Percutaneous Curettage and Local Autologous Cancellous Bone Graft: A Simple and Efficient Method of Treatment for Benign Bone Cysts

Document Type : RESEARCH PAPER


1 Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine- Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan

2 Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan


Background: Several treatment modalities have been reported to minimize the recurrence after surgical treatment of benign bone cysts. In this study, we evaluated local tumor control, recurrence rate, and bone healing of benign bone cysts after treatment with a simple technique, percutaneous curettage and a local autologous cancellous bone graft. Methods: Retrospective analysis of the records of 16 patients diagnosed with benign bone cysts between 2003 and 2010. We documented the demographic data, radiographic signs of healing (progressive decrease in radiolucency, remineralisation, ossification, consolidation of the cyst, and reconstitution of the bone), healing rate, postoperative complications, and recurrence. Results: Seven of the 16 patients (43.75%) were diagnosed with a simple bone cyst (SBC), while nine (56.25%) had an aneurysmal bone cyst (ABC). On average, radiographic signs of healing were present within 3–6 months, but in two patients these signs presented after 16 months. During the follow-up period, there was no difference in the healing rate between patients with SBC and ABC; no signs of deep or superficial wound infection, no postoperative fracture, and no recurrence in any case over an average of 6.3 years of follow-up. Conclusion: Treatment of benign bone cysts (SBC/ABC) with minimally invasive percutaneous curettage and a local autologous cancellous bone graft is a simple and effective modality with a promising outcome in the local control of recurrence and in enhancing bony consolidation. Level of evidence: IV


1. Gerasimov AM, Toporova SM, Furtseva LN, Berezhnoy AP, Vilensky EV, Alekseeva RI. The role of lysosomes in the pathogenesis of unicameral bone cysts. Clin Orthop Relat Res. 1991;(266):53-63.
2. Cottalorda J, Kohler R, Sales de Gauzy J, Chotel F, Mazda K, Lefort G, et al. Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review. J Pediatr Orthop B. 2004;13(6):389-394.
3. Steffner R. Benign bone tumors. Cancer Treat Res. 2014;162:31-63.
4. Flont P, Malecki K, Niewola A, Lipczyk Z, Niedzielski K. Predictive characteristic of simple bone cyst treated with curettage and bone grafting. BMC musculoskeletal disorders. 2015;16(1):1-6.
5. Wright JG, Yandow S, Donaldson S, Marley L, Simple Bone Cyst Trial Group. A randomized clinical trial comparing intralesional bone marrow and steroid injections for simple bone cysts. JBJS. 2008;90(4):722-30.
6. Kadhim M, Thacker M, Kadhim A, Holmes Jr L. Treatment of unicameral bone cyst: systematic review and meta analysis. Journal of children's orthopaedics. 2014;8(2):171-91.
7. Jamshidi K, Mirkazemi M, Izanloo A, Mirzaei A. Locking plate and fibular strut-graft augmentation in the reconstruction of unicameral bone cyst of proximal femur in the paediatric population. International orthopaedics. 2018;42(1):169-74.
8. Couto A, Sá Rodrigues A, Nunes B, Torres J, Gutierres M. Arthroscopic approach to simple bone cyst of the humeral head-a step toward a minimally invasive technique. JSES Open Access. 2018;2(4):211-214.
9. Aiba H, Kobayashi M, Waguri-Nagaya Y, Goto H, Mizutani J, Yamada S, et al. Treatment of simple bone cysts using endoscopic curettage: a case series analysis. J Orthop Surg Res. 2018;13(1):168.
10. Aiba H, Kobayashi M, Waguri-Nagaya Y, Goto H, Mizutani J, Yamada S, et al. Treatment of aneurysmal bone cysts using endoscopic curettage. BMC Musculoskelet Disord. 2018;19(1):268.
11. Koch G, Cazzato RL, Gilkison A, Caudrelier J, Garnon J, Gangi A. Percutaneous Treatments of Benign Bone Tumors. Semin
Intervent Radiol. 2018;35(4):324-332.
12. Park HY, Yang SK, Sheppard WL, Hegde V, Zoller SD, Nelson SD, et al. Current management of aneurysmal bone cysts. Curr Rev Musculoskelet Med. 2016;9(4):435-444.
13. Horstmann PF, Hettwer WH, Petersen MM. Treatment of benign and borderline bone tumors with combined curettage and bone defect reconstruction. J Orthop Surg (Hong Kong). 2018;26(3):2309499018774929.
14. Chen CJ, Brien EW. Early postoperative compilations of bone filling in curettage defects. Journal of orthopaedic surgery and research. 2019;14(1):1-2.
15. Rossi G, Mavrogenis AF, Facchini G, Bartalena T, Rimondi E, Renzulli M, et al. How effective is embolization with N-2-butyl-cyanoacrylate for aneurysmal bone cysts?. Int Orthop. 2017;41(8):1685-1692.
16. Oliveira MBDR, Meohas W, de Carvalho GS, Rodrigues RR, Oliveira FCR, de Sa Lopes AC, et al. Primary Aneurysmal Bone Cyst of Long Bones Treated with a Single Dose of Calcitonin and Methylprednisolone Percutaneous Intralesional Injection: A Case Series and Literature Review. J Orthop Oncol 2016; 3: 113.
17. Batisse F, Schmitt A, Vendeuvre T, Herbreteau D, Bonnard C. Aneurysmal bone cyst: A 19-case series managed by percutaneous sclerotherapy. Orthop Traumatol Surg Res. 2016;102(2):213-216.
18. Palmerini E, Ruggieri P, Angelini A, Boriani S, Campanacci D, Milano GM, et al. Denosumab in patients with aneurysmal bone cysts: A case series with preliminary results. Tumori. 2018;104(5):344-351.
19. Tsagozis P, Brosjö O. Current Strategies for the Treatment of Aneurysmal Bone Cysts. Orthop Rev (Pavia). 2015;7(4):6182.
20. Ulici A, Balanescu R, Topor L, Barbu M. The modern treatment of the simple bone cysts. J Med Life. 2012;5(4):469-473.
21. Cottalorda J, Kohler R, Chotel F, de Gauzy JS, Lefort G, Louahem D, et al. Recurrence of aneurysmal bone cysts in young children: a multicentre study. J Pediatr Orthop B. 2005;14(3):212-218.
22. Kaelin AJ, MacEwen GD. Unicameral bone cysts. Natural history and the risk of fracture. Int Orthop. 1989;13(4):275-282.
23. Capanna R, Campanacci DA, Manfrini M. Unicameral and aneurysmal bone cysts. Orthop Clin North Am. 1996;27(3):605-614.
24. Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res. 1986;(204):9-24.
25. Neer CS, Francis KC, Johnston AD, Kiernan HA Jr. Current concepts on the treatment of solitary unicameral bone cyst. Clin Orthop Relat Res. 1973;(97):40-51.
26. Gundle KR, Bhatt EM, Punt SE, Bompadre V, Conrad EU. Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort. Open Orthop J. 2017;11:486-492.
27. Benayahu D, Kletter Y, Zipori D, Wientroub S. Bone marrow-derived stromal cell line expressing osteoblastic phenotype in vitro and osteogenic capacity in vivo. J Cell Physiol. 1989;140(1):1-7.
28. Beresford JN. Osteogenic stem cells and the stromal system of bone and marrow. Clin Orthop Relat Res. 1989;(240):270-280.
29. Mylle J, Burssens A, Fabry G. Simple bone cysts. A review of 59 cases with special reference to their treatment. Arch Orthop Trauma Surg. 1992;111(6):297-300.
30. Reddy KI, Sinnaeve F, Gaston CL, Grimer RJ, Carter SR. Aneurysmal bone cysts: do simple treatments work?. Clin Orthop Relat Res. 2014;472(6):1901-1910.