BONE AND CARTILAGE DEBRIS IN THE SYNOVIAL MEMBRANE: Its Significance in the Early Diagnosis of Neuro-Arthropathy


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Abstract

The observation of bone and cartilage debris ground into the synovial membrane appears to have diagnostic value in the early evolutionary stages of neuro-arthropathy in cases wherein the clinical and roentgenographic features are equivocal, being still those of an osteo-arthritis. This feature served as the basis for the diagnosis by the pathologist of neuro-arthropathy in its earlier stage of evolution in five patients, three of whom presented no other evidence of such a lesion; in the other two cases, the clinical and roentgenographic evidence was equivocal. It has been a constant finding in the pathological material from all patients with neuropathic joints. Furthermore, the amount of bone and cartilage detritus appeared proportionate to the degree of disruption of the remaining components of the affected joint, and to the stage of evolution of the neuro-arthropathy and of its underlying neurological disease. However, since, in a control group of thirty cases with operable lesions of the knee joint, it was also found in the material from two cases of advanced degenerative arthritis of the knee joint without a neurogenic basis, one must conclude that the observation of imbedded debris, while highly suggestive, is not altogether specific to the neuro-arthropathies.The pathogenesis appears to be based on the formation of debris through the erosion of articular cartilage and subchondral bone, which has become ground into the articular soft tissues by continued weight-bearing on a joint less sensitive than a normal joint.

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