Removing A Giant Cell Tumor From The Anterior Talofibular Ligament

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Steven Yager, DPM, FACFAS, and Barbara Lee, DPM

   During nine months of postoperative follow-up, the patient showed no complications of the right ankle. Almost one year after the surgery, the patient presented with pain in the right ankle again and with tenderness over the anterior talofibular ligament. I ordered a new MRI. However, the patient did not go for study and was lost in follow-up.

What The Literature Reveals About Giant Cell Tumors

A giant cell tumor is a fairly common bone tumor that accounts for about 5 percent of all the primary bone tumors. It is a benign tumor that has a high chance of recurrence. The recurrence may be due to an initial incomplete excision of the tumor. The giant cell tumor occurs most commonly in the fingers, occurring less in the ankle.5 According to one study, there was no recurrence after the surgery and no cases of malignancy in the 15 cases that were available for long-term follow-up.5 The clinical picture may present as an insidious onset of pain with a history of trauma, which one may misdiagnose as an ankle sprain.

   Although there is one documented case involving arthroscopic resection of an extra-articular tenosynovial giant cell tumor from the ankle, we chose to open up the ankle to remove the granuloma.6 This also allowed us to repair the ligament. There are articles on giant cell tumor of the tendon sheath in the ankle but to our knowledge, no giant cell tumor of the tendon sheath has been associated with anterior talofibular ligament.5-7

   Dr. Yager is a Fellow of the American College of Foot and Ankle Surgeons. He is in private practice at the New York Foot and Ankle Institute.

   Dr. Lee is a third-year resident at the Mount Sinai Hospital Podiatric Residency Program in New York City.

1. Askoy B, Erturer E, Toker S, Seckin F, Sener B. Tenosynovial giant cell tumour of the posterior cruciate ligament and its arthroscopic treatment. Singapore Med J. 2009; 50(6):e204-5.

2. Singh PJ, Constable L, O'Donnell J. Arthroscopic excision of a giant-cell tumour of the ligamentous teres. J Bone Joint Surg Br. 2009; 91(6):809-11.

3. Carls J, Kohn D, Maschek H. Benign giant-cell tumor of the patellar ligament. Arthroscopy. 1998; 14(1):94-8.

4. Otsuka Y, Mizuta H, Nakamura E, Kudo S, Inoue S, Takagi K. Tenosynovial giant-cell tumor arising from the cruciate ligament of the knee. Arthroscopy. 1996; 12(4):496-9.

5. Gibbons C, Khwaja H, Cole A, Cooke P, Athanasou N. Giant cell tumour of the tendon sheath in the Foot and Ankle. J Bone Joint Surg (Br) 2002; 84(7):1000-1003.

6. Spahn G, Bousseljot F, Schulz HJ, Bauer T. Arthroscopic resection of an extra-articular tenosynovial giant cell tumor from the ankle region arthroscopy. Arthroscopy. 2003; 19(7):55-58.

7. Illian C, Kortmann HR, Kunstler HO, et al. Tenosynovial giant cell tumors as accidental findings after episodes of distortion of the ankle: two case reports. J Med Case Rep 2009; 3:9331

8. Sharma S, Wani IH, Gupta N, et al. Giant cell tumor of talus: a case report. Cases J. 2009; 2(1):74.

9. Banks A, Downey M, Martin D, Miller S. Tumors of the foot and Ankle. McGlamry's Comprehensive Textbook Of Foot And Ankle Surgery 3rd edition. Lippincott, Philadelphia, 2004, pp. 1414-1416, 1559.

10. Darwish FM, Haddad WH. Giant cell tumour of tendon sheath: experience with 52 cases. Singapore Med J. 2008; 49(11):879-82.

11. Vasconez HC, Nisanci M, Lee EY. Giant cell tumour of the flexor tendon sheath of the foot. J Plast Reconstr Aesthet Surg. 2008; 61(7):815-8.

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