Lipoma arborescens is a rare intra-articular lesion consisting of a vi
llous lipomatous proliferation of the synovial lining. This case repor
t draws attention to the history, physical findings, and arthroscopic
appearance of lipoma arborescens, a rare lesion of the synovial lining
of the knee. Arthroscopically, the lesion appears as a synovial lesio
n with numerous fatty-appearing globules and villous projections. In a
ddition, magnetic resonance imaging is a valuable tool to differentiat
e the lesion from rheumatoid arthritis, pigmented villonodular synovit
is, and synovial chondromatosis in those patients who present with a c
hronic, swollen, and painful joint.