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

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

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.