Dear Editor in Chief,
Journal of Clinical Orthopaedics and Trauma (JCOT),
As clinicians working in the NHS and one of the largest Tertiary Bone Tumour referral management centre in the UK, we read with interest the recently published case report illustrating “Arthroscopic management of Juxta-articular chondroblastoma with bone substitutes by Acharya PU and Mirza K.1 The report describes an arthroscopic approach to curettage a chondroblastoma involving the distal femoral epiphysis followed by synthetic calcium hydroxyapatite bone substitute for cavity management.
Can we highlight modern technology being undertaken at our centre and many abroad to deal with such lesions utilising minimally invasive, percutaneous Radiofrequency ablation (RFA) or cryotherapy. With advances in technology over the last two decades, percutaneous management with RFA or cryotherapy is being considered the gold standard modality for management of such benign or less aggressive osteo-cartilaginous tumours. Percutaneously delivered RFA or cryotherapy has the advantage of providing a safe, quick procedure with minimal morbidity in experienced hands. This percutaneous technique avoids injury to articular cartilage and the necessity of second arthroscopic procedure as needed in the described case-report or the need of using synthetic bone substitute. Thus, the use of Calcium hydroxyapatite bone substitute with its own inherent risk profile such as local inflammatory response can be circumvented. Larger lesions can be treated successfully using multiple needles or cryotherapy. With a success rate of treating such lesions of over 88%, we hope this letter emphasizes the importance of percutaneous management of bone lesions like osteoid osteoma, osteoblastoma and chondroblastoma.2, 3, 4
We believe RFA or cryotherapy should be first line of treatment rather than arthroscopic resection or curettage in the management algorithm of such osteo-cartilaginous bone tumours to enhance patient related clinical outcomes.
Funding
No funding to declare.
Declaration of competing interest
No conflicts of interest.
References
- 1.Acharya P.U., Mirza K. Arthroscopic management of Juxta-articular chondroblastoma with bone substitutes – a case report. J Clin Orthop Trauma. 2022 doi: 10.1016/j.jcot.2022.101895. [DOI] [PMC free article] [PubMed] [Google Scholar]
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