A 15-year-old presents with nocturnal knee pain relieved by aspirin. X-ray shows a 10 mm radiolucent nidus surrounded by dense reactive bone sclerosis in the proximal tibial cortex. CT confirms a central mineralised nidus. What is the best minimally invasive treatment?

• A CT-guided radiofrequency ablation (RFA) of the nidus ✓
• B Wide surgical excision with 2 cm margins
• C Long-term NSAID therapy without ablation
• D Intralesional curettage and bone grafting

Explanation

Osteoid osteoma is characterised by a vascular nidus <2 cm with surrounding reactive sclerosis, causing prostaglandin-mediated nocturnal pain classically relieved by NSAIDs. CT-guided radiofrequency ablation (RFA) is now the treatment of choice due to its accuracy (targeting the nidus precisely under CT guidance), minimal morbidity, outpatient procedure, >90% success rate, and rapid pain resolution. Wide resection is excessive for a benign lesion; long-term NSAIDs only suppress symptoms without cure; intralesional curettage requires more extensive surgery and has higher recurrence if the nidus is incompletely removed.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.