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Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients.

ABSTRACT: Aneurysmal bone cysts are associated with a high rate of recurrence. Many aneurysmal bone cysts arise near open physes or articular cartilage in skeletally immature patients. Fear of damaging these structures could cause surgeons to curette the tumors less aggressively. We hypothesized location of an aneurysmal bone cyst in a periarticular or juxtaphyseal location would increase the risk of recurrence. We retrospectively studied 53 patients with aneurysmal bone cysts treated between 1989 and 2004. All patients had primary disease, and all patients underwent curettage of the lesion. Ten patients (18.9%) had local recurrence. Gender, race, and size did not predict recurrence; however 12 years of age or younger was associated with recurrence. Of the 19 juxtaphyseal cysts directly adjacent to an open physis, eight developed recurrence. Of the five periarticular cysts, two developed recurrence. The data suggest the risk of recurrence is highest in pediatric patients with juxtaphyseal or periarticular aneurysmal bone cysts. Meticulous treatment of these cysts is necessary, but we believe an overly aggressive approach that destroys the physis or articular cartilage is not warranted. Preservation of these structures remains a high priority of treatment.

SUBMITTER: Lin PP

PROVIDER: S-EPMC2505199 | biostudies-other | 2008 Mar

REPOSITORIES: biostudies-other

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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.

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Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients.

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