Arthroscopy-Associated Complications in Osteosarcoma: A Case Report and Review of the Literature.

Abstract

Iatrogenic seeding of sarcoma cells into a joint is a feared, although uncommon, phenomenon. In 1983, Joyce and Mankin described twelve patients who had undergone arthroscopy for suspected intra-articular pathology and were later determined to have extra-articular malignancies. Failure to appreciate the extra-articular lesion in eight of these patients led to delays in definitive treatment as well as the introduction of diseased tissue into the joint space1. In 2003, Musculo et al. reported a similar series of twenty-five patients with suspected athletic injuries who were operated on first and only later diagnosed with benign or malignant bone tumors2. Microscopic seeding of a joint with tumor cells from an undiagnosed malignancy is a risk in treating bone and soft-tissue tumors3-5. Iatrogenic spread of a tumor by arthroscopy is a rare complication that can substantially alter surgical outcomes for patients, leading to more aggressive surgical treatment when conservative therapy may have initially been possible6-8. In a busy clinical practice, orthopaedic surgeons must remain vigilant in assessing all patients with musculoskeletal pain, particularly patients with an equivocal etiology. We report the case of a young man with osteosarcoma who had arthroscopy-related complications. The patient’s family was informed that data concerning this case would be submitted for publication, and they provided consent. A previously healthy nineteen-year-old man presented to his primary physician with knee pain, swelling, and limited weight-bearing. The patient offered a reportedly “vague” history of trauma to the knee, sustained while playing with the family dog. After evaluation, the physician decided on empiric treatment with rest and nonsteroidal anti-inflammatory drugs. Despite the medication, the pain continued to worsen, and the patient was subsequently referred for orthopaedic evaluation. The patient presented to the orthopaedist with poorly localized pain about the knee …