Management of sarcomas possibly involving the knee joint when to perform extra-articular resection of the knee joint and is it safe?

Shahid, Muhammad; Albergo, N.; Purvis, Taylor E.; Heron, KathrynM.A.; Gaston, Laëtitia; Carter, S.; Grimer, R. J.; Jeys, Lee

doi:10.1016/j.ejso.2016.05.018

Cited by 15 publications

(7 citation statements)

References 17 publications

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“…However, the following reports demonstrated comparable function between the EAR and IAR groups with preservation of the extensor mechanism [30] , [31] . In our recent study, we equally described similar results between the two groups [26] . Conversely, in comparison to IAR, EAR of the hip joint involves comparable muscle resection, which might explain the similar functional outcomes between the present two groups and why our functional outcomes were comparable to those in the previous literature [6] .…”

Section: Discussionsupporting

confidence: 75%

“…EARs of the knee and shoulder joint in patients with sarcomas are known to be associated with an increased risk of local failure, complications, and subsequent failure of limb-salvage [1] , [2] , [26] , [27] , [28] . However, little is known about the oncological and functional risk of EARs of the hip joint in patients with sarcomas.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

Fujiwara

Tsuda

Stevenson

et al. 2021

Journal of Bone Oncology

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

Fujiwara

Tsuda

Stevenson

et al. 2021

Journal of Bone Oncology

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“…The native T1 sequence is best suited for determining the resection height [29]-"trust in T1". The protocol must be supplemented by further sequences, i.e., T2 TSE and the T1 TSE sequence with contrast media and fat saturation, to address extraosseous tumor infiltration of adjacent vascular/nerve bundles or joint compartments as these findings impact the extent and technique of local therapy (Figure 1) [30,31].…”

Section: Local Tumor Assessment and Staging-"trust In T1"mentioning

confidence: 99%

Ewing Sarcoma—Diagnosis, Treatment, Clinical Challenges and Future Perspectives

Zöllner

Amatruda

Bauer

et al. 2021

JCM

148

114

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Ewing sarcoma, a highly aggressive bone and soft-tissue cancer, is considered a prime example of the paradigms of a translocation-positive sarcoma: a genetically rather simple disease with a specific and neomorphic-potential therapeutic target, whose oncogenic role was irrefutably defined decades ago. This is a disease that by definition has micrometastatic disease at diagnosis and a dismal prognosis for patients with macrometastatic or recurrent disease. International collaborations have defined the current standard of care in prospective studies, delivering multiple cycles of systemic therapy combined with local treatment; both are associated with significant morbidity that may result in strong psychological and physical burden for survivors. Nevertheless, the combination of non-directed chemotherapeutics and ever-evolving local modalities nowadays achieve a realistic chance of cure for the majority of patients with Ewing sarcoma. In this review, we focus on the current standard of diagnosis and treatment while attempting to answer some of the most pressing questions in clinical practice. In addition, this review provides scientific answers to clinical phenomena and occasionally defines the resulting translational studies needed to overcome the hurdle of treatment-associated morbidities and, most importantly, non-survival.

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“…Given the challenge highlighted in predicting the presence of a tumour within the joint based on the interpretation of MRI alone, we have attempted to develop a rational algorithm previously described to manage equivocal cases, adapted from Shahid et al 17 (Figure 1). In those cases where there is no apparent tumour visible in the joint, in the notch, or Hoffa’s fat pad, but clinical concerns remain about joint involvement, then at the time of surgery a mini-arthrotomy is performed to assess for a visible tumour or blood-stained synovial fluid.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of MRI scans in predicting intra-articular joint involvement in high-grade sarcomas around the knee

et al. 2023

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AimsIntra-articular (IA) tumours around the knee are treated with extra-articular (EA) resection, which is associated with poor functional outcomes. We aim to evaluate the accuracy of MRI in predicting IA involvement around the knee.MethodsWe identified 63 cases of high-grade sarcomas in or around the distal femur that underwent an EA resection from a prospectively maintained database (January 1996 to April 2020). Suspicion of IA disease was noted in 52 cases, six had IA pathological fracture, two had an effusion, two had prior surgical intervention (curettage/IA intervention), and one had an osseous metastasis in the proximal tibia. To ascertain validity, two musculoskeletal radiologists (R1, R2) reviewed the preoperative imaging (MRI) of 63 consecutive cases on two occasions six weeks apart. The radiological criteria for IA disease comprised evidence of tumour extension within the suprapatellar pouch, intercondylar notch, extension along medial/lateral retinaculum, and presence of IA fracture. The radiological predictions were then confirmed with the final histopathology of the resected specimens.ResultsThe resection histology revealed 23 cases (36.5%) showing IA disease involvement compared with 40 cases without (62%). The intraobserver variability of R1 was 0.85 (p < 0.001) compared to R2 with κ = 0.21 (p = 0.007). The interobserver variability was κ = 0.264 (p = 0.003). Knee effusion was found to be the most sensitive indicator of IA involvement, with a sensitivity of 91.3% but specificity of only 35%. However, when combined with a pathological fracture, this rose to 97.5% and 100% when disease was visible in Hoffa’s fat pad.ConclusionMRI imaging can sometimes overestimate IA joint involvement and needs to be correlated with clinical signs. In the light of our findings, we would recommend EA resections when imaging shows effusion combined with either disease in Hoffa’s fat pad or retinaculum, or pathological fractures.Cite this article: Bone Joint J 2023;105-B(6):696–701.

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Management of sarcomas possibly involving the knee joint when to perform extra-articular resection of the knee joint and is it safe?

Cited by 15 publications

References 17 publications

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

Extra-articular resection of the hip joint for pelvic sarcomas: Are there any oncological and functional risks compared with intra-articular resection?

Ewing Sarcoma—Diagnosis, Treatment, Clinical Challenges and Future Perspectives

Accuracy of MRI scans in predicting intra-articular joint involvement in high-grade sarcomas around the knee

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