Primary and Metastatic Bone Tumors of the Patella: Literature Review and Institutional Experience

Document Type : RESEARCH PAPER

Authors

Department of Orthopaedic Oncology Harvard Medical School, Massachusetts General Hospital Boston MA, USA

Abstract

Background: Patellar tumors are rare but certainly must be considered in the differential diagnosis in patients with knee pain. Diagnosis can be challenging as often patellar neoplasms are confused with benign conditions and their clinical presentation is usually not specific. We performed an institutional and a literature review to determine what are the most common tumors affecting the patella and what is the best management. Methods: This is a case series from our institution including all patients with benign, malignant, and metastatic patellar neoplasms. Charts were reviewed for patient demographics, clinical presentation, pathology characteristics, radiographic classification, and oncologic and functional outcomes. Results: Twenty-four patients were identified; twelve patients had benign lesions, 10 metastatic and 2 primary malignant tumors. Chondroblastoma and Giant Cell Tumor were the most common tumors. Management of benign lesions with intralesional curettage and packing with bone graft or cement demonstrated excellent results with no local recurrence. In terms of malignant tumors, the spectrum of treatment is variable; it could range from medical management alone or in combination with surgical procedures to total patellectomy with reconstruction of the extensor mechanism. Conclusion: Patellar tumors should be part of the differential in patients with chronic knee pain that does not respond to initial conservative interventions. Recurrence rate with intralesional curettage and bone grafting or cement packing is very low and therefore should be the treatment of choice for benign intraosseous neoplasms. Resection with negative margins in malignant neoplasms or bone metastasis decreases local recurrence but only in the former group there is a potential impact in survival. Level of evidence: IV

Keywords


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Hoeher J. Uncommon cause for anterior knee pain - Aggressive 
aneurysmal bone cyst of the patella. Sport Med Arthrosc Rehabil 
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Dec;39(12):582–6. 
33. 33. Stoler B, Staple TW. Metastases to the Patella. Radiology. 
1969 Oct;93(4):853–6. 
34. 34. Tas F, Keskin S. Patellar metastasis of melanoma. Indian J 
Med Res. 2013 Sep;138(3):370. 
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Function. 5th ed. Duffield M, editor. F.A. Davis Company; 2006. 
36. 36. DAI H, QIANG M, CHEN Y, ZHAI W, ZHANG K. Lung cancer 
presenting as heel pain: A case report. Oncol Lett. 2014 
Aug;8(2):736–8. 
37. 37. BAPTISTA AM, SARGENTINI SC, ZUMÁRRAGA JP, 
CAMARGO AFDEF, CAMARGO OPDE. Tumors of the patella: the 
experience of institute of orthopedics and traumatology at 
university of Sao Paulo, Brazil. Acta Ortopédica Bras. 2016 
Jun;24(3):151–4. 
38. 38. P.C. Ferguson, A.M. Griffin, R.S. Bell. Primary Patellar 
Tumors. Clin Orthop Relat Res. 1997 Mar;336:199–204. 
39. 39. Malhotra R, Sharma L, Kumar V, Nataraj AR. Giant cell tumor 
of the patella and its management using a patella, patellar 
tendon, and tibial tubercle allograft. Knee Surgery, Sport 
Traumatol Arthrosc. 2009 Sep;18(2):167–9. 
40. 40. Ottaviani G, Jaffe N. The Epidemiology of Osteosarcoma. In: 
Cancer treatment and research. 2009. p. 3–13. 
41. 41. Isakoff MS, Bielack SS, Meltzer P, Gorlick R. Osteosarcoma: 
Current Treatment and a Collaborative Pathway to Success. J 
Clin Oncol. 2015 Sep 20;33(27):3029–35. 
42. 42. Whelan JS, Davis LE. Osteosarcoma, Chondrosarcoma, and 
Chordoma. J Clin Oncol. 2018 Jan 10;36(2):188–93. 
43. 43. CAMERON GW. Giant-cell tumor of the patella; a case report. 
J Bone Joint Surg Am. 1955 Jan;37-A(1):184–6. 
44. 44. HENELT ER, WOUGHTER HW. Giant cell tumor of the patella 
associated with trauma. J Trauma. 1961 Nov;1:608–13. 
45. 45. Copeland CX, Enneking WF, Robbins WJ. Aneurysmal bone 
cyst of the patella. A report of two cases. Clin Orthop Relat Res. 
45:145–50. 
46. 46. LAMMOT; T. Enchondroma of the Patella: A CASE REPORT. 
J Bone Jt Surg. 1968;50(6):1230–2. 
47. 47. Bansal VP SRGDBA. Haemangioma of the patella. A report of 
two cases. J Bone Jt Surg Br. 1974;1(56):139–41. 
48. 48. LEWIS MM, BULLOUGH PG. An Unusual Case of Cystic 
Chondroblastoma of the Patella. Clin Orthop Relat Res. 1976 
Nov;(121):188-190. 
49. 49. Wilson JS, Genant HK, Carlsson A, Murray WR. Patellar giant 
cell tumor. Am J Roentgenol. 1976;127(5):856–8. 
50. 50. Wientroub S SRBMPIWS. Unicameral Bone Cyst of the 
Patella. Clin Orthop Relat Res. 1979;(140):159–61. 
51. 51. Gottschalk, F., Solomon, L., Isaacson, C., & Schmaman A. 
Aneurysmal bone cysts of the patella secondary to 
chondroblastoma. Case reports. South African Med J. 
1985;3(67):105–6. 
52. 52. Moser RP, Brockmole DM, Vinh TN, Kransdorf MJ, Aoki J. 
Chondroblastoma of the patella. Skeletal Radiol. 
1988;17(6):413–9. 
53. 53. De Coster E VTRSMCKOMOP. Osteoblastoma of the Patella. 
Case Report and Review of the Literature . Clin Orthop Relat Res. 
1989;(243):216–9. 
54. 54. Kransdorf MJ, Moser RP, Vinh TN, Aoki J, Callaghan JJ. 
Primary tumors of the patella. Skeletal Radiol. 1989 
Aug;18(5):365–71. 
55. 55. Bulas R V., Hayes CW, Conway WF, Loughran T. Case report 
738: Osteoid Osteoma of the Patella. Skeletal Radiol. 1992 
Jul;21(5):326–9. 
56. 56. Pevny T, Rooney RJ. Case report 876. Skeletal Radiol. 1994 
Nov;23(8):664–7. 
57. 57. Saglik Y, Uçar DH, Yildiz HY, Dogan M. Unicameral bone cyst 
of the patella - A case report. Int Orthop. 1995 Oct;19(5):280–1. 
58. 58. Wolfe MW, Halvorson TL, Bennett JT, Martin PC. 
Chondroblastoma of the patella presenting as knee pain in an 
adolescent. Am J Orthop (Belle Mead NJ). 1995 Jan; 24(1):61–4. 
59. 59. Castro MD, Irwin RB. Aneurysmal bone cyst of the patella. 
Am J Orthop (Belle Mead NJ). 1996 Oct;25(10):717–9. 
60. 60. Tam W, Resnick D, Haghighi P, Vaughan L. Intraosseous 
ganglion of the patella. Skeletal Radiol. 1996;25(6):588–91. 
61. 61. Ghekiere J, Geusens E, Lateur L, Samson I, Sciot R, Baert AL. 
Chondroblastoma of the patella with a secondary aneurysmal 
bone cyst. Eur Radiol. 1998 Jul;8(6):992–5. 
62. 62. Obrebski M, Ucieklak J, Wysocki M. [Giant cell tumor of the 
patella]. Chir Narzadow Ruchu Ortop Pol. 1998;63(6):607–9. 
63. 63. Chaudhary D, Bhatia N, Ahmed A, Chopra RK, Malik AC, 
Singh AK, et al. Unicameral bone cyst of the patella. Orthopedics. 
2000 Dec ;23(12):1285–6. 
64. 64. Macdonald D, Fornasier V, Cameron J. Multicentric giant cell 
tumour involving the patella. Can J Surg. 2001 Jun;44(3):222–3. 
65. 65. Shen CISHNHRW& HS. Osteoblastoma of the patella: case 
report. Chang Gung Med J. 2001;24(4):269-. 
66. 66. Trebše R, Rotter A, Pišot V. Chondroblastoma of the patella 
associated with an aneurysmal bone cyst. Acta Orthop Belg. 
2001;67(3):290–6. 
67. 67. Agarwal S, Jain UK, Chandra T, Bansal GJ, Mishra US. Giantcell tumors of the patella. Orthopedics. 2002 Jul;25(7):749–51. 
68. 68. Koós Z, Than P. Rare localization of osteoid osteoma in the 
patella. Vol. 35, Pediatric Radiology. Pediatr Radiol; 2005. p. 
929–30. 
69. 69. Marudanayagam A, Gnanadoss JJ. Secondary aneurysmal 
bone cyst of the patella: a case report. Iowa Orthop J. 
2006;26:144–6. 
70. 70. Oh JH, Kim HH, Gong HS, Lee SL, Kim JY, Kim WS. Primary 
Aneurysmal Bone Cyst of the Patella: A Case Report. J Orthop 
Surg. 2007 Aug;15(2):234–7. 
71. 71. Bhagat S, Sharma H, Bansal M, Reid R. Presentation and 
outcome of primary tumors of the patella. J Knee Surg. 2008 
Jul;21(3):212–6. 
72. 72. Chakraverty GUC. Late presentation of GCT of the patella. J 
Orthop Surg. 2009;12. 
73. 73. Reddy VRV, Chidanand KJC, Gudi N. Chondroblastoma 
patella presenting as a pathological fracture. Indian J Orthop. 
2008;42(1):100. 
74. 74. Reddy NS, Sathi VR. Primary aneurysmal bone cyst of 
patella. Indian J Orthop. 2009 Apr;43(2):216–7. 
75. 75. Singh J, James SL, Kroon HM, Woertler K, Anderson SE, 
Davies AM. Tumour and tumour-like lesions of the patella – a 
multicentre experience. Eur Radiol. 2009 Mar 25 [cited 2020 
Apr 16];19(3):701–12. 
76. 76. Balke M, Dedy N, Mueller-Huebenthal J, Liem D, Hardes J, 
Hoeher J. Uncommon cause for anterior knee pain - Aggressive 
aneurysmal bone cyst of the patella. Sport Med Arthrosc Rehabil 
Ther Technol. 2010 Apr 1;2(1).year-old boy. Am J Orthop (Belle Mead NJ). 2010 
Dec;39(12):582–6. 
33. 33. Stoler B, Staple TW. Metastases to the Patella. Radiology. 
1969 Oct;93(4):853–6. 
34. 34. Tas F, Keskin S. Patellar metastasis of melanoma. Indian J 
Med Res. 2013 Sep;138(3):370. 
35. 35. Pamela Levangie; Cynthia Norkin. Joint Structure and 
Function. 5th ed. Duffield M, editor. F.A. Davis Company; 2006. 
36. 36. DAI H, QIANG M, CHEN Y, ZHAI W, ZHANG K. Lung cancer 
presenting as heel pain: A case report. Oncol Lett. 2014 
Aug;8(2):736–8. 
37. 37. BAPTISTA AM, SARGENTINI SC, ZUMÁRRAGA JP, 
CAMARGO AFDEF, CAMARGO OPDE. Tumors of the patella: the 
experience of institute of orthopedics and traumatology at 
university of Sao Paulo, Brazil. Acta Ortopédica Bras. 2016 
Jun;24(3):151–4. 
38. 38. P.C. Ferguson, A.M. Griffin, R.S. Bell. Primary Patellar 
Tumors. Clin Orthop Relat Res. 1997 Mar;336:199–204. 
39. 39. Malhotra R, Sharma L, Kumar V, Nataraj AR. Giant cell tumor 
of the patella and its management using a patella, patellar 
tendon, and tibial tubercle allograft. Knee Surgery, Sport 
Traumatol Arthrosc. 2009 Sep;18(2):167–9. 
40. 40. Ottaviani G, Jaffe N. The Epidemiology of Osteosarcoma. In: 
Cancer treatment and research. 2009. p. 3–13. 
41. 41. Isakoff MS, Bielack SS, Meltzer P, Gorlick R. Osteosarcoma: 
Current Treatment and a Collaborative Pathway to Success. J 
Clin Oncol. 2015 Sep 20;33(27):3029–35. 
42. 42. Whelan JS, Davis LE. Osteosarcoma, Chondrosarcoma, and 
Chordoma. J Clin Oncol. 2018 Jan 10;36(2):188–93. 
43. 43. CAMERON GW. Giant-cell tumor of the patella; a case report. 
J Bone Joint Surg Am. 1955 Jan;37-A(1):184–6. 
44. 44. HENELT ER, WOUGHTER HW. Giant cell tumor of the patella 
associated with trauma. J Trauma. 1961 Nov;1:608–13. 
45. 45. Copeland CX, Enneking WF, Robbins WJ. Aneurysmal bone 
cyst of the patella. A report of two cases. Clin Orthop Relat Res. 
45:145–50. 
46. 46. LAMMOT; T. Enchondroma of the Patella: A CASE REPORT. 
J Bone Jt Surg. 1968;50(6):1230–2. 
47. 47. Bansal VP SRGDBA. Haemangioma of the patella. A report of 
two cases. J Bone Jt Surg Br. 1974;1(56):139–41. 
48. 48. LEWIS MM, BULLOUGH PG. An Unusual Case of Cystic 
Chondroblastoma of the Patella. Clin Orthop Relat Res. 1976 
Nov;(121):188-190. 
49. 49. Wilson JS, Genant HK, Carlsson A, Murray WR. Patellar giant 
cell tumor. Am J Roentgenol. 1976;127(5):856–8. 
50. 50. Wientroub S SRBMPIWS. Unicameral Bone Cyst of the 
Patella. Clin Orthop Relat Res. 1979;(140):159–61. 
51. 51. Gottschalk, F., Solomon, L., Isaacson, C., & Schmaman A. 
Aneurysmal bone cysts of the patella secondary to 
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Volume 10, Issue 2
February 2022
Pages 190-203
  • Receive Date: 13 November 2020
  • Revise Date: 29 July 2021
  • Accept Date: 21 August 2021
  • First Publish Date: 30 August 2021