Classification
| Stage | Description |
|---|---|
| 1 | Benign, latent |
| 2 | Benign, active |
| 3 | Benign, aggressive |
| I | Malignant, low grade |
| II | Malignant, high grade |
| III | Distant metastasis |
- A is intracompartmental, B is extracompartmental
- AJCC staging is also used in MDT practice
Enneking margins
| Margin | Description |
|---|---|
| Intralesional | Plane through tumour, as in curettage |
| Marginal | Through the reactive zone, which may hold satellite cells |
| Wide | Tumour with reactive zone and normal cuff, skip lesions possible |
| Radical | Entire compartment removed |
Original publication Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980(153):106-20.
Investigations
- Biopsy is the last staging step, at the treating sarcoma centre
- MRI and staging before biopsy
- Core needle biopsy preferred, open incisional if non-diagnostic
- Tract planned along the future incision for en bloc excision
- Longitudinal limb incisions
- Single compartment through muscle, avoiding intermuscular planes, joints and neurovascular structures
- Sample the soft tissue component or leading edge
- Round or oval cortical window reduces fracture risk
- Drain in line with and close to the incision
- Send culture and use frozen section for adequacy
- Avoid excisional biopsy of suspected sarcoma
Management
- Benign latent lesions need intralesional treatment only
- Active and aggressive lesions need extended curettage with burr, phenol, liquid nitrogen or cement
- High grade sarcomas need a wide margin
- Fascia, periosteum and capsule are barriers allowing narrower margins
- Limb salvage gives survival equivalent to amputation with adequate margins
- Amputation for neurovascular encasement, fracture contamination, poor biopsy or infection
- Rotationplasty in young children around the knee
- Modular endoprostheses, expandable in skeletally immature patients
- Allograft, allograft-prosthesis composite, or vascularised fibula with allograft (Capanna)
- Recycled autograft, bone transport or arthrodesis
- Flaps and extensor mechanism reconstruction for soft tissue
Complications
- Infection, aseptic loosening and structural failure
- Allograft non-union and fracture
- Local recurrence and wound problems after radiotherapy
- Many patients need revision over their lifetime
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.