Arthroscopic excision of giant cell tumour at femoral attachment of anterior cruciate ligament and simultaneous anterior cruciate ligament reconstruction: a case report
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20242411Keywords:
GCT, Osteoclastoma, ACL, Arthroscopy, KneeAbstract
Giant cell tumors (GCT) are typically noncancerous bone tissue growths that have a slow growth rate, occurring more frequently in the age group of 15-40 years. They are mainly found in the distal femur, proximal tibia, and tendons of hand. Magnetic resonance imaging (MRI) is gold standard for diagnosis. The preferred method of treatment is surgical excision performed under direct visualization. Here we present a rare case involving a GCT located in the distal femur at the attachment of anterior cruciate ligament (ACL) concomitant with a tear in the ACL. The patient presented with pain and instability of left knee while walking following trauma. MRI revealed a chronic partial tear of ACL and altered signal area in lateral condyle of femur at the attachment of ACL. CT guided biopsy showed osteoclastoma over postero-medial aspect of lateral condyle of left femur. Diagnostic arthroscopy showed lax and torn ACL. Soft mass with reddish pink appearance was noted. Arthroscopic excision was done under direct vision and ACL was reconstructed with Semi-tendinosis graft. A simultaneous minimally invasive approach to treating a GCT and ACL tear can offer significant benefits in terms of reduced recovery time, improved functional outcomes, and potentially lower recurrence rates.
References
Noailles T, Brulefert K, Briand S, Longis PM, Andrieu K, Chalopin A, et al. Giant cell tumor of tendon sheath: Open surgery or arthroscopic synovectomy? A systematic review of the literature. Orthopaedics Traumatol Surg Res. 2017;103(5):809-14.
Lu KH. Arthroscopic excision of juxta-articular giant-cell tumor arising from the patellar tendon sheath. Arthroscopy J Arthroscopic Rel Surg. 2004;20(5):e35-8.
Spahn G, Bousseljot F, Schulz HJ, Bauer T. Arthroscopic resection of an extra-articular tenosynovial giant cell tumor from the ankle region. Arthroscopy. 2003;19:E8-11.
Lüthje P, Nurmi-Lüthje I. Tenosynovial juxta-articular giant-cell tumour of the knee--an unusual location of the tumour. Acta Orthop Belg. 2006;72(6):772-4.
Lee JH, Wang SI. A tenosynovial giant cell tumor arising from femoral attachment of the anterior cruciate ligament. Clin Orthop Surg. 2014;6:242-4.
Lucas DR. Tenosynovial giant cell tumor:Case report and review. Arch Pathol Lab Med. 2012;136:901-6.
Wood GS, Beckstead JH, Medeiros LJ, Kempson RL, Warnke RA. The cells of giant cell tumor of tendon sheath resemble osteoclasts. Am J Surg Pathol. 1988;12:444-52.
Bojanic I, Ivkovic A, Dotlic S, Ivkovic M. Localized pigmented villonodular synovitis of the knee: Diagnostic challenge and arthroscopic treatment: A report of three cases. Knee Surg Sports Traumatol Arthrosc. 2001;9:350-4.
Kubat O, Mahnik A, Smoljanovic A, Bojanic I. Arthroscopic treatment of localized and diffuse pigmented villonodular synovitis of the knee. Coll Antropol. 2010;34:1467-72.
Loariaut P, Dijan P, Boyer T, Bonvarlet J, Delin C, Makridis K. Arthroscopic treatment of localized pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc. 2012;20:1550-3.
De Ponti A, Sansone V, Malchere M. Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 2003;19:602-7.
Cho HJ, Lee SH, Han SB, Lee DK, Kim CH, Lee DH. Bilateral tenosynovial giant cell tumor of the knee accompanied by chronic ACL tear. J Orthopaed Sci. 2012;17:93-7
Gao K, Chen J, Chen S, Li Y. Arthroscopic excision of giant cell tumor of the tendon sheath in the knee mimicking patellar tendinopathy: a case report. Oncology Letters. 2016;11(5):3543-5.
