between 2009 and 2016 were enrolled. Of these, eight intra-articular and 16 diffuse extra-articular PVNS/TGCT of the knee were classified. The anatomical locations of the PVNS/TGCT masses were determined with a newly devised mapping scheme. Analysis was performed on the prevalence of each compartment and agreement rates between each compartment.


The point prevalence of intra-articular posterior compartment was higher in diffuse extra-articular PVNS/TGCT group compared with intra-articular PVNS/TGCT group. The point prevalence of diffuse PVNS/TGCT was most prevalent in the extra-articular posterolateral compartment (12 out of 16 diffuse extra-articular PVNS/TGCT patients, 75%) and second most common in the below to joint capsule compartment (11 out of 16, 68.8%). The agreement rate was the highest between intra-articular posterolateral and extra-articular posterolateral compartments (75%).


Extra-articular invasion of diffuse PVNS/TGCT occurred in specific patterns in the knee joint. Extra-articular lesions were always accompanied by lesions in intra-articular compartments. In particular, lesions in the intra-articular posterior compartments were observed in all of the diffuse extra-articular PVNS/TGCT patients. The point prevalence of diffuse extra-articular PVNS/TGCT for each compartment was the highest [12 out of 16 (75%)] in extra-articular posterolateral compartment. In contrast, invasion to the extra-articular posteromedial side was less frequent [5 out of 16 (31.3%)] than to the extra-articular posterolateral side. Knowing where the lesions frequently occur may provide important information for deciding the timing, method, and extent of surgery.

Level of evidence

Level IV.


Pigmented villonodular synovitis Tenosynovial giant cell tumor Arthroscopy Synovectomy Diffuse PVNS 



We thank Dr. Joon Seo Lim from the Scientific Publications Team at Asan Medical Center for his editorial assistance in preparing this manuscript.


No external funds were received in support of this work. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

Institutional review board (IRB)/Ethics committee approval was obtained (IRB No. S2016-1529-0001) from Asan Medical Center (Seoul, South Korea).

Informed consent

Institutional review board (IRB)/Ethics committee waived the need for patients’ informed consent based on the retrospective nature of the study.

Supplementary material

167_2018_4942_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 KB)


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Investigation Performed at the University of Ulsan College of MedicineAsan Medical CenterSeoulSouth Korea
  2. 2.Hospital RUNSeoulSouth Korea
  3. 3.Incheon Red Cross HospitalIncheonSouth Korea
  4. 4.Department of Orthopedic Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea

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