Open resection of 24 patients with diffuse tenosynovial giant cell tumor of the ankle and evaluation of long-term follow-up

Abstract Background: Ankle tendon sheath giant cell tumor (TSGCT) is one of the ankle's most common soft tissue tumors. Among these tumors, diffuse tendon sheath giant cell tumor (D-TSGCT) has a low incidence rate but a high treatment recurrence rate and often affects ankle joint function and quality of life. The present study investigated patients' clinical characteristics, recurrence rate, complications, and postoperative function. Methods: Twenty-four patients treated with open resection of ankle D-TSGCTs between 2011 and 2018 were retrospectively analyzed. Basic patient information, clinical case information, lesion site, treatment method, recurrence rate, function, and other evaluations were collected. The follow-up period ranged from 60-113 months, with a mean of 75.7 months. Results: Of the 24 patients, 10 (41.7%) were male and 14 (58.3%) were female. The mean age was 36.5 years (range 24-53 years). The most common symptom was a palpable mass, followed by a visit to the clinic (54.2%), and the second most common symptom was ankle swelling and discomfort (29.2%). Postoperatively, 4 patients (17%) experienced pain in the surgical area, and 3 patients (12.5%) experienced ankle instability. Tumor recurrence was observed in 5 of 24 patients (21%).The American College of Foot and Ankle Surgeons (AOFAS) score (preoperative, 78.5±5.6; postoperative, 85.8±5.0; P<0.0001) was significantly different from the Musculoskeletal Tumor Society (MSTS) score (preoperative, 66.8±9%; postoperative, 84.6±8.8%; P<0.0001)—the ankle joint functional assessment scale (AJFAT) score (preoperative, 34.0±4.1; postoperative, 33.1±5.8%; P=0.1187). The difference between the Foot and Ankle Function Scale (FAAM) score and physical activity score was not statistically significant (preoperative, 76.1±4.5; postoperative, 76.9±4.4; preoperative, 23.8±2.5; and preoperative, 25.0±2.9; P>0.05). Conclusions: Surgical treatment of ankle D-TSGCT requires clearing the location of the lesion and the degree of diffusion and selecting an appropriate surgical approach to maximize the preservation of ankle function while reducing the recurrence rate. However, complete resection by the naked eye alone may destroy ankle joint stability, and postoperative follow-up and rehabilitation training should be considered.