Diagnosis
The diagnostic backup is performed in several steps. Chondromatosis can be detected in the X-ray if the chondromas are calcified. In most cases, a reliable diagnosis can already be made with the X-ray.
An MRI is recommended if the chondromas are hardly calcified. In this case the x-rays do not show the disease so well. In the MRI they can be shown with different sequences and, if necessary, additionally with contrast medium.
The imaging can be difficult if it is a synovial chondromatosis (in the joint) which shows only slight calcification and where there is free body – then the chondromas can only be differentiated from the synovial fluid with difficulty. In synovial chondromatosis, conspicuous features are often found in the knee. In addition to the long-term destruction of the cartilage tissue, the knee MRI reveals above all the freely floating chondromes.
Depending on the degree of calcification, these can be displayed in different MRI sequences. If they are severely calcified or ossified, they can be made visible in the T1 sequence. If there is no tendency to calcify, they can become conspicuous in the T2 sequence; here, however, the difficulty is that they show up just like the synovial fluid, which makes their presentation complex. They are easier to diagnose if they are close to the bone.
Treatment / Therapy
Chondromatosis does not always require therapy. It is true that the chondromes that make the symptoms, such as pain or movement impairments, should be removed. This can be done by superficial ablation (curettage) or complete resection.
Chondromatosis should be checked regularly in order to detect possible signs of degeneration at an early stage and take action. If a specimen biopsy of the bone is performed, the access route should be chosen so that as few soft tissue compartments (muscle logs) as possible are punctured, since all these parts must be resected (removed) if the biopsied structure presents as malignant. This must then be done prophylactically to prevent the tumour from spreading.
In synovial chondromatosis, arthroscopy (knee arthroscopy) of the affected joints can be helpful. The condition of the joint can be well examined with arthroscopy. At the same time, the free cartilage parts that are located in the joint cavity can be removed, thus reducing the symptoms.
Damaged cartilage tissue can also be removed. The restoration of cartilage is a large field of research, but not yet completely possible. A final intervention would be synovialectomy. This involves the surgical removal of the entire inner joint membrane (membrana synovialis). This can reduce the progression of arthrosis.
Forecast
Depending on the cause, the prognosis can vary greatly. In general, there is a risk of pathological fractures of the bones at the chondromes. Depending on the cause of the occurrence of chondromatosis, degeneration of the chondromas must be considered.
Particularly in Maffucci-Kast syndrome, between 30 and 40 percent of the chondromes tend to degenerate into chondrosarcomas. In Ollier syndrome the degeneration rate is about 30%. In synovial chondromatosis, on the other hand, the prognosis is very good – here degenerative tendencies are evident in 5% of affected patients. Here, however, wear-related arthrosis occurs more frequently.
