Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea; Department of Orthopedic Surgery, Konyang University College of Medicine, Konyang Univiersity Hospital, South Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea.
Knee. 2023 Mar;41:360-372. doi: 10.1016/j.knee.2023.01.024. Epub 2023 Feb 26.
The mainstay treatment for tenosynovial giant cell tumor (TGCT) is open excision. However, open excision is associated with the risk of stiffness, infection, neurovascular injury, and prolonged hospital stay and rehabilitation. The purpose of this study was to evaluate the efficacy of arthroscopic excision of tenosynovial giant cell tumor (TGCT) of the knee joint, including the diffuse type of TGCT.
Patients who underwent arthroscopic excision of TGCT between April 2014 and November 2020 were retrospectively analyzed. TGCT lesions were divided into 12 distributions (nine intra- and three extra-articular lesions). The distribution of TGCT lesions, portals used, degree of excision, recurrence, and magnetic resonance imaging (MRI) scans were evaluated. The prevalence of intra-articular lesions in diffuse TGCT was also analyzed to validate the existence of a connection between intra- and extra-articular lesions.
Twenty-nine patients were included in the study. Fifteen patients (52%) had localized TGCT, and 14 patients (48%) had diffuse TGCT. The recurrence rates for localized, and diffuse TGCT were 0%, and 7%, respectively. Intra-articular posteromedial (i-PM), intra-articular posterolateral (i-PL), and extra-articular posterolateral (e-PL) lesions were found in all patients with diffuse TGCT. The prevalence rates of i-PM and i-PL lesions among e-PL lesions were both 100% (p = 0.026 and p < 0.001, respectively). Diffuse TGCT lesions were managed with posterolateral capsulotomy and viewed from the trans-septal portal.
Arthroscopic excision of TGCT was effective in both localized and diffuse TGCT. However, diffuse TGCT was associated with posterior and extra-articular lesions. Therefore, technical modification such as posterior, trans-septal portal, and capsulotomy were required.
Retrospective case series; level Ⅳ.
腱鞘巨细胞瘤（TGCT）的主要治疗方法是开放性切除术。然而，开放性切除术存在僵硬、感染、神经血管损伤以及住院时间和康复时间延长的风险。本研究旨在评估关节镜下切除膝关节腱鞘巨细胞瘤（TGCT），包括弥漫型 TGCT 的疗效。
回顾性分析 2014 年 4 月至 2020 年 11 月期间行关节镜下 TGCT 切除术的患者。将 TGCT 病变分为 12 个部位（9 个关节内和 3 个关节外病变）。评估 TGCT 病变的分布、使用的入路、切除程度、复发率和磁共振成像（MRI）扫描结果。还分析了弥漫型 TGCT 的关节内病变的发生率，以验证关节内和关节外病变之间的联系。
本研究共纳入 29 例患者。15 例（52%）为局限性 TGCT，14 例（48%）为弥漫性 TGCT。局限性和弥漫性 TGCT 的复发率分别为 0%和 7%。所有弥漫性 TGCT 患者均存在关节内后内侧（i-PM）、关节内后外侧（i-PL）和关节外后外侧（e-PL）病变。e-PL 病变中 i-PM 和 i-PL 病变的发生率均为 100%（p=0.026 和 p<0.001）。弥漫性 TGCT 病变采用后外侧入路行关节囊切开，并从横隔入路进行观察。
关节镜下切除 TGCT 对局限性和弥漫性 TGCT 均有效。然而，弥漫性 TGCT 与后外侧和关节外病变相关。因此，需要进行技术改进，如后外侧、横隔入路和关节囊切开。
回顾性病例系列；IV 级。
