Systematic Arthroscopic Treatment of Diffuse Pigmented Villonodular Synovitis in the Knee

Pigmented villonodular synovitis (PVNS) is a benign aggressive disease that presents in either a localized (LPVNS) or diffuse (DPVNS) form. Arthroscopic synovectomy is the standard operative treatment for LPVNS, and when used to treat DPVNS, it is usually combined with an open posterior procedure. The purpose of this Technical Note is to report the technique that we have refined to allow for arthroscopic synovectomy as the sole treatment for DPVNS. We describe our technique with the factors we have found to be important to ensure adequate arthroscopic synovectomy, while minimizing risks and complications. The combination of additional portals, the use of multiple different shavers and arthroscopes, and the use of a leg holder all maximize our ability to clear disease.