Giant cell tumors of the knee: subchondral bone integrity affects the outcome

Abstract

From January 1992 to July 2001, we treated 38 patients with giant cell tumour in the knee region. Seventeen tumours were located in the distal femur and 21 in the proximal tibia . Twenty patients were classified as Campanacci grade II, 15 as grade III, and three as grade I. Patients' mean age was 34.5 (19-65) years, and the mean follow-up was 52 (24-134) months. Operative procedures were chosen according to the extent of bone and soft-tissue involvement. In 28 patients, intralesional curettage and bone grafting was performed and in ten patients a wide resection. We defined subchondral bone of the knee to be affected when the distance to the tumour was less than 3 mm. We then measured the area of affected subchondral bone radiographically using plain radiographs, CT, and MRI. In patients initially treated with curettage and bone grafting, the mean area of initially affected subchondral bone was 18.6 (0-81)%. The mean Enneking functional score at follow-up was 88 (66.6-100). There was a linear trend showing that the larger the area of affected subchondral bone, the worse the functional score. Among patients initially treated with wide resection, the mean area of affected subchondral bone was 68.2 (41-100)%. There was, however, no significant association between affected subchondral bone area and functional score.

Comparison of the degenerative changes in weight-bearing joints following cementing or grafting techniques in giant cell tumour patients: medium-term results

“…There were three patients with Stage 1 lesions, 45 patients with Stage 2 lesions and 32 patients with Stage 3 lesions. Average subchondral involvement by the tumour was 27.5% (range: 15-89%) according to the method of Chen et al [5]. The Campanacci staging did not show a significant correlation with degenerative changes at any of the time points in the follow-up (p>0.05).…”

“…The area of affected subchondral bone was measured on anteroposterior and lateral radiographs. The subchondral bone was defined as affected when the distance between it and the tumour was less than 3 mm [5]. The GCTs were staged according to the system described by Campanacci et al [3]: stage 1 lesions were intraosseus, stage 2 lesions were intraosseus lesions with cortical thinning and stage 3 lesions extended extraosseously.…”

“…The GCTs were staged according to the system described by Campanacci et al [3]: stage 1 lesions were intraosseus, stage 2 lesions were intraosseus lesions with cortical thinning and stage 3 lesions extended extraosseously. The size of the subchondral involvement of the tumour was assessed according to the method published by Chen et al [5] with the percentage of affected subchondral bone calculated as the ratio of the affected length to the total length of the compartment's subchondral bone.…”

Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications

“…Errani et al [10] found mean MSTS scores of 92% and 94% for patients treated with two adjuvants versus three adjuvants, respectively. Chen et al [6] found mean MSTS scores of 88% in patients who underwent intralesional curettage.…”

Giant cell tumour with intra-articular extension: a case report

“…Treatment depends upon the stage according to the Campanacci grade. 6 With more involvement of subchondral bone, 2 the functional outcome is generally worse after treatment. Custom mega Prosthesis as the primary modality 1 in the management of malignant bone tumours of the lower limb is seen to have superior results with minimal complications.…”