Most recent 2014 recommendation regarding PVNS from JAAOS journal
Management of diffuse PVNS with an open versus arthroscopic approach remains a topic of debate, but the current standard of care is complete arthroscopic synovectomy.
For diffuse disease, an open or combined open/arthroscopic synovectomy is often required, especially for posterior knee lesions and hip lesions. For diffuse disease limited to the anterior knee, an arthroscopic synovectomy may suffice. These procedures are meticulous and can be lengthy and technically challenging.
Recurrence of PVNS is common.
Radiation therapy via external beam or local injection of radioactive substances (isotopic synoviorthresis) can be effective when repeat synovectomy has failed.
Synoviorthesis involves local injection of chemicals or radioactive substances and is often used as an adjuvant treatment 2 to 3 months after synovectomy.22 Some experts recommend adjuvant isotopic synoviorthresis after synovectomy to decrease recurrence rates; however, further studies are needed to establish this as the standard of care.
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