Arthroscopic Visualization and Assisted Excision of Osteoid Osteoma at the Knee

Abstract

In describing 5 cases of benign osteoblastic tumors composed of osteoid and atypical woven bone, Jaffe 17 in 1935 introduced the term osteoid osteoma, although it had been previously described by Bergstrand 4 in 1930. Since then, this small (less than 1.5 cm), painful tumor has been reported in more than 1200 cases 19 and makes up approximately 10% of all benign bone tumors. 1,23 With a peak incidence in the first 3 decades of life, this tumor occurs approximately 3 times more commonly in males, 2,18 half of the time in the femur and tibia 11 and 13% of the time within a joint, with the most common site being the hip. 18,20 The typical patient with osteoid osteoma will have pain at night that is responsive to salicylates. In a young patient, this history, supplemented by classic imaging findings, tends to make the diagnosis of osteoid osteoma straightforward. However, if the tumor has intra-articular involvement, the diagnosis can become much more difficult, as an atypical picture may unfold both clinically and radiologically. 9,14,15,22 Clinically, the presence of joint effusions, synovitis, range of motion limitations, weakness, flexion deformity, atrophy, or contractures may exist. Radiologically, there may be a lack of characteristic osteoid osteoma imaging findings. 14,32 Although intra-articular involvement of osteoid osteomas have been described since 1935, there have only been 2 reported cases of osteoid osteomas within the synovial cavity of the knee. 6,16 From these reports, 1 was removed arthroscopically. In this article, we present the first published arthroscopic images of an osteoid osteoma at the knee joint and review the relevant literature.

Arthroscopic Excision of an Intraarticular Osteoid Osteoma in the Distal Femur

“…Clinically, they may resemble traumatic or degenerative pathologies 367). Intraarticular osteoid osteomas of the knee are commonly misdiagnosed as primary synovitis, medial plica hypertrophy, a meniscal tear, or patellofemoral syndrome and are mistreated accordingly 2). In our patient, the initial diagnosis, that is, a bone bruise of the lateral femoral condyle, was erroneous, and resultantly, a proper treatment was delayed for 1 year.…”

“…Osteoid osteomas typically consist of a small yellowish to red pea nidus of osteoid and woven bone with interconnected trabeculae in the background and rim composed of highly vascularized fibrous connective tissue 123). Sclerotic bone reaction may occur to variable degrees around the lesion.…”

“…Sclerotic bone reaction may occur to variable degrees around the lesion. Most osteoid osteomas arise in the cortices of long bones usually in the diaphyseal or metadiaphyseal location12) and occur less frequently in the cancellous region and least frequently in the subperiosteal region 2). Intraarticular osteoid osteomas are rare.…”

“…Intraarticular osteoid osteomas are rare. They may cause atypical joint pain and elude timely diagnosis 2345). Clinically, they may resemble traumatic or degenerative pathologies 367).…”

“…It is usually located in the metadiaphysis of long bones 1234). However, if the tumor exhibits intraarticular involvement, the diagnosis can be more difficult and atypical clinical and radiologic features may lead to a delayed diagnosis 23567). The treatment is aimed at nidus removal traditionally by en-bloc resection, by curettage, or by various other methods 148).…”