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Midterm outcomes of 18 patients with primary intra-articular diffuse tenosynovial giant cell tumor (TGCT) of the knee treated with complete arthroscopic synovectomy and postoperative low-dose radiotherapy at a mean follow-up of 68 months

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Objective

To evaluate the long-term clinical outcome of the treatment of complete arthroscopic synovectomy combined with low-dose external radiotherapy in the knee affected by primary intra-articular diffuse tenosynovial giant cell tumor (TGCT).

Methods

From May 2009 to January 2016, 18 patients with intra-articular diffuse TGCT underwent complete arthroscopic synovectomy and low-dose external-beam radiotherapy in Zhongnan Hospital were enrolled in this retrospective study. The preoperative symptoms of patients, the complications during or after the arthroscopic procedure and the recurrence were collected and recorded. Each patient was evaluated before treatment and at the follow-up visit. Efficacy evaluation criteria were based on Ogilvie-Harris score, and the evaluation of the functional ability of knee was based on the International Knee Documentation Committee (IKDC) Score.

Results

The mean time from symptom onset to surgery was 9.1 ± 5.8 months (range from 3 to 29 months). The most frequent preoperative symptoms were joint effusion (100%), diffuse non-specific knee pain (66.7%), and a decreased range of motion (83.3%). Mean follow-up time was 68.0 ± 18.1 months (range from 35 to 120 months). The mean evaluation score according to the Ogilvie-Harris criteria before treatment was 3.19 ± 0.74, which corresponded to a rating of “poor”. The mean score after treatment was 8.79 ± 1.57, rated as “good”. The Ogilvie-Harris score was significantly increased after treatment (P = 0.003). The IKDC score of all patients increased significantly from 37.1 ± 3.8 before treatment to 83.9 ± 11.3 after treatment. The IKDC score was obviously increased after treatment (P = 0.001). No recurrence was noted at final follow-up. There were no complications during or after the arthroscopic procedure.

Conclusion

The outcome of this study proved that complete arthroscopic synovectomy combined with low-dose external radiotherapy was appropriate for treating primary intra-articular diffuse TGCT of the knee joint. It could be safely and reliably used with minimal complications, fast postoperative recovery and satisfactory control of recurrence rates.

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Availability of data and material

The dataset used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Kubat O, Mahnik A, Smoljanović T, Bojanić I (2010) Arthroscopic Arthroscopic treatment of localized and diffuse pigmented villonodular synovitis of the knee. Coll Antropol 34:1467–1472

    PubMed  Google Scholar 

  2. Gouin F, Noailles T (2017) Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res 103(1S):S91–S97

    Article  CAS  PubMed  Google Scholar 

  3. Myers BW, Masi AT (1980) Pigmented villonodular synovitis and tenosynovitis: a clinical epidemiologic study of 166 cases and literature review. Med (Baltim) 59:223–238

    Article  CAS  Google Scholar 

  4. Mastboom MJL, Verspoor FGM, Verschoor AJ et al (2017) Higher incidence rates than previously known in tenosynovial giant cell tumors. Acta Orthop 88(6):688–694

    Article  PubMed  PubMed Central  Google Scholar 

  5. Granowitz SP, D’Antonio J, Mankin HL (1976) The pathogenesis and long-term end results of pigmented villonodular synovitis. Clin Orthop Relat Res 114:335–351

    Google Scholar 

  6. Botez P, Sirbu PD, Grierosu C, Mihailescu D, Savin L, Scarlat MM (2013) Adult multifocal pigmented villonodular synovitis–clinical review. Int Orthop 37:729–733

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dines JS, DeBerardino TM, Wells JL, Dodson CC, Shindle M, DiCarlo EF et al (2007) Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee. Arthroscopy 23:930–937

    Article  PubMed  Google Scholar 

  8. Gouin F, Noailles T (2017) Localized and diffuse forms of tenosynovial giant cell tumor (formerly giant cell tumor of the tendon sheath and pigmented villonodular synovitis). Orthop Traumatol Surg Res 103:S91–S97

    Article  CAS  PubMed  Google Scholar 

  9. Auregan JC, Klouche S, Bohu Y, Lefève N, Herman S, Hardy P (2014) Treatment of pigmented villonodular synovitis of the knee. Arthroscopy 30:1327–1341

    Article  PubMed  Google Scholar 

  10. Mollon B, Lee A, Busse JW, Griffin AM, Ferguson PC, Wunder JS et al (2015) The effect of surgical synovectomy and radiotherapy on the rate of recurrence of pigmented villonodular synovitis of the knee: an individual patient meta-analysis. Bone Jt J 97-B:550–557

    Article  CAS  Google Scholar 

  11. Blanco CE, Leon HO, Guthrie TB (2001) Combined partial arthroscopic synovectomy and radiation therapy for diffuse pigmented villonodular synovitis of the knee. Arthroscopy 17:527–531

    Article  CAS  PubMed  Google Scholar 

  12. Chin KR, Barr SJ, Winalski C, Zurakowski D, Brick GW (2002) Treatment of advanced primary and recurrent diffuse pigmented villonodular synovitis of the knee. J Bone Joint Surg Am 84-A:2192–2202

    Article  Google Scholar 

  13. Gu HF, Zhang SJ, Zhao C, Chen Y, Bi Q (2014) A comparison of open and arthroscopic surgery for treatment of diffuse pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc 22:2830–2836

    Article  PubMed  Google Scholar 

  14. De Ponti A, Sansone V, Malcherè M (2003) Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy 19:602–607

    Article  PubMed  Google Scholar 

  15. Patel KH, Gikas PD, Pollock RC, Carrington RW, Cannon SR, Skinner JA, Briggs TW, Aston WJS (2017) Pigmented villonodular synovitis of the knee: a retrospective analysis of 214 cases at a UK tertiary referral centre. Knee 24(4):808–815

    Article  CAS  PubMed  Google Scholar 

  16. Mastboom MJL, Palmerini E, Verspoor FGM, Rueten-Budde AJ, Stacchiotti S, Staals EL, Schaap GR, Jutte PC, Aston W, Gelderblom H, Leithner A, Dammerer D, Takeuchi A, Thio Q, Niu X, Wunder JS; TGCT Study Group, van de Sande MAJ (2019) Surgical outcomes of patients with diffuse-type tenosynovial giant-cell tumours: an international, retrospective, cohort study. Lancet Oncol 20(6):877–886

  17. Colman MW, Ye J, Weiss KR, Goodman MA, McGough RL 3rd (2013) Does combined open and arthroscopic synovectomy for diffuse PVNS of the knee improve recurrence rates? Clin Orthop Relat Res 471(3):883–890

    Article  PubMed  Google Scholar 

  18. Gu HF, Zhang SJ, Zhao C, Chen Y, Bi Q (2014) A comparison of open and arthroscopic surgery for treatment of diffuse pigmented villonodular synovitis of the knee. Knee Surg Sports Traumatol Arthrosc 22(11):2830–2836

    Article  PubMed  Google Scholar 

  19. Kramer DE, Frassica FJ, Frassica DA, Cosgarea AJ (2009) Pigmented villonodular synovitis of the knee: diagnosis and treatment. J Knee Surg 22:243–254

    Article  PubMed  Google Scholar 

  20. Keyhani S, Kazemi SM, Ahn JH, Verdonk R, Soleymanha M (2019) Arthroscopic treatment of diffuse pigmented villonodular synovitis of the knee: complete synovectomy and septum removal-midterm results. J Knee Surg 32:427–433

    Article  PubMed  Google Scholar 

  21. Park G, Kim YS, Kim JH, Lee SW, Song SY, Choi EK et al (2012) Low-dose external beam radiotherapy as a postoperative treatment for patients with diffuse pigmented villonodular synovitis of the knee: 4 recurrences in 23 patients followed for mean 9 years. Acta Orthop 83:256–260

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ogilvie-Harris DJ, McLean J, Zarnett ME (1992) Pigmented villonodular synovitis of the knee: the results of total arthroscopic synovectomy, partial arthroscopic synovectomy and arthroscopic local excision. J Bone Jt Surg Am 74:119–123

    Article  CAS  Google Scholar 

  23. Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114

    Article  CAS  PubMed  Google Scholar 

  24. Mastboom MJL, Staals EL, Verspoor FGM, Rueten-Budde AJ, Stacchiotti S, Palmerini E, Schaap GR, Jutte PC, Aston W, Leithner A, Dammerer D, Takeuchi A, Thio Q, Niu X, Wunder JS, van de Sande MAJ; Tenosynovial Giant Cell Tumors (TGCT) Study Group (2019) Surgical treatment of localized-type tenosynovial giant cell tumors of large joints: a study based on a multicenter-pooled database of 31 international sarcoma centers. J Bone Jt Surg Am 101(14):1309–1318

  25. Byers PD, Cotton RE, Deacon OW, Lowy M, Newman PH, Sissons HA et al (1968) The diagnosis and treatment of pigmented villonodular synovitis. J Bone Jt Surg Br 50:290–305

    Article  CAS  Google Scholar 

  26. Flandry FC, Hughston JC, Jacobson KE, Barrack RL, McCann SB, Kurtz DM (1994) Surgical treatment of diffuse pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 300:183–192

    Article  Google Scholar 

  27. Chiari C, Pirich C, Brannath W, Kotz R, Trieb K (2006) What affects the recurrence and clinical outcome of pigmented villonodular synovitis? Clin Orthop Relat Res 450:172–178

    Article  PubMed  Google Scholar 

  28. Schwartz HS, Unni KK, Pritchard DJ (1989) Pigmented villonodular synovitis. A retrospective review of affected large joints. Clin Orthop Relat Res 247:243–255

    Article  Google Scholar 

  29. Sharma V, Cheng EY (2009) Outcomes after excision of pigmented villonodular synovitis of the knee. Clin Orthop Relat Res 467:2852–2858

    Article  PubMed  PubMed Central  Google Scholar 

  30. Flandry F, Hughston JC (1987) Pigmented villonodular synovitis. J Bone Jt Surg Am 69:942–949

    Article  CAS  Google Scholar 

  31. Zvijac JE, Lau AC, Hechtman KS, Uribe JW, Tjin ATEW (1999) Arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy 15:613–617

    Article  CAS  PubMed  Google Scholar 

  32. Griffin AM, Ferguson PC, Catton CN, Chung PW, White LM, Wunder JS et al (2012) Long-term outcome of the treatment of high-risk tenosynovial giant cell tumor/pigmented villonodular synovitis with radiotherapy and surgery. Cancer 118:4901–4909

    Article  PubMed  Google Scholar 

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Acknowledgements

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Funding

This study was supported by National Science Foundation of China (no. 81972036) and National Health and Family Planning Scientific Research Project (no. 2016ZX-01-018S06).

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, No. 169 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China

    Kai Tie, Hua Wang, Biao Chen, Xu Yang & Liaobin Chen

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  1. Kai Tie
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  2. Hua Wang
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  3. Biao Chen
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  5. Liaobin Chen
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Contributions

TK has made substantial contributions to conception and design of the study. WH was involved in acquisition of data, data entry and data cleaning. CB was involved in analysis and interpretation of data. YX has been involved in drafting the manuscript. CLB was involved in revising manuscript critically for important intellectual content. All authors contributed substantially to its revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Liaobin Chen.

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Conflict of interest

The authors declare no conflict of interest.

Ethics approval

This study was approved by the ethical committee of Zhongnan Hospital of Wuhan University (NO. 2019038).

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The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient have given his consent for his images and other clinical information to be reported in the journal. The patient understands that their name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Tie, K., Wang, H., Chen, B. et al. Midterm outcomes of 18 patients with primary intra-articular diffuse tenosynovial giant cell tumor (TGCT) of the knee treated with complete arthroscopic synovectomy and postoperative low-dose radiotherapy at a mean follow-up of 68 months. Arch Orthop Trauma Surg 143, 2121–2127 (2023). https://doi.org/10.1007/s00402-022-04465-7

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