Outcomes of Tenosynovial Giant Cell Tumor of the Foot and Ankle.

IF 2.4 2区医学 Q2 ORTHOPEDICS Foot & Ankle International Pub Date : 2023-10-01 Epub Date: 2023-08-30 DOI:10.1177/10711007231189491

James Robert Barnett, Branavan Rudran, Amir Khan, Sarah O'Reilly-Harbidge, Shelain Patel, Karan Malhotra, Nicholas Cullen, Matthew Welck, William Aston

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Abstract

Background: Tenosynovial giant cell tumor (TGCT) is a benign proliferative disease affecting synovial membranes. There are 2 forms, localized (L-TGCT) and diffuse (D-TGCT), which although histologically similar behave differently. It is locally invasive and is treated in most cases by operative excision. The aim of this study was to assess current practice, how the patients' presentation affected their outcome, as well as review the recurrence rates and complications.

Methods: A retrospective analysis of 123 cases was performed in patients treated between 2003 and 2019 with TGCT of the foot and/or ankle. Data were collected on age at presentation, radiologic pattern of disease, location of disease, treatment provided, and recurrence rates. The minimum follow-up was 2 years with a mean of 7.7 years.

Results: There were 61.7% female patients with a mean age of 39 (range, 11-76) years. L-TGCT accounted for 85 (69.1%) cases and D-TGCT for 38 (30.9%). The most prevalent preoperative symptoms were a palpable mass (78/123) and pain (65/123). Radiologically confirmed recurrence in the operative group was noted in 14.5% (16/110) cases. This comprised 4% (3/75) of operatively treated L-TGCT and 37% (13/35) of operatively treated D-TGCT. Patients with pain on presentation and those with erosive changes on presenting magnetic resonance imaging (MRI) were more likely to have persistent postoperative pain (P < .001 for both). Where patients had both preoperative pain and erosive changes, 57.1% had postoperative pain. Thirteen cases were managed nonoperatively where symptoms were minimal, with 1 case requiring surgery at a later date.

Conclusion: Outcomes of TGCT management are dependent on the disease type, extent of preoperative erosive changes, and presence of preoperative pain. These data are useful for counseling patients regarding the outcomes of surgical intervention and help guide the timing of intervention.

Level of evidence: Level III, retrospective cohort study.

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足和踝关节的Tenosynovial巨细胞瘤的结果。

背景：腱突巨细胞瘤（TGCT）是一种影响滑膜的良性增殖性疾病。有两种形式，局限性（L-TGCT）和弥漫性（D-TGCT），尽管在组织学上相似，但表现不同。它是局部侵袭性的，在大多数情况下通过手术切除来治疗。这项研究的目的是评估目前的实践，患者的表现如何影响他们的结果，并回顾复发率和并发症。方法：对2003年至2019年间接受足部和/或踝关节TGCT治疗的123例患者进行回顾性分析。收集了表现时的年龄、疾病的放射学模式、疾病的位置、提供的治疗和复发率的数据。最低随访时间为2 年，平均7.7 年。结果：女性患者61.7%，平均年龄39岁（11～76岁）。L-TGCT占85例（69.1%），D-TGCT占38例（30.9%）。术前最常见的症状是可触摸的肿块（78/123）和疼痛（65/123）。14.5%（16/110）的病例经放射学证实手术组复发。这包括手术治疗的L-TGCT的4%（3/75）和手术治疗的D-TGCT的37%（13/35）。磁共振成像（MRI）显示疼痛和侵蚀性改变的患者更有可能出现持续的术后疼痛（P < .001）。在患者同时有术前疼痛和糜烂变化的情况下，57.1%的患者有术后疼痛。13例在症状轻微的情况下进行了非手术治疗，其中1例需要在以后进行手术。结论：TGCT治疗的结果取决于疾病类型、术前侵蚀性变化的程度和术前疼痛的存在。这些数据有助于就手术干预的结果向患者提供咨询，并有助于指导干预的时机。证据水平：III级，回顾性队列研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot & Ankle International 医学-整形外科

CiteScore

5.60

自引率

22.20%

发文量

144

审稿时长

2 months

期刊介绍： Foot & Ankle International (FAI), in publication since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. This journal is an ideal resource for highly-trained orthopaedic foot and ankle specialists and allied health care providers. The journal’s Founding Editor, Melvin H. Jahss, MD (deceased), served from 1980-1988. He was followed by Kenneth A. Johnson, MD (deceased) from 1988-1993; Lowell D. Lutter, MD (deceased) from 1993-2004; and E. Greer Richardson, MD from 2005-2007. David B. Thordarson, MD, assumed the role of Editor-in-Chief in 2008. The journal focuses on the following areas of interest: • Surgery • Wound care • Bone healing • Pain management • In-office orthotic systems • Diabetes • Sports medicine

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