≥5 cm Tumor with Cortical Breach Predicts Recurrence and Distinguishes ACT from Enchondroma in Long Bones

A maximum tumor diameter of ≥5 cm and cortical bone destruction can be considered important predictive factors for local recurrence, and they may also assist in differentiating between atypical cartilaginous tumors (ACTs) and enchondromas. Based on our findings, we are more inclined to consider lesions ≥5 cm as ACTs, particularly when accompanied by cortical destruction, as these features suggest a more aggressive biological behavior. Therefore, we recommend performing extended curettage combined with intraoperative electrocautery or other effective local adjuvant techniques in such cases to achieve adequate tumor control and reduce the risk of recurrence.