Intra-articular osteoid osteoma as a differential diagnosis of diffuse mono-articular joint pain

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.

Intraoperative Identification and Mosaicplasty in a Case of Femur Subchondral Osteoid Osteoma

Osteoid osteomas (OOs) are non-malignant primary bone abnormalities marked by a central nidus surrounded by reactive sclerosis. They typically manifest as aggravated nocturnal pain that responds to non-steroidal anti-inflammatory drugs (NSAIDs). These growths are most frequently found within the intracortical bone and the diaphysis of elongated bones. Within the realm of uncommon conditions, intra-articular OOs (IAOOs) exhibit distinctive presentations, often leading to postponed or inaccurate diagnoses. We present a patient with OO at the distal femur, accessible through the knee joint, which was intraoperatively identified and localized using a needle pricking technique and treated by arthrotomy and mosaicplasty.

Intra-articular Osteoid Osteoma of the Intermediate Cuneiform Bone Causing Articular Degeneration: A Rare Case and Literature Review

Osteoid osteoma of the cuneiform bone is an exceedingly rare and easily missed cause of foot pain. The uncharacteristic and nonspecific radiographs of such intra-articular osteoid osteoma further increase difficulty in making the diagnosis. To date, there has been no description of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration in any published literatures. We present a case of intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration, who underwent curettage, allograft bone graft, and navicular-cuneiform arthrodesis. The patient presented with radiographic bone union, full motor function recovery and pain-free at the 22-month follow-up. This report adds to the existing literature. Intra-articular osteoid osteoma of the intermediate cuneiform bone causing articular degeneration is an exceedingly rare and easily missed cause of foot pain. It proves a complicated and challenging task to identify intra-articular osteoid osteoma. Clinicians should be particularly careful not to exclude the possibility of arthritis and, thus, vigilant when choosing the surgical option.

The Diagnostic Challenge of Osteoid Osteoma in the Bones of the Hand—A Case Series

Osteoid osteoma (OO) is a benign bone tumor that rarely occurs in the bones of the hand. Due to the comparatively non-specific symptoms when occurring in the hand, OO is often misdiagnosed at first presentation, posing a diagnostic challenge. In the present case study, six cases of phalangeal and carpal OO, treated surgically at our department between 2006 and 2020, were retrospectively reviewed. We compared all cases regarding demographic data, clinical presentation, imaging findings, time to diagnosis, surgical treatment, and clinical outcome in follow-up examinations. When OO occurs in the bones of the hand, it can lead to swelling and deformities, such as enlargement of the affected bone and nail hypertrophy. Initial misdiagnoses such as primary bone tumors other than OO, tendinitis, osteomyelitis, or arthritis are common. Most of the presented cases showed a prolonged time until diagnosis, whereby the primarily performed imaging modality was often not sensitive. CT proved to be the most sensitive sectional imaging modality for diagnosing OO. With adequate surgical treatment, complications and recurrence are rare.

Osteoid osteoma in the bones of the hand: a systematic literature review

INTRODUCTION

Osteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones.

MATERIALS AND METHODS

We performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options.

RESULTS

We included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection.

CONCLUSIONS

Osteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity.

Bir çocukta ön diz ağrısının nadir bir nedeni: Patellar Osteoid Osteoma ve literatürün gözden geçirilmesi

Giriş: Osteoid Osteoma (OO) belirgin bir nidus ve onu çevreleyen sklerotik reaktif zon ile karakterize küçük selim bir kemik tümörüdür. Genellikle uzun kemiklerde yerleşmekle birlikte nadiren patellada da görülebilmektedir.Vaka Sunumu: Sekiz yaşında kız çocuğu ön diz ağrısı şikayetiyle polikliniğimize başvurdu. Hastanın ağrı şikayetleri yaklaşık bir yıldır mevcuttu. Hastada Patellar Osteoid Osteoma tespit edildi. Lezyon kürete edildi ve cerrahi sonrası ilk gün hastanın ağrıları tamamen geçti.Sonuç: Her ne kadar Patellar OO nadir gözükse de çocuk ve genç erişkinlerdeki uzun süreli diz ağrısının ayırıcı tanısında düşünülmesi gerekir.Anahtar Kelimeler: Osteoid Osteoma, patella, diz ağrısı, küretaj, gecikmiş tanı, kemik neoplazmı

Intra-articular osteoid osteoma of the capitulum: A diagnostic challenge

Here, we describe the first case of intra-articular osteoid osteoma of the capitulum, which is presented as elbow pain, extension lack, and sensation of click in joint flexion. Surgical treatment either arthroscopic or open is more in use in this location of the tumor than cortical osteoid osteoma.

Intra-articular osteoid osteoma at the elbow mimicking arthritis: a case report

Osteoid osteomas are benign, typically intracortical lesions most often affecting the diaphysis of long bones. Nocturnal pain and characteristic symptoms that are relieved by administration of non-steroidal anti-inflammatory drugs (NSAIDs) are present and can help in the diagnosis of osteoid osteoma. We report a case of 18-year-old boy with an osteoid osteoma in the olecranon fossa with an atypical clinical manifestation. The initial manifestation was arthritis-like symptoms such as local heat, motion pain rather than pain at rest, and limited range-of-motion. Notably, NSAIDs were not effective at all for relieving his symptoms. Magnetic resonance imaging showed bone marrow edema around the elbow joint. The symptoms were resistant to conservative treatments, and thus, surgical resection was required. Histopathological examination showed that the lesion consisted of woven bones and osteoid tissues that anastomosed with each other. Combined with a tumor size that was less than 2 cm, clinicopathologically, the tumor was diagnosed as an osteoid osteoma. The pain was immediately relieved after the operation, and range-of-motion recovered at 2 months postoperatively. At 1 year after the surgery, the patient did not exhibit recurrence of the tumor or exacerbation of elbow pain and had a full range of elbow motion. Osteoid osteoma should be considered for the differential diagnosis of arthritis of the elbow in patients who are adolescents and young adults, which is the peak age of onset for osteoid osteoma.

Comparison of arthroscopy versus percutaneous radiofrequency thermal ablation for the management of intra- and juxta-articular elbow osteoid osteoma: case series and a literature review

BACKGROUND

Today, intra-articular and juxta-articular osteoid osteomas are treated with arthroscopy and radiofrequency thermal ablation. However, for the case of an elbow joint, arguments are made for the use of a minimally invasive technique to be the optimal choice. This study aims to analyse our experiences of arthroscopically treated elbow osteoid osteomas and to compare it with the published results of both techniques.

METHODS

The retrospective study analyses the patients who underwent elbow arthroscopy ablation of an elbow osteoid osteoma at a single institution from January 2014 until March 2020. Clinical and diagnostic features, success and treatment failure rates, complications and tumour recurrence rates were all compared to 13 studies of intra-articular elbow osteoid osteoma arthroscopic ablation and 15 studies involving radiofrequency thermal ablation of intra-articular osteoid osteoma within different joints.

RESULTS

Four males and two females, with a mean age of 19.3 years, were encompassed. All the patients had immediate postoperative pain relief and improved range of motion. No tumour recurrences were observed during a median of 21.7 months. The literature review yielded 86.4% success rate, 68.2% successful biopsies, one minor complication and no recurrences following the arthroscopic ablation of an elbow osteoid osteoma; while radiofrequency thermal ablation of an intra-articular elbow osteoid osteoma yielded 96.3% success rate, 33.3% successful biopsies, no complications and 3.7% recurrence rate.

CONCLUSIONS

Our results are consistent with the published literature proving that arthroscopic ablation is an efficient method with low treatment failure rates and no recurrences in treating intra- and juxta-articular elbow osteoid osteomas. Advantages of arthroscopic ablation stem from the ability to visualise and safely deal with the lesion and the joint's reactive changes resulting in high biopsy rates, no recurrences and better postoperative elbow's range of motion. Still, the technique selection should be personalised considering the medical expertise of every institution.

[Surgical treatment of a symptomatic intra-articular osteoid osteoma (IAOO)]

Intraartikuläre Osteoidosteome (IAOO) sind mit 10 % aller Osteoidosteome selten. Die atypischen klinischen und radiologischen Befunde führen meist zu einem langen Intervall zwischen Beschwerdebeginn und Diagnosestellung sowie Einleitung einer adäquaten Therapie. Dieser Fallbericht handelt von einer 32-jährigen Patientin, die seit Jahren intermittierende Kniegelenksschmerzen bei tiefer Beugung und selten nachts angibt. Bei IAOO in der Trochlea femoris war eine Radiofrequenzablation (RFA) aufgrund der direkt subchondralen Lage kontraindiziert. Daher erfolgte eine operative Sanierung mittels Knorpel-Knochen-Transplantation.

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.

A Rare Case of Intra-Articluar Osteoid Osteoma of the Elbow Managed With Arthroscopic Excision

Osteoid osteoma (OO) of the elbow is a very rare entity as it typically occurrs in the lower extremity of extra-articular long bones. Hereby, we report a case for a 28-year-old female patient has been diagnosed with a unique presentation of sub-periosteal osteoid osteoma in the intra-articular portion of distal humerus. She underwent arthroscopic excision for the lesion which is considered a reliable minimally invasive management modality. In addition to this, findings of a 1-year follow-up after excision is reported.

[Difficulties in diagnosing an osteoid osteoma of the big toe : A case report with review of the literature]

BACKGROUND

Osteoid osteomas belong to the benign osseous neoplasia and can occur on the entire skeleton. The prolonged diagnosis of an osteoid osteoma of the great toe prompted us to prepare a case report with a literature review to identify possible sources of error and to contribute to a more expeditious diagnosis and therapy.

LITERATURE

Currently, only two case reports on osteoid osteomas of the toes are known in the German literature. Internationally, however, a large number of cases have been described, which, when viewed as a whole, present a homogeneous picture. A very clear accumulation of osteoid osteomas at the distal phalanx of the great toe suggests a possible post-traumatic aetiology. The typical NSAID-sensitive night pain is clinically unambiguous and should make one think of an osteoid osteoma at any site on the body. The symptom of macrodactyly, which is unique to the toes, is striking and may provide a helpful clue to establishing the diagnosis. The median time from symptom onset to correct diagnosis was 12 months. One possible reason for this prolonged diagnosis is the often atypical and ambiguous imaging. Surgical therapy is the method of choice for osteoid osteomas of the toes and should always be supplemented by histopathologic examination.

Arthroscopic Excision of an Intra-articular Osteoid Osteoma in the Trochlear Notch of Ulna - A Case Report

Introduction:

Osteoid osteoma (OO) is a benign osteoblastic skeletal lesion commonly affecting the diaphysis of long bones. Intra-articular lesions, which present with atypical symptoms, are uncommon and elbow joint involvement is only rarely reported. Conservative treatment is ineffective and surgical excision or ablation is the therapeutic goal in symptomatic patients. Minimally invasive surgery is gaining popularity as a less morbid alternative in joints as opposed to open surgical excision. Herein, we report the first arthroscopic excision of an intra-articular OO involving the trochlear notch of ulna.

Case Report:

A 30-year-old man presented with chronic pain and stiffness of his dominant right elbow limiting his routine activities despite treatment with analgesics. Right elbow joint showed features of moderate effusion and X-ray was normal. Computed tomography revealed an OO in the trochlear notch of ulna breaching the cortex. He underwent arthroscopic en bloc excision of the lesion followed by decompression of the surrounding sclerotic bone and radiofrequency ablation of the base. At 6th month follow-up, the patient was asymptomatic with full range of motion at elbow.

Conclusion:

Periarticular OO is a debilitating illness with atypical clinical and radiological features with no response to medical treatment. Although curative, open surgical excision often adds to the morbidity in the postoperative period. Growing experience in elbow arthroscopy has made minimally invasive surgery a safe low morbid alternative procedure. However, a precise knowledge of the instrumentation and anatomy is essential to avoid incomplete excision and recurrence with arthroscopic approach.

Polyostotic osteoid osteoma: A case report

Osteoid osteomas are common, benign osteoblastic tumors that can occur in any bone in the body. They are almost always solitary, with only rare reports of multiple tumors in the same patient. When multiple, they typically are found within the same bone. We present a unique case of a young female athlete who presented initially at 16 years old with a right tibial osteoid osteoma and later at 18 years old with a right acetabular osteoid osteoma. Our case demonstrates the rare entity of polyostotic osteoid osteoma, the potential limitations of MRI in the diagnosis of osteoid osteoma, and the utility of radiofrequency ablation in the treatment of osteoid osteoma.

A Rare Cause of Anterior Knee Pain in a Young Athlete and a Delayed Diagnosis: Osteoid Osteoma of the Patella

Intra-articular osteoid osteomas are a rare cause of articular pain. Their diagnosis can be challenging due to their non-specific clinical presentation and imaging characteristics. We present the case of a young soccer player with a 12-month history of anterior knee pain that was first attributed to Sinding Larsen Johansson syndrome and then to Hoffa’s syndrome. A CT scan was performed that revealed the localization of an osteoid osteoma of the patella. The patient was successfully treated by percutaneous radiofrequency ablation under CT guidance without complications and returned to full sports activity. Although a rare entity, osteoid osteoma of the patella with its atypical clinical features could be included in the differential diagnosis of persistent anterior knee pain in the young adult. High clinical suspicion is necessary to avoid delay in diagnosis and irrelevant procedures for the patient.

Intra-articular osteoid osteoma accompanied by extensive bone marrow edema. A clinical and micro-morphological analysis

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A series of patients with intra-articular osteoid osteoma (OO) is demonstrated.

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Extensive and persistent bone marrow edema syndrome masked the correct diagnosis.

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No consistent patterns of impaired bone mineral status could be confirmed in these patients.

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Nidus specimens displayed significantly higher mineralization heterogeneity determined by qBEI.

Osteoid osteoma (OO) is a benign bone tumor producing non-mineralized bone matrix (i.e., osteoid). While peritumoral edema is commonly found in OO, extensive bone marrow edema has been reported less frequently. Furthermore, the micro-morphological characteristics of the nidus and its central calcification remain unclear. In this study, a consecutive series of four patients suffering from extensive bone marrow edema triggered by intra-articular osteoid osteoma underwent clinical examination, magnetic resonance imaging (MRI) and computed tomography (CT) as well as dual-energy X-ray absorptiometry (DXA) and laboratory bone turnover analyses. The obtained resection specimens were processed by undecalcified histology and were subsequently analyzed by light microscopy and quantitative backscattered electron imaging (qBEI). We report an entity of intra-articular osteoid osteoma in the knee and foot, in which an extensive and persistent bone marrow edema syndrome masked the correct diagnosis. While metabolic bone diseases were excluded in all cases, the reassessment of the patients’ clinical history including pain characteristics (nocturnal, aspirin sensitivity) led us to perform additional CT, where the tumor was diagnosed. The micro-morphological analysis of the OO biopsies revealed that the nidus was surrounded by hyperosteoidosis, while central mineralization was detected in all cases. This mineralized area showed a significantly higher mineralization heterogeneity than the surrounding trabecular bone and more disorganized collagen fibers detected by qBEI and polarized light microscopy, respectively. Taken together, our results indicate that osteoid osteoma should be considered when persistent and extensive, peri-articular bone marrow edema is diagnosed. The central calcification that is found inside the nidus in conventional imaging was mirrored by bone matrix with a heterogeneous mineralization pattern.

Intra-articular osteoid osteoma of tempromandibular joint: A case report

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Osteoid osteoma is a benign bone neoplasm, with significant nocturnal pain that responds to NSAIDs.

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A case of an intra-articular osteoid osteoma involving the articular eminence and glenoid fossa of TMJ in a 46-years-old female is reported.

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CT scan imaging is helpful in displaying the typical radiographic features and localization of the lesion.

Introduction

An osteoid osteoma is a benign bone neoplasm with limited growth potential, characterized by significant nocturnal pain that usually responds to non-steroidal anti-inflammatory drugs (NSAIDs). The tumor may occur in any part of the skeleton, most commonly in the lower extremities and vertebrae.

Presentation of case

A 46-year-old female was diagnosed with a rare case of an intra-articular variant of osteoid osteoma, involving the articular eminence and glenoid fossa of the temporo-mandibular joint (TMJ).

Discussion

The tumor presented as a painful progressive swelling in the right pre-auricular area that had lasted for more than 2 years and which had been previously treated as a TMJ disorder. Computed tomography revealed a well-defined heterogeneous nidus involving the articular eminence of the TMJ. Surgical excision was performed and histological examination confirmed the diagnosis. In this article, in addition to describing the case, all cases of osteoid osteoma of the jaws and TMJ reported in the English-language literature are reviewed.

Conclusion

Osteoid osteoma involving the TMJ is a rare presentation and may exhibit ambiguous symptoms, which could lead to misdiagnosis and delayed treatment.

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.

Arthroscopic excision of intra-articular sub-periosteal osteoid osteoma of elbow: a case report

We are presenting a unique case of a sub-periosteal osteoid osteoma involving coronoid fossa in a 25-year-old male. He was symptomatic for 2 years and his presentation mimicked mono-articular inflammatory arthritis. His plain radiographs were normal and the computed tomogram confirmed features of a sub-periosteal osteoid osteoma. He was treated with arthroscopic excision of the lesion. Pain relief was noticed immediately after the surgery and maintained at latest follow up of 1 year.

Trigeminal Neuralgia Secondary to Osteoid Osteoma of the Petrous Bone: Report of 4 Cases and Brief Review of Literature

OBJECTIVE

To retrospectively analyze clinical data of 4 patients with trigeminal neuralgia (TN) secondary to osteoid osteoma (OO) of the petrous bone and discuss treatment for this rare disease.

METHODS

Between January 2008 and December 2016, 4 patients in whom TN secondary to petrous bone OO was diagnosed received surgical treatment in Xuan Wu Hospital of Capital Medical University. We summarized the characteristics and treatments of this rare disease through retrospective review of the clinical information, imaging features, surgical details, and follow-up outcomes of the 4 patients.

RESULTS

Among the 4 patients, 2 were men; mean age was 39.3 ± 12.3 years (range, 26-52 years). All patients presented with symptoms of typical TN. Preoperative bone window computed tomography scan of the brain showed a regular bony lesion located at the petrous bone, contacting the trigeminal nerve. All patients experienced total relief of symptoms after surgical resection of the lesion by retrosigmoid sinus approach. During a mean follow-up of 14.2 months (range, 7-23 months), no preoperative symptoms recurred.

CONCLUSIONS

TN secondary to petrous bone OO is extremely uncommon. Surgical decompression is an effective treatment for patients with petrous bone OO and associated TN.

Persistent wrist monarthritis: down to the bone

A minority of osteoid osteomas are found to be juxta-articular and within the small bones of the wrist. We present a 30-year-old man diagnosed with an osteoid osteoma of the lunate bone, presenting with 3 years of left wrist pain, swelling and reduced range of motion. Given the patient’s background and laboratory testing, consideration was given to both inflammatory and infectious causes and the diagnosis was delayed, requiring repeat interval imaging and assisted by multiple imaging modalities. Management by surgical excision led to resolution of pain and swelling. In cases of a prolonged isolated monarthritis, juxta-articular osteoid osteoma should be considered in the differential.

Unusual cause of the thumb basal joint pain: osteoid osteoma of the trapezium

The trapezium is rare site of osteoid osteoma development. The diagnostic challenge lies in its rare occurrence, and requires differentiation from various disease entities causing thumb basal joint pain. We report the case of a 29-year-old male who presented with severe thumb basal joint pain. He was initially treated for calcific periarthritis because of concomitant calcifications around the thumb basal joint, but had undiscovered osteoid osteoma. A high index of suspicion to a patient with wrist pain unresponsive to prior treatment is necessary for diagnosis of osteoid osteoma.