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Loose bodiesArthroscopic Removal DR{SHEKHAR SRIVASTAV Consultant- Knee & Shoulder Surgery Sant Parmanand Hospital, Delhi


Loose bodies Free loose bodies- single or multiple  Fixed loose bodies  Presentation-Intermittent catching & Pain -Recurrent effusion -Limitation of motion -Feeling of instability 


Loose Bodies Causes-Degenerative chondral/osteophytes -Osteochondral fragmenttraumatic -Meniscal fragment -Fibrosed synovial villi -Broken implants/instruments -Bone cement residue

Diagnosis - Clinical - X-rays if calcified or metal - MRI


Loose bodies Management Dignostic arthroscopy  commonly located in supra-patellar pouch, ant. Intercondylar area, poster-medial & posterolateral recess, Gutters, beneath meniscus  Reduce inflow to decrease turbulence  Percutaneously fix with needles  Make appropriate portal  Remove under vision 


Loose Bodies


Loose Body


Loose Body


Foreign body removal

28 yr old  TBW patella -3 yrs back  C/O locking & instability episodes


Foreign body removal


Foreign Body Removal


Foreign Body Removal


Foreign Body Removal


Post-op


Problem 20 yr old male  Pain, effusion, locking sensationRt. Knee  Inability to fully extend knee


Diagnostic Arthroscopy


Post Compartment


Biopsy


Loose body


Take Home Message Loose bodies in knees can present as Pain , Locking Sensation, Instability or Loss of Extension  Diagnostic Arthroscopy to look into every corner  Localise & Fix the Loose Bodies  Determine accurate portal placement with the help of a needle  Must follow loose body going out of the joint 


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Diagnosis Synovial Chondromatosis

Knee ,Shoulder ,Ankle  Male more affected than females  Metaplasia of synovial villi into cartilage  Treatmentarthroscopic removal of loose bodies,partial synovectomy 


Synovium


Synovium

Loose body arthroscopy by dr shekhar srivastav  

Loose body arthroscopy by dr shekhar srivastav http://www.delhiarthroscopy.com/index.html