Ten Years of Atypical Cartilaginous Tumors—Is Curettage Really Enough?

<b>Background</b>: Atypical cartilaginous tumors (ACT), formerly classified as Grade 1 chondrosarcomas (CS1) of the extremities, are hyaline cartilage-producing neoplasms. The WHO classification (4th edition, 2013) redefined ACT as locally aggressive rather than malignant tumors, prompting a shift toward less aggressive surgical management. This study reports data of a single, tertiary musculoskeletal tumor center and compares the long-term oncological outcomes of wide resections and intralesional curettage for primary ACT. <b>Methods</b>: This retrospective study included 61 patients with ACT treated at a tertiary tumor center between 2003 and 2023. Patients were divided into two cohorts: Cohort 1 was treated before 2013 with wide or radical resection, while cohort 2 was treated with an intralesional approach. Data on recurrence, revision rates, survival, and predictors of outcomes were analyzed using Kaplan-Meier survival analysis and log-rank testing. <b>Results</b>: Wide resections were performed in 24 patients, requiring prosthetic reconstruction in 76% of cases. Intralesional curettage was performed in 37 patients. Local recurrence occurred in 8% in wide resections versus 16% of curettage cases (<i>p</i> = 0.198), with no significant difference in time to recurrence between cohorts. Unplanned revision rates were higher in the wide resection group (42%) compared to curettage (35%), driven primarily by prosthesis-related complications. Overall survival was high in both groups (88% in wide resections vs. 94% in curettage; <i>p</i> = 0.705). Resection margins, and metastases were identified as significant predictors of both recurrence and tumor-related death. <b>Conclusions</b>: Intralesional curettage provides comparable oncological outcomes to wide resections with reduced morbidity, supporting its use as the preferred treatment for ACT in appropriately selected patients.