Surgical Treatment of Solitary Periarticular Osteochondromas About the Knee in Pediatric and Adolescent Patients

Abstract

Background:Solitary osteochondromas, or osteocartilaginous exostoses (OCEs), represent the most common benign bone tumor. Despite frequently causing symptoms about the knee in younger populations, there is minimal previous literature investigating surgical treatment.Methods:We retrospectively reviewed the records of patients <20 years old who had undergone surgical treatment of symptomatic, pathologically confirmed, solitary periarticular knee OCE at a single pediatric center between 2003 and 2016. The clinical course, radiographic and pathological features, and complications were assessed. Prospective outreach was performed to investigate patient-reported functional outcomes.Results:Two hundred and sixty-four patients (58% male, 81% athletes) underwent excision of a solitary OCE about the knee at a mean age (and standard deviation) of 14.3 ± 2.24 years. Fifty-five percent of the procedures were performed by orthopaedic oncologists, 25% were performed by pediatric orthopaedic surgeons, and 20% were performed by pediatric orthopaedic sports medicine surgeons, with no difference in outcomes or complications based on training. Of the 264 lesions, 171 (65%) were pedunculated (versus sessile), 157 (59%) were in the distal part of the femur (versus the proximal part of the tibia or proximal part of the fibula), and 182 (69%) were medial (versus lateral). Postoperatively, 96% of the patients returned to sports at a median of 2.5 months (interquartile range, 1.9 to 4.0 months). Forty-two patients (16%) experienced minor complications not requiring operative intervention. Six patients (2%) experienced major complications (symptoms or disability at >6 months or requiring reoperation), which were more common in patients with sessile osteochondromas (p = 0.01), younger age (p = 0.01), and distal femoral lesions as compared with proximal tibial lesions (p = 0.003). Lesion recurrence was identified in 3 patients (1.1%). Overall, the median Pediatric International Knee Documentation Committee (Pedi-IKDC) and mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) scores were 97 (interquartile range, 93 to 99) and 16.7 ± 8.15, respectively, at a median duration of follow-up of 5.8 years.Conclusions:In our large cohort of pediatric patients who underwent excision of solitary knee osteochondromas, most patients were male adolescent athletes. Most commonly, the lesions were pedunculated, were located in the distal part of the femur, and arose from the medial aspect of the knee. Regardless of surgeon training or lesion location, patients demonstrated excellent functional outcomes, with minimal clinically important postoperative complications and recurrences, although patients with sessile lesions and younger age may be at higher risk for complications.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review

“…In clinical practice, however, the physicians usually deal with mild changes, such as osteochondromas that are typically also located near the growth plate [ 48 ]. An example is presented in Figure 15 .…”

Effect of Solitary Osteochondroma on Alignment and Length in the Lower Extremities

“…5,6 Solitary osteochondroma (SO) accounts for 10% to 15% of all bone tumors and 20% to 50% of all benign bone tumors. 2,7,8 Lesions vary widely in size and are generally classified as sessile or pedunculated according to the characteristic continuity of the underlying bone. 2,3 Although solitary lesions can occur in any bone, they most frequently occur around the knee.…”

“…2,3 Although solitary lesions can occur in any bone, they most frequently occur around the knee. [6][7][8] In previous studies, more than 30% of SO occurred either on the distal femur or proximal tibia. 1,2,[7][8][9] Although most osteochondroma are asymptomatic and discovered incidentally on radiographs, pain or discomfort can develop as the lesion grows.…”

“…[6][7][8] In previous studies, more than 30% of SO occurred either on the distal femur or proximal tibia. 1,2,[7][8][9] Although most osteochondroma are asymptomatic and discovered incidentally on radiographs, pain or discomfort can develop as the lesion grows. Fortunately, surgical excision of SO has demonstrated excellent outcomes with low complication and recurrence rates.…”

“…Fortunately, surgical excision of SO has demonstrated excellent outcomes with low complication and recurrence rates. 4,6,8,9 In patients with MHE, limb length discrepancy (LLD) and angular knee deformity, 5,10 predominantly genu valgum, are common and may require surgical correction even in the absence of subjective symptoms. 11,12 Solitary lesions are generally not thought to influence the longitudinal growth of the lower extremities; however, to our knowledge, there is a lack of information about the effects of untreated SO on the longitudinal growth of the lower extremities in children and adolescents.…”