Dataset Information

Arthroscopic intralesional curettage for large benign talar dome cysts.

ABSTRACT:

Introduction

Surgical management of large talar dome cysts is challenging due to increased morbidity by associated cartilage damage and malleolar osteotomy. The purpose of this study is to evaluate the clinical and radiological outcome of endoscopic curettage and bone graft for large talar dome cysts.

Methods

This is a retrospective analysis of data for eight patients (eight feet) who were treated by arthroscopic curettage and grafting for large talar dome cysts. Seven cases were treated by posterior ankle arthroscopy as the lesion was located posteriorly while one case was treated by anterior ankle arthroscopy as the lesion was breached anteriorly.

Results

The final diagnosis, was; large osteochondral lesion of talus (two cases), aneurysmal bone cyst (ABC) (two case), intra-osseous ganglion (two cases), Chronic infection in talus (one case) and angiomatous lesion of the talus (one case). The mean follow up period was 18.3 (±3.06 SD) months (range 16-25 months). The median preoperative AOFAS score was 74.5 (±5.34 SD) points. The mean postoperative AOFAS score at one year follow up was 94.6 (±2.97 SD) points. None of the patient had recurrence of the lesion during follow up. Return to normal daily activity was achieved at 11.25 (±2.37 SD) weeks.

Discussion

In this short case series study, large talar dome bony cysts of different pathologies including aneurysmal bone cysts could be treated effectively by endoscopic curettage and bone grafting with no recurrence no complications during the follow-up period.

SUBMITTER: El Shazly O

PROVIDER: S-EPMC4849243 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Publications

Arthroscopic intralesional curettage for large benign talar dome cysts.

El Shazly Ossama O Abou El Soud Maged M MM Nasef Abdelatif Nasef Mohamed NM

SICOT-J 20151201

<h4>Introduction</h4>Surgical management of large talar dome cysts is challenging due to increased morbidity by associated cartilage damage and malleolar osteotomy. The purpose of this study is to evaluate the clinical and radiological outcome of endoscopic curettage and bone graft for large talar dome cysts.<h4>Methods</h4>This is a retrospective analysis of data for eight patients (eight feet) who were treated by arthroscopic curettage and grafting for large talar dome cysts. Seven cases were ...[more]

PMID: 27163087

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Project description:BackgroundAlthough aneurysmal bone cysts (ABCs) are benign tumours, they have the potential to be locally aggressive. Various treatment approaches, such as en bloc resection, open curettage, radiotherapy, sclerotherapy, and embolization have been proposed, but the most appropriate treatment should be selected after considering the risk of tumour recurrence and treatment complications. Endoscopic curettage (ESC) may be a less invasive alternative to open curettage for ABC treatment. We aimed to describe the use of ESC for the treatment of ABCs and to report our clinical outcomes, including the incidence rate of recurrence, radiological appearance at final follow-up, time to solid union, complications, and postoperative function.MethodsBetween 1998 and 2015, 30 patients (18 men and 12 women; mean age, 17.4 years) underwent ESC for the treatment of primary ABCs at our hospital (mean postoperative follow-up, 55 months). ESC was performed under arthroscopic guidance for direct visualization, and curettage extended until normal bone was observed in the medullary cavity. To investigate bone healing after ESC, we evaluated the consolidation of cysts at the final evaluation (based on the modified Neer classification) and time to solid union after surgery, which was defined as sufficient cortical bone thickness to prevent fracture and allow physical activities.ResultsRecurrence was identified in 3 cases (10%). Curative outcomes were obtained after repeated ESC or open curettage. A log-rank analysis indicated that age < 10 years (p = 0.004) and contact of the tumour with the physis (p = 0.01) increased the risk of tumour recurrence. Residual tumours were identified in 9 cases (30%); these lesions remained inactive over the extended follow-up period. The average time to solid union after endoscopic curettage was 3.2 months. Transient radial nerve palsy was identified in 1 case. Good postoperative functional recovery occurred in all cases.ConclusionsESC is a minimally invasive technique for the treatment of ABCs, and the tumour recurrence rate is comparable to that of other standard procedures. However, the application of this method should be carefully considered, especially for patients < 10 years and when the tumour comes in contact with the physis.

Project description:AimsIntralesional curettage is a commonly used treatment for primary bone tumors. However, local recurrence of tumors after curettage remains a major challenge.Questions(1) Is blood pressure related to local recurrence after intralesional curettage for benign or intermediate bone tumors? (2) What's the impact of tourniquet usage on the risk of recurrence from high blood pressure?MethodsThis retrospective study evaluated patients receiving intralesional curettage for primary bone tumors from January 2011 to January 2015. A total of 411 patients with a minimum five-year follow-up were included for analysis. Demographic and disease-related variables were first assessed in univariable analyses for local recurrence risk. When a yielded p-value was < 0.2, variables were included in multivariable analyses to identify independent risk factors for local recurrence. Patients were then stratified by tourniquet usage (use/non-use), and risk from high blood pressure was evaluated in both subgroups.ResultsAt an average follow-up of 6.8 ± 1.0 years, 63 of 411 patients (15.3%) experienced local recurrence. In multivariable analyses, local recurrence was associated with age (OR, 0.96; 95% CI, 0.94-0.99; p = 0.005); tumor type; lesion size (> 5 cm: OR, 3.58; 95% CI, 1.38-9.33; p = 0.009); anatomical site (proximal femur: OR, 2.49; 95% CI, 1.21-5.15; p = 0.014; proximal humerus: OR, 3.34; 95% CI, 1.61-6.92; p = 0.001); and preoperative mean arterial pressure (> 110 mmHg: OR, 2.61; 95% CI, 1.20-5.67; P = 0.015). In subgroup analyses, after adjusting for age, tumor type, lesion size, and anatomical site, tourniquet use modified the preoperative mean arterial pressure - recurrence relationship: when tourniquet was not used, preoperative mean arterial pressure predicted local recurrence (95-110 mmHg, 4.13, 1.42-12.03, p = 0.009; > 110 mmHg, 28.06, 5.27-149.30, p < 0.001); when tourniquet was used, preoperative mean arterial pressure was not related to local recurrence (all p values > 0.05).ConclusionsA high preoperative blood pressure was related to local recurrence after intralesional curettage for primary bone tumors in our study. Tourniquet usage and controlling blood pressure might be beneficial for reducing local recurrence in patients scheduled to receive intralesional curettage for primary bone tumor treatment.Level of evidenceLevel IV, hypothesis-generating study.

Dataset Information

Arthroscopic intralesional curettage for large benign talar dome cysts.

Introduction

Methods

Results

Discussion

Publications

Arthroscopic intralesional curettage for large benign talar dome cysts.

Similar Datasets

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