Primary synovial chondromatosis (SC) and pigmented villonodular synovitis (PVNS) are elusive diseases of synovial membrane often presenting diagnostic and treatment challenges. As incidence is low, data is scarce. Early diagnosis has permitted timely interventions, leading to improved treatment outcomes and reduced secondary changes. The comparative efficacy of arthroscopic versus open synovectomy is discussed, with special emphasis on recurrence rates, functional outcomes, and potential complications. While the arthroscopic approach shows promise, understanding the full spectrum of benefits and limitations in the context of these synovial diseases remains crucial. This review offers insight into the advancements and considerations of available treatments and adjuvant therapies.