Management of Tibial Adamantinoma: Balancing Oncologic Cure and Reconstructive Longevity

Well-differentiated tibial adamantinoma is a rare, low-grade malignant bone tumor primarily located in the anterior portion of the proximal two-thirds of the tibia and characterized by a biphasic histology. Because of its significant resistance to both radiotherapy and systemic chemotherapy, achieving local control and long-term survival strictly relies on surgical intervention. To evaluate these interventions, a review of English-language literature across PubMed/MEDLINE, Google Scholar, and the Cochrane Library was conducted, focusing on long-term retrospective studies, multicenter series, and case reports. This review assesses oncological and functional outcomes, specifically analyzing the incidence of late tumor recurrence and the durability of complex limb-salvage reconstructive procedures. The literature indicates that en bloc resection with wide safety margins remains the treatment of choice, demonstrating a significantly lower rate of local recurrence compared to intralesional curettage. Although the 10-year overall survival rate is highly favorable, adamantinoma exhibits a characteristically prolonged latency period, with local recurrences and pulmonary or lymphatic metastases commonly emerging 15 to 20 years postoperatively. Furthermore, the extensive intercalary tibial defects resulting from wide resections pose substantial reconstructive challenges. Long-term complications - such as aseptic non-union, deep infection, and progressive structural graft fatigue - are common in limb-salvage constructs utilizing massive structural allografts, vascularized fibular autografts, or hybrid techniques, often necessitating multiple complex revision surgeries. Ultimately, while en bloc resection offers the most consistent oncologic cure despite its reconstructive complexity, effective long-term management mandates lifelong monitoring for delayed metastasis alongside proactive surveillance for mechanical failure in limb-salvage reconstructions.