Massive ankle synovial chondromatosis with 81 loose bodies: A case report of arthroscopic management via controlled portal enlargement and suction-assisted clearance

Abstract

Synovial chondromatosis (SC) of the ankle is a rare, benign monoarticular arthropathy characterized by synovial osteochondral
metaplasia. Although arthroscopic removal is the standard of care, a massive loose body burden poses significant technical challenges, often forcing conversion to open arthrotomy. We present a 49-year-old male with chronic ankle pain and severe motion restriction due to extensive SC, failing conservative management. To maintain a minimally invasive approach, we utilized a controlled anteromedial portal enlargement to extract massive fragments (up to 15 mm) intact, simultaneous arthroscopic capsular and adhesion release, and final systematic wide-bore suction-assisted joint clearance. A total of 81 loose bodies were extracted. At the 1 year follow-up, the patient achieved substantial pain relief and significant functional improvement without clinical evidence of recurrence. Controlled portal modification combined with suction clearance safely expands the boundaries of arthroscopic management in high-burden SC. Level of Evidence V; Case Report.