Pigmented villonodular synovitis of the shoulder associated with massive rotator cuff tear treated by arthroscopic synovectomy and debridement

Pigmented villonodular synovitis (PVNS) is a rare condition. Our purpose is to describe the largest series of patients with shoulder PVNS, massive irreparable rota- tor cuff tear, and glenohumeral osteoarthritis treated with arthroscopic debridement and synovectomy. Methods We treated 9 patients with PVNS of the shoulder, irreparable rotator cuff tear, and slight glenohumeral arthropathy (group I). Patients underwent arthroscopic syn- ovectomy and debridement. Results [constant score (CS) and subjective shoulder value (SSV)] were compared to those obtained from a control group (group II) of 20 consecutive patients undergoing arthroscopic debridement for irrepara- ble cuff tear associated with hemorrhagic synovitis with no or slight glenohumeral arthropathy. Histologic examination was obtained in all cases to obtain the correct diagnosis. Results The preoperative shoulder function in group I was reduced with respect to group II. Upon follow-up, CS and SSV were lower in group I. Preoperatively, the dif- ferences relating to the CS value and to each item of the S. Gumina (&) S. Carbone G. Giannicola Department of Orthopaedic and Traumatology, University of Rome Sapienza, Rome, Italy e-mail: stefcarbone@yahoo.it V. Campagna Department of Orthopaedic and Traumatology, Policlinico Militare Celio, Rome, Italy A. Castagna Department of Orthopaedic and Traumatology, Istututo Clinico Humanitas, Milan, Italy C. D. Rocca Department of Medical-Surgical Science and Biotechnologies, University of Rome ‘‘Sapienza’’, Rome, Italy score were always statistically significant; instead, at fol- low-up, significant differences emerged in the CS, ADL, and ROM. At follow-up, significant differences emerged between CS of group I and of group II without glenohu- meral arthropathy. Differences using the SSV were always statistically significant. Conclusions The poor functional outcome of patients affected by PVNS can be attributed to the coexistence of the irreparable cuff tear and to the glenohumeral arthropathy. All patients with PVNS had shoulder osteoarthritis; it cannot be simply attributed to natural history of massive irreparable cuff tears, but to the pigmented villonodular synovitis.