Arthroscopic removal as an effective treatment option for intra-articular osteoid osteoma of the knee

Table 1 Demographic information, clinical presentation, preoperative and postoperative features of the patients treated by arthroscopic removal of intra-articular osteoid osteoma of the knee

Age (yr)/gender	Side	Symptoms	Pain alleviating on NSAIDs	Duration of symptoms until the accurate diagnosis (mo)	Trauma history	Location	Diagnostic imaging	Arthroscopic portals	HPA confirmed osteoid osteoma	Follow-up (mo)	Recurrence
16/F	L	Persistent knee pain worsening at night	Yes	15	Yes	Anterolateral part of the femur above the cartilage border of the trochlea	CT, bone scan	AM, AL, SL	Yes	171	No
23/M	L	Persistent knee pain worsening in activity and at night	Partially	24	No	Anteromedial part of the femur on the cartilage border of the trochlea	MRI (2)1, bone scan	AM, AL	Yes	24	No
17/F	L	Persistent knee pain worsening in activity and at night	Yes	6	No	Anterolateral part of the femur above the cartilage border of the trochlea	MRI, CT	AM, AL, SL	Yes	55	No
37/F	R	Persistent knee pain and swelling	Yes	12	No	Posterior aspect of the lateral femoral condyle	MRI, CT, bone scan	AM, AL, PM, PL	Yes	24	No

¹Patient had a first magnetic resonance imaging (MRI) performed, after which another physician performed an open biopsy at our department. As the symptoms persisted over the course of 10 mo, the patient was referred to the senior author to re-evaluate the case. After detailed analysis, the senior author suspected of intra-articular osteoid osteoma (iaOO) of the knee and issued a bone scan and a follow-up MRI, which confirmed the diagnosis of iaOO of the knee. NSAIDs: Non-steroidal anti-inflammatory drugs; HPA: Histopathologic analysis; F: Female; M: Male; CT: Computerized tomography; MRI: Magnetic resonance imaging; AM: Anteromedial; AL: Anterolateral; SL: Superolateral; PM: Posteromedial; PL: Posterolateral.

Table 2 Literature review of cases with intra-articular osteoid osteoma of the knee treated by arthroscopic or arthroscopically assisted removal

Ref.	Age (yr) /gender	Side	Symptoms	Pain alleviating on NSAIDs	Duration of symptoms until the accurate diagnosis (mo)	Trauma history	Location	Diagnostic imaging	Surgery	HPA confirmed osteoid osteoma	Follow-up (mo)	Recurrence
Heuijerjans et al[3], 1986	29/F	NR	Knee pain, limited ROM	NR	108	NR	Lateral tibial plateau	NR	Arthroscopic removal	Yes	18	No
Franceschi et al[13], 2005	28/M	NR	Light knee pain worsening at night, swelling, limited ROM	Yes	12	NR	Lateral tibial plateau	MRI, CT	Arthroscopically assisted removal – percutaneous K wire insertion to the tumor under CT, arthroscopic visualization of the knee, tumor removal by a core reamer and curettage, bone defect filled with autologous bone graft from proximal tibia	Yes	24	No
Franceschi et al[14], 2008	16/F	L	Light knee pain worsening at night, swelling, limited ROM	Yes	NR	NR	Central region of the patella	MRI, CT, bone scan	Arthroscopically assisted removal – percutaneous K wire insertion to the tumor under CT, arthroscopic visualization of the knee, tumor removal by a hollow drill and curettage, bone defect filled with autologous bone graft from proximal tibia	Yes	36	No
Abnousi et al[15], 2008	35/M	L	Diffuse dull knee pain worsening on activity, limited ROM, swelling	Partially	24	No	Medial femoral condyle	MRI, CT	Arthroscopically assisted removal – arthroscopic visualization of the tumor and en-bloc resection via miniature arthrotomy	Yes	22	No
Gunes et al[16], 2008	18/M	R	Knee pain worsening at night	Yes	6	NR	Medial femoral condyle	MRI, CT	Arthroscopic removal	Yes	15	No
Furukawa et al[17], 2011	23/F	L	Persistent knee painworsening at night, swelling	Partially	24	NR	Lateral femoral condyle	MRI, CT, bone scan	Arthroscopic removal	Yes	24	No
Saeed et al[18], 2011	38/M	L	Mild knee pain worsening at night	Yes	26	NR	Lateral tibial plateau	MRI, CT, bone scan	Arthroscopic removal	Yes	72	Yes1
Adachi et al[19], 2014	32/M	L	Severe knee pain, worsening at night, limited ROM	Partially	NR	No	Lateral tibial plateau	MRI	Arthroscopically assisted removal – arthroscopic visualization of the tumor, insertion of a K wire in the tumor under fluoroscopy and removal with core reamer, bone defect filled with artificial bone	Yes	18	No
Kang et al[20], 2016	20/F	R	Mild knee pain worsening at night	No	12	No	Lateral femoral condyle	MRI, CT, bone scan	Arthroscopic removal	Yes	24	No
Rolvien et al[1], 2016	26/M	NR	Knee pain worsening at night	Yes	24	No	Lateral tibial plateau	MRI, CT	Arthroscopic removal	Yes	3	No
Krause et al[10], 2016	26/M	NR	Knee pain worsening at night	Partially	19	NR	Lateral tibial plateau	MRI, CT	Arthroscopic removal	Yes	3	No
Rolvien et al[11], 2019	48/M	R	Persistent knee pain	Yes	24	NR	Lateral femoral condyle	MRI, CT	Arthroscopic removal	Yes	NR	NR
Monroe et al[12], 2019	20/M	R	Knee pain worsening in activity	No	18	No	Medial femoral trochlea	MRI, CT	Arthroscopic removal – bone defect filled with allograft	Yes	84	No
	28/M	R	Persistent knee pain	Partially	36	NR	Medial femoral condyle	MRI, CT	Arthroscopically assisted removal – arthroscopic visualization of the tumor and removal via small arthrotomy, bone defect filled with allograft	Yes	6	No

¹Six years following the arthroscopic removal, the patient had similar symptoms, and the follow-up imaging revealed recurrence of the osteoid osteoma at the same location. Another arthroscopic removal could cause extensive damage of the lateral tibial plateau, and to avoid such complication, the authors decided to perform an unicondylar knee arthroplasty. HPA: histopathologic analysis, NSAIDs: Non-steroidal anti-inflammatory drugs; NR: Not reported; F: Female; M: Male; MRI: Magnetic resonance imaging; CT: Computerized tomography; K: Kirschner; ROM: Range of motion.