From the Guidelines
Tibial osteochondroma should be managed with observation for asymptomatic lesions, and surgical removal is recommended when the osteochondroma causes pain, interferes with joint function, compresses nerves or blood vessels, or shows concerning growth after skeletal maturity, as stated in the most recent guidelines 1.
Diagnosis and Treatment
The diagnosis of tibial osteochondroma is based on morphology, and approximately 50% of central chondrosarcomas carry IDH1 or IDH2 mutations; however, molecular analysis is not required routinely 1.
- The majority of conventional chondrosarcomas are locally aggressive or low-grade, non-metastasising tumours (atypical cartilaginous tumour/chondrosarcoma grade I), rather than high-grade chondrosarcoma (grades II-III) 1.
- Low-grade peripheral chondrosarcomas (arising from osteochondromas) should be surgically excised, aiming to excise the tumour with a covering of normal tissue over it 1.
- Higher-grade chondrosarcomas (grade II-III) and all chondrosarcomas of the pelvis or axial skeleton should be surgically excised with wide margins 1.
Prognosis and Follow-up
The risk of malignant transformation to chondrosarcoma is very low (less than 1% for solitary lesions) 1.
- After surgical removal, recurrence is uncommon unless the cartilage cap was incompletely excised.
- Regular follow-up with a physician is important, especially for growing children, to monitor for any changes in size or symptoms.
- Pain at the site of a cartilaginous lesion may be an indicator of malignancy, and a contrast-enhanced MRI can reveal high-grade areas, providing a useful guide to the site of biopsy 1.
From the Research
Tibial Osteochondroma
- Osteochondroma is the most common benign bone tumor, and it can occur in the tibia 2.
- Tibial osteochondromas can be solitary or multiple, and they can cause symptoms such as pain, mechanical irritation, and limited mobility [(2,3)].
- The treatment of choice for symptomatic tibial osteochondromas is surgical resection, which can be performed through various approaches, including the posterolateral approach 4.
- In some cases, tibial osteochondromas can cause complications such as pathologic fractures, joint malposition, and tendon ruptures, which may require surgical intervention [(5,6)].
- Magnetic resonance imaging (MRI) is a valuable tool in the diagnosis and management of tibial osteochondromas, as it can demonstrate the tumor's relationship with adjacent structures and detect potential complications 3.
Clinical Presentation
- Tibial osteochondromas can present with a range of symptoms, including pain, swelling, and limited mobility [(2,5)].
- In some cases, tibial osteochondromas can cause mechanical irritation, leading to tendon ruptures, such as Achilles tendon ruptures 6.
- The clinical presentation of tibial osteochondromas can vary depending on the location and size of the tumor, as well as the presence of any complications [(2,3)].
Treatment Options
- Surgical resection is the treatment of choice for symptomatic tibial osteochondromas [(2,4)].
- The surgical approach can vary depending on the location and size of the tumor, as well as the presence of any complications [(4,5)].
- In some cases, surgical resection may need to be combined with other procedures, such as tendon repair or joint reconstruction 6.