Tumor grade is graded in a low risk of distant spread (<25%)

- Low mitotic rate

- Low nuclear to cytoplasmic ratio
- Limited pleomorphism
Limitations :

The Enneking surgical staging system is based on the natural evolution of mesenchymal tumors and thus
is not applicable to tumors originating in either the marrow or reticuloendothelial system. These include
lymphomas, multiple myeloma, plasmacytoma, Ewing’s sarcoma, other round cell neoplasms, and
metastatic carcinomas. Lesions originating in the skull also behave differently and thus cannot be staged
or classified using this system.

Larger lesions may be more likely to metastasize and may benefit from adjuvant chemotherapy [10]. The
Enneking surgical staging system does not consider this important factor. This parameter is accounted for
in the AJCC staging system for soft tissue sarcomas, but this classification lacks consideration of
anatomic boundaries. Ideally, a combination of the staging systems may provide a stronger instrument
than either alone.

the Enneking surgical staging system does not take into account the presence of a continuous epidural
compartment, neurologic implication of sacrificing the spinal cords and roots, and need for restoring spinal
stability. Use of this system along with the Weinstein-Boriani-Biagini (WBB) classification has been
studied for spinal tumors and appears to be safe and feasible and to improve disease control and
survival, although both systems show only moderate interobserver reliability and additional studies are
warranted [1].

ACL
ACL is a femorotibial joint of the anterior structure consisting of a strong band made of connective tissue
and collagenous fibers that originate from the anteromedial aspect of the intercondylar region of the tibial
plateau and extends posteromedially to attach to the lateral femoral condyle.
The most at-risk athletes for noncontact injury include skiers, soccer players, and basketball
players, while the most at-risk athletes for contact injury are football players.

- When engaging the quadriceps musculature while slowing down, this places abnormally
increased stress on the ACL,
- female athletes are more likely to place their knees in increased valgus angulations when
changing directions suddenly, which increased the stress on the ACL ligament.

complain of hearing and feeling a sudden “pop” and feel that their knee “gives out” from under
them at the time of injury. Other symptoms include tenderness along the joint line, pain, and
swelling, decreased or loss of range of motion, and difficulty ambulating.

Pemfis

NCOA 311

Acute treatment consists of the “RICE” therapy, which includes rest, ice, compression of the
affected knee, and elevation of the affected lower extremity. Patients should be non-weight
bearing and may utilize crutches or a wheelchair if necessary. Pain relief can be achieved with
over-the-counter medications such as NSAIDs but is typically at the treating physician's
discretion.