A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management

Background The management of the GCT continues to be controversial. The most accepted treatment reported is extended curettage with various adjuvants. However, the rate of recurrence has been very high (10–66%). For better understanding of the lesion and its management, it has become necessary to re...

Full description

Saved in:
Bibliographic Details
Published in:Indian journal of orthopaedics 2023-10, Vol.57 (10), p.1689-1696
Main Author: Yadav, Surender Singh
Format: Article
Language:English
Subjects:
Conservative Orthopedics
Medicine
Medicine & Public Health
Orthopedics
Point of View
Surgical Orthopedics
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background The management of the GCT continues to be controversial. The most accepted treatment reported is extended curettage with various adjuvants. However, the rate of recurrence has been very high (10–66%). For better understanding of the lesion and its management, it has become necessary to revise the existing grading system. Materials and Methods The recommendation of the proposed grading is based on 480 cases of GCT along with the analysis of other major reports published. Out of these, 279 were grade-II and 109 grade-III which were subjected to en bloc excision and reconstruction with non-vascularized fibular graft. Depending on the site, the grafts were stabilized with a suitable plate or extra long Kirschner wires. Results The observations made in 480 cases over a period of 5 decades revealed that for Campanacci grade-II and grade-III lesions, en bloc excision and suitable reconstruction resulted in minimum recurrence rate of 1.2%. The fibular reconstruction after excision has proved advantageous to our patients as it provides a stable joint in the form of an arthrodesis of the neighboring joint. Conclusion GCT of bone has been a challenging lesion. Extended curettage has been recommended as the choice of treatment but the reported rate of recurrence has been high. En bloc excision and suitable reconstruction with fibular strut graft have resulted in 1.2% recurrence. It is, therefore, suggested the existing grading system should be revised mainly for grade-II and grade-III lesions which can bring down the high rate of recurrence in this unpredictable tumor. Level of Evidence Level-IV.
ISSN:0019-5413
1998-3727
DOI:10.1007/s43465-023-00921-7