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 Oncology Test 1: Diagnosis and Surgical Technique
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The Journal of Bone and Joint Surgery (American) 85:1209-1214 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Tumors About the Knee Misdiagnosed as Athletic Injuries

D. Luis Muscolo, MD, Miguel A. Ayerza, MD, Arturo Makino, MD, Matías Costa-Paz, MD and Luis A. Aponte-Tinao, MD

Investigation performed at the Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Buenos Aires, Argentina

D. Luis Muscolo, MD
Miguel A. Ayerza, MD
Arturo Makino, MD
Matías Costa-Paz, MD
Luis A. Aponte-Tinao, MD
Institute of Orthopedics "Carlos E. Ottolenghi," Italian Hospital of Buenos Aires, Potosí 4215, 1199 Buenos Aires, Argentina. E-mail address for D.L. Muscolo: vgaiteiro{at}hitalba.edu.ar

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Read in part at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, Florida, March 19, 2000.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: Musculoskeletal tumors may originally mimic a traumatic condition, and, on the basis of an erroneous diagnosis of an athletic injury, an invasive diagnostic or therapeutic procedure may be performed. We determined the number of such cases treated at our institution, and we analyzed the initial and final diagnoses as well as the changes in the indicated oncologic surgical technique due to the initial erroneous diagnosis.

Methods: Twenty-five patients who had a bone or soft-tissue tumor about the knee that originally had been diagnosed as an athletic injury were referred to our institution. The complete clinical, radiographic, and pathological records were reviewed. Studies that had been performed prior to the invasive procedure and at the time of admission to our institution were evaluated to determine differences in the tumor stage and the oncologic treatment that was indicated at each time.

Results: Of 667 knee tumors diagnosed in our institution, twenty-five (3.7%) previously had been treated with an intra-articular procedure as a result of a misdiagnosis of an athletic injury. The final diagnoses made at our institution were a benign tumor in eleven patients and a malignant tumor in fourteen. Oncologic surgical treatment was affected in fifteen of the twenty-five patients.

Conclusions: When a knee tumor is initially misdiagnosed as an athletic injury, treatment may be adversely affected by the delay in diagnosis or an inappropriate invasive procedure that results in extension of the tumor. Initial poor-quality radiographs and an unquestioned original diagnosis despite persistent symptoms were the most frequent causes of an erroneous diagnosis.

Level of Evidence: Prognostic study, Level IV (case series). See Instructions to Authors for a complete description of levels of evidence.



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