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Findings When comparing from 2010 to 2019, there has been marked progression in the degenerative changes of the right knee and most profoundly of the medial compartment. On the lateral radiographs in particular, there has been interval development of a partially calcified mass in the popliteal fossa. This raised concern for a partially calcified popliteal aneurysm prompting the MRI. On the MRI, there is a heterogeneous mass that abuts the popliteal artery and causes erosion of the adjacent bone. Additionally shown is particularly the advanced cartilage loss of the medial compartment.

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Diagnosis: Secondary Synovial Chondromatosis Primary synovial chondromatosis is a metaplastic process of the synovium which almost invariably involves one joint. There is a proliferation of the synovium which becomes calcified and ossified and by erosion eventually leads to loss of cartilage. This is typically stated to yield innumerable bodies to count. In degenerative joint disease, some individuals generate a marked synovial response giving prominent synovitis. As in the primary process this eventually becomes calcified and then ossified. As compared to the primary form there are often multiple bodies but they can be counted and advanced cartilage wear is identified. The primary process also would typically come to light in a younger individual than the patient in this case. At the end stage, both processes can yield areas of massive conglomeration that become calcified/ossified as in this case. As for the concern of aneurysm, it is important to identify the popliteal artery as normal and although in close proximity, distinct from this mass. Additionally, an understanding of this process allows one to exclude neoplastic processes that could arise around the knee in an adult such as soft tissue sarcoma.

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Profile for Hospital for Special Surgery

HSS What's the Diagnosis Case #131  

77-year-old man with increasing right knee pain and increasing size of mass of the popliteal region.

HSS What's the Diagnosis Case #131  

77-year-old man with increasing right knee pain and increasing size of mass of the popliteal region.