title: Arthroscopic guided biopsy and radiofrequency thermoablation of a benign neoplasm of the tibial spines area: a treatment option.
abstract: BACKGROUND
  Lesions located in the area of the tibial spines are rare. In most cases, treatment follows histological diagnosis, but when imaging and clinical data are considered to be "very" characteristic for benign lesions, such as chondroblastoma or osteoid osteoma, treatment may be performed without biopsy. Traditional curettage requires opening the joint, which presents a high risk of contamination of the joint itself and surrounding structures, such as the popliteal area, with possible contamination of the neurovascular bundle when performing curettage with the posterior approach. In this case, the re-excision of a local recurrence would be extremely difficult.
  
  
  RESULTS
  We describe a technique using arthroscopic guidance for radiofrequency thermoablation of a benign lesion in the tibial spines area. We report on an illustrative case. The patient so treated, reported immediate relief from the pain, and after two weeks, was free of pain. The biopsy performed before the treatment confirmed the radiological diagnosis of chondroblastoma. At one year of follow-up, the patient is without pain, with a 0-130° range of motion, has no activity limitations and is apparently free of disease.
  
  
  CONCLUSIONS
  This technique allows a radiofrequency thermoablation of a lesion in the tibial spines area and in the posterior tibial surface to be performed without opening the joint, monitoring the tibial plateau surface, probably decreasing the risk of cartilage damage. Unfortunately, in the case presented, the high pressure from the arthroscopy's pump broke the tibial plateau surface creating a communication to the tibial tunnel used for thermoablation.
authors.affiliation: Oncological Orthopedics Department, Muscular-skeletal Tissue Bank, IFO - Regina Elena National Cancer Institute, Rome, Italy. carminezoccali@libero.it
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Teori
authors.forename: Nicola
authors.initials: N
authors.lastname: Salducca
authors.forename: Berardino
authors.initials: B
authors.lastname: Di Paola
authors.forename: Ezio
authors.initials: E
authors.lastname: Adriani
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000209:etiology; D001182:Arthroscopy; D001706:Biopsy / Q000379:methods*; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation; D002804:Chondroblastoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome