Subchondral giant-cell tumor of the proximal tibia: arthroscopic treatment for accelerated articular cartilage and meniscal degeneration in two patients.

Abstract

Giant-cell tumor most commonly occurs in the distal femur and proximal tibia and characteristically involves the subchondral bone. Incomplete resection leads to recurrence rates of up to 50%. Intralesional curettage, adjuvant treatments, and polymethyl methacralate (PMMA) reconstruction is the current mainstay of treatment and has produced recurrence rates of less than 10%. Achieving adequate curettage while preserving the articular cartilage of the tibial plateau poses a significant challenge, especially when the tumor involves the subchondral bone. We report on 2 cases, both with symptomatic full-thickness tibial articular cartilage loss and one with a meniscal tear, after curettage, phenol cautery, and PMMA reconstruction of giant-cell tumor of the proximal tibia. Arthroscopic chondroplasty and planing of the exposed cement was performed in both cases, theoretically reducing focal areas of stress concentration that could lead to further meniscal damage and injury to the femoral condyle articular surface in weight-bearing. Partial meniscectomy for a complex meniscal tear was performed in one case. Eighteen months postoperatively, both patients were asymptomatic, working full-time, and participating in light physical activity. Repetitive heavy loading of the knee, such as running, was prohibited, and long-term follow-up is warranted to assess for further joint degeneration and need for total knee arthroplasty.