Intra-articular osteoid osteoma of the lateral tibial plateau treated with arthroscopically assisted removal and retrograde osteochondral grafting

Arthroscopic treatment of osteoid osteoma in the posterior proximal tibia: A case report and literature review

BACKGROUND

Osteoid osteoma (OO) is a benign lesion characterized by an increased fibrous component in the bone marrow, presence of bone-like structures within the medullary cavity, and a surrounding sclerotic bone rim. Reports on OO located in the posterior proximal tibia are rare.

CASE SUMMARY

Herein, we report the case of an 18-year-old male, admitted for the evaluation of right knee pain. The right knee pain had started 6 months prior without any apparent cause, which was notably severe at night, affecting sleep, and was exacerbated while climbing stairs or bearing weight. The patient also experienced pain on flexion. Three-dimensional computed tomography and magnetic resonance imaging revealed a nodular lesion beneath the cortical bone of the posterior medial plateau of the right tibia and an abnormal signal focus on the posterior lateral aspect of the right tibial plateau associated with extensive bone marrow edema. A small amount of fluid was present in the right knee joint capsule. The patient subsequently underwent arthroscopic excision of the OO. Postoperatively, there was significant relief of pain, and the knee range of motion returned to normal.

CONCLUSION

Although OO in the posterior proximal tibia is a rare occurrence, it can be effectively excised through minimally invasive arthroscopic visualization.

Arthroscopic removal as an effective treatment option for intra-articular osteoid osteoma of the knee

BACKGROUND

Intra-articular osteoid osteoma (iaOO) can be found in 5.2% up to 10% of cases. They may cause non-specific symptoms, mimicking degenerative or traumatic pathologies. If iaOO is left untreated, it may lead to severe muscle atrophy, tenderness, swelling, and limited range of motion. Therefore, surgical treatment is recommended. The main goal of surgical treatment is complete removal or destruction of iaOO.

AIM

To evaluate the efficiency of arthroscopic removal of iaOO of the knee in our cases and cases available in the literature.

METHODS

Analysis of available hospital records of four patients with iaOO of the knee treated by arthroscopic removal from August 2005 to December 2015 at our Department was performed. All patients had a diagnosis of iaOO confirmed by histopathologic analysis. Additional literature review of cases of iaOO of the knee available on PubMed and Google Scholar was made. All cases of iaOO of the knee treated by arthroscopic or arthroscopically assisted removal were reviewed in order to further evaluate the efficiency of the method.

RESULTS

The average age of patients included in our study was 23.2 (range 16-37) years. The average duration of the symptoms prior to surgery was 14.2 (range 6-24) months. All of the patients had persistent knee pain. Three patients reported worsening of pain during the night, while two reported worsening of pain during activity. Three patients reported alleviation of pain on non-steroidal anti-inflammatory drugs (NSAIDs), while one patient reported partial alleviation of pain on NSAIDs. No intraoperative complications were noted, and the postoperative period was uneventful in all patients. The patients reported immediate pain relief in the postoperative period. No recurrence of the disease was noted in any of the patients during the follow-up period of at least 24 mo. The literature review revealed 14 cases with an average age of 27.6 (range 16-48) years and onset of symptoms 27.7 (range 6-108) months prior to surgery, with recurrence of the disease noted in a single case.

CONCLUSION

Arthroscopic removal is an efficient treatment method that allows excision of iaOO that is neither insufficient nor excessive, thus avoiding disease recurrence while obtaining adequate material for histopathologic analysis.

Intra-articular Osteoid Osteoma of the Distal Femur Treated with Osteochondral Grafting: A Report of 2 Cases

CASE

Intra-articular osteoid osteoma (IAOO) is a relatively rare entity and can pose a therapeutic challenge due to proximity to the cartilage surface. We present 2 cases of subchondral osteoid osteomata within the distal femur treated with excision and osteochondral grafting of the resultant defect.

CONCLUSIONS

Subchondral IAOO can pose a therapeutic challenge. Our patients had an effective pain relief and return to activities with this treatment strategy.

Intra-Articular Osteoid Osteoma as a Cause of Anteromedial Knee Pain

A 32-year-old male patient presented to our clinic with chronic left knee pain that was ongoing for about 1.5 years. The patient visited several times our clinic and the other clinics; conservative treatment (including rest, knee brace, and ice application with NSAIDs) was recommended by various different doctors. The anamnesis, physical examination, and plain radiography were nonspecific. Early MRI findings mislead us to believe it is bone marrow edema. One and half years with noneffective treatment, the knee pain persisted. At the latest visit intra-articular osteoid osteoma was suspected and the knee MRI with CT was employed. Even though the diagnosis of intra-articular osteoid osteoma often presents a challenge for the surgeons, with a present awareness of intra-articular osteoid osteomas which lack the characteristic sclerotic lesions and nidus on plain X-rays and the aid of multislice CT, a correct diagnosis which warrants proper treatment can be achieved. The possibility of osteoid osteomas, especially in young adults with persistent knee pain with unknown reasons that show normal plain radiographs results, must not be overlooked. The treatment method of these lesions should be customized depending on the location of the lesion, experience of the surgeon, and cost of method.

Intra-articular osteoid osteoma at the femoral trochlea treated with osteochondral autograft transplantation

We present the case of an intra-articular osteoid osteoma at the femoral trochlea. Intra-articular osteoid osteoma can present a diagnostic challenge both clinically and with imaging because it presents differently from the classic cortical osteoid osteoma. Given the lesion's proximity to overlying cartilage, the patient underwent resection of the lesion with osteochondral autograft transplantation at the surgical defect. A comprehensive literature review and discussion of intra-articular osteoma will be provided.

Intra-articular osteoid osteoma in the proximal tibia and its imaging characteristics

Due to mostly non-specific clinical symptoms and variable appearance on magnetic resonance imaging (MRI), the diagnosis of an intra-articular osteoid osteoma (iaOO) is often delayed. We report the case of a 26-year-old male with an atypical clinical manifestation of an iaOO in the proximal tibia and its MRI specific characteristics of tumor progression. The patient presented to our clinic after receiving multiple unsuccessful conservative and surgical interventions due to anterior knee pain, which persisted for 12months. Prior to the correct diagnosis of iaOO manifestation, the patient was subjected to multiple steroid infiltrations and two arthroscopies including partial meniscal resection. Due to increasing complaints, meniscal transplantation, bone decompression and/or ACL reconstruction were recommended. Subsequent computer tomography (CT) scanning and successful test medication with salicylates (ASS) confirmed iaOO presentation. Only after arthroscopic tumor resection was the patient symptom free at three months of follow-up. The present description of MRI specific characteristics of iaOO progression has the potential to accelerate correct tumor detection in the future.

T2 Mapping Magnetic Resonance Imaging Encourages an Arthroscopic Approach for Osteoid Osteoma in the Acetabulum

Intra-articular osteoid osteoma (OO) is uncommon, especially in the hip joint. Delayed treatment may cause early osteoarthritis; however, diagnosis and complete excision are often challenging. We describe the feasibility of the combination of T2 mapping magnetic resonance imaging evaluation and arthroscopic excision of OO in the acetabulum. A 12-year-old boy presented with a 6-month history of hip pain. An undifferentiated tumor of the medial wall of the acetabulum was suspected on radiographs and computed tomography. T2 mapping showed joint effusion, and the T2 value of the acetabular cartilage just above the tumor was significantly high. These findings suggested OO in the acetabulum. An arthroscopic excision was performed for biopsy and excision of the tumor to avoid damage to the normal cartilage and growth plate. Histologic examination confirmed the OO. At 16 months' follow-up, there was no evidence of recurrence. This is the first report to evaluate intra-articular OO by T2 mapping and to treat it arthroscopically. Arthroscopic treatment assisted by T2 mapping has excellent potential as a minimally invasive technique to enable us to approach the tumor from the area of discriminative abnormal cartilage with minimal damage to the normal cartilage and surrounding tissue.