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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...
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| Published in: | Indian journal of orthopaedics 2023-10, Vol.57 (10), p.1689-1696 |
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| container_title | Indian journal of orthopaedics |
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| creator | Yadav, Surender Singh |
| description | 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. |
| doi_str_mv | 10.1007/s43465-023-00921-7 |
| format | article |
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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.</description><identifier>ISSN: 0019-5413</identifier><identifier>EISSN: 1998-3727</identifier><identifier>DOI: 10.1007/s43465-023-00921-7</identifier><identifier>PMID: 37766948</identifier><language>eng</language><publisher>New Delhi: Springer India</publisher><subject>Conservative Orthopedics ; Medicine ; Medicine & Public Health ; Orthopedics ; Point of View ; Surgical Orthopedics</subject><ispartof>Indian journal of orthopaedics, 2023-10, Vol.57 (10), p.1689-1696</ispartof><rights>Indian Orthopaedics Association 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c398t-2a15dbdddf05eeae3bd98152df0a108104ffb73d1000d5c8409979ce5fad8dab3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519896/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10519896/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37766948$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yadav, Surender Singh</creatorcontrib><title>A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management</title><title>Indian journal of orthopaedics</title><addtitle>JOIO</addtitle><addtitle>Indian J Orthop</addtitle><description>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.</description><subject>Conservative Orthopedics</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Point of View</subject><subject>Surgical Orthopedics</subject><issn>0019-5413</issn><issn>1998-3727</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kcFvFCEUxkmjsWv1H-jBcPQy7QOGAU6mmdTtJq0mpl4lzMBMaWZghdma_vfF3droxRPwvt_7HvAhdErgjACI81yzuuEVUFYBKEoqcYRWRClZMUHFK7QCIKriNWHH6G3O9wCcCtq8QcdMiKZRtVyhHxf4i_uF28kH35sJm2DxN2N9nOK4L7STydkPZb_4GHAc8DoVPYx43d7u8c2S8Wbemn7BBVjuHL4xwYxudmF5h14PZsru_fN6gr5_vrxtr6rrr-tNe3Fd9UzJpaKGcNtZawfgzhnHOqsk4bScDQFJoB6GTjBbng2W97IGpYTqHR-MldZ07AR9Ovhud93sbF9GJzPpbfKzSY86Gq__VYK_02N80AQ4UVI1xeHjs0OKP3cuL3r2uXfTZIKLu6ypFECYgBoKSg9on2LOyQ0vcwjo38noQzK6JKP3yWhRmj78fcOXlj9RFIAdgFykMLqk7-MuhfJr_7N9Aoplmoc</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Yadav, Surender Singh</creator><general>Springer India</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20231001</creationdate><title>A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management</title><author>Yadav, Surender Singh</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-2a15dbdddf05eeae3bd98152df0a108104ffb73d1000d5c8409979ce5fad8dab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Conservative Orthopedics</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Point of View</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yadav, Surender Singh</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Indian journal of orthopaedics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yadav, Surender Singh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management</atitle><jtitle>Indian journal of orthopaedics</jtitle><stitle>JOIO</stitle><addtitle>Indian J Orthop</addtitle><date>2023-10-01</date><risdate>2023</risdate><volume>57</volume><issue>10</issue><spage>1689</spage><epage>1696</epage><pages>1689-1696</pages><issn>0019-5413</issn><eissn>1998-3727</eissn><abstract>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.</abstract><cop>New Delhi</cop><pub>Springer India</pub><pmid>37766948</pmid><doi>10.1007/s43465-023-00921-7</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Indian journal of orthopaedics, 2023-10, Vol.57 (10), p.1689-1696 |
| issn | 0019-5413 1998-3727 |
| language | eng |
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| source | PubMed Central Free; Springer Nature |
| subjects | Conservative Orthopedics Medicine Medicine & Public Health Orthopedics Point of View Surgical Orthopedics |
| title | A New Clinical and Radiological Classification of Grading GCT and Its Impact on the Management |
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