The Orthobullets Podcast

Foundations | Pathology | Pigmented Villonodular Synovitis

Nov 3, 2025
Dive into the fascinating world of pigmented villonodular synovitis (PVNS)! Discover its aggressive nature and the intricacies of its clinical presentation, including common symptoms and exam findings. Learn about the molecular mechanisms behind PVNS and the diagnostic tools, such as MRI features. Explore various treatment options, from nonoperative strategies to surgical solutions, and understand the distinctions between localized and diffuse forms. Join real-life case discussions that illuminate key diagnostic and management decisions!
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INSIGHT

PVNS Is A Locally Aggressive Synovial Neoplasm

  • Pigmented villonodular synovitis (PVNS) is a locally aggressive neoplastic synovial disease causing synovial expansion and bony erosions.
  • It commonly presents with joint effusion and recurrent atraumatic hemarthrosis in adults aged 30–40.
INSIGHT

Localized Versus Diffuse Patterns And Cause

  • PVNS can be localized (often anterior knee) or diffuse with extra-articular extension.
  • The disease is driven by CSF1 overexpression causing focal synovial hyperplasia.
INSIGHT

Clinical Presentation And Classic MRI Finding

  • Recurrent atraumatic hemarthrosis with pain, stiffness, and swelling is the hallmark presentation.
  • MRI shows synovial expansion with low signal on both T1 and T2 due to hemosiderin deposits.
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