Arthroscopic Excision of Intra-Articular Osteoid Osteoma at the Elbow

Abstract

Osteoid osteoma (OO) apparent in the intra-articular region of the elbow is very rare. Although computed tomography-guided excision and radiofrequency ablation have been recognized as useful treatment options, arthroscopic excision has recently received focus as an alternative strategy for lesions close to neurovascular structures or intra- and juxta-articular lesions. We herein report a 17-year-old female who underwent arthroscopic treatment for intra-articular OO located at the olecranon/coronoid fossa. Her symptoms included elbow pain that was exacerbated at night and contracture of elbow flexion-extension, and she was diagnosed with intra-articular OO after 12 months of symptomatic history. Arthroscopically, thorough synovectomy for both the anterior and posterior aspects of the joint enabled definition of the tumor margin with hyperemic alteration and excision of the lesion as an en bloc specimen. At the 12-month follow-up, the patient had no recurrence of elbow limitation or pain. This case report describes the advantages of arthroscopic treatment, including a low-invasive approach and easy accessibility to the whole intra-articular space, which can provide clear visualization of the tumorous lesion.

Intra-articular Osteoid Osteoma of the Olecranon Fossa

“…Osteoid osteoma of the elbow, in particular, has been reported to present as a monoarthritis with joint effusion, rather than the typical nocturnal pain responsive to NSAIDs [11,12]. Unsurprisingly, literature on this topic has described confusion of this entity with a variety of diagnoses such as lateral epicondylitis, osteochondral defect, hemophilic arthropathy, infection, and trauma [2][3][4][5]8,13].…”

“…Osteoid osteomas occur within the femur or tibia in 50% of cases, usually at the metaphyseal-diaphyseal junction [ 2 , 4 ]. However, presentation in nearly every bone has been reported [ 7 ].…”

“…The tumor classically presents with an insidious onset of pain that is worse at night and relieved by non-steroidal anti-inflammatory medications (NSAIDs). The postulated mechanism by which this lesion causes pain is due to vasodilation-related stimulation of unmyelinated nerve endings within the nidus secondary to significant lesional prostaglandin synthesis [ 3 , 4 ]. This increased prostaglandin production also explains the sensitivity of this lesion to NSAIDs [ 5 ].…”

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

“…Intra-articular radiofrequency ablation can cause osteonecrosis or cartilage damage [ 3 , 8 ], while open surgery is associated with longer post-operative morbidity. Recently, various authors have reported arthroscopic excision of the lesion as a less invasive approach [ 12 ]. The direct magnified vision under arthroscope, the option to perform further maneuverers such as synovial biopsy/debridement and capsular releases to improve ROM are additional advantages.…”

Arthroscopic Excision for Intra-Articular Osteoid Osteoma of the Olecranon Fossa: A Case Report and Literature Review

“…The advantage of arthroscopy is reduced postoperative pain related to minimal incisions, fewer wound problems, wider intraoperative vision, a less invasive surgery, and earlier return to full activity levels [13]. To the best of our knowledge, 19 cases in 1 case series and 8 case reports describe arthroscopic resection for OO in the elbow [8,[19][20][21][22][23][24][25][26]. Six patients with OO in the olecranon fossa are among these cases.…”