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Background: Pigmented villonodular synovitis (PVNS) is a rare, aggressive and benign disorder of the joint synovium, bursae and tendon sheaths. Osseous erosions and subchondral cysts may develop as the result of synovium infiltration in diffused type PVNS. We present a retrospective study of a series of patients who were diagnosed with PVNS about the ankle joint, there clinical outcome was evaluated in this study. Material and Method: 15 patients with radiographically and histologically confirmed diffused type PVNS about the ankle joint are identified in our foot and ankle department. MRI scans are used for evaluation of the tumor and bony erosions pre and post operatively. Patients were managed with total synovectomy for the tumor tissue and bone grafting for bony erosions. Ankle function was assessed using the American Orthopedic Foot and Ankle Society –Ankle and Hindfoot (AOFAS-AH) score and the Muscularskeletal Tumour Society (MSTS) score before and after surgery. Results: The mean follow-up duration was 37.4 months (range 25 to 50 months). There were 6 males and 9 females, with a mean age of 35 years old (range 18 to 65 years). All patients had talar erosion with the average size of 10.1*9.1*8.2mm, distal tibia was affected in 5 patients with the average size of 6.2*5.6*5.8mm. 7 patients had tendon involvement, 3 patients had recurrence and underwent ankle fusion eventually. At the time of last follow-up, the mean AOFAS-AH score increased from 52 to 83 points (p<0.05), the MSTS score increased from 27 to 73 points (p<0.05). Conclusion: For diffused type PVNS with large bony erosions, total synovectomy together with bone grafting seems to be a safe and effective operation for salvage. Fusion is recommended for failed and aggressive erosions of the ankle joint.