Clinical Orthopaedics and Related Research

, Volume 466, Issue 10, pp 2519–2526 | Cite as

Unicameral Bone Cyst: A Retrospective Study of Three Surgical Treatments

  • Anthony D. Sung
  • Megan E. Anderson
  • David Zurakowski
  • Francis J. Hornicek
  • Mark C. Gebhardt
Original Article


Between 1979 and 2004, 167 patients younger than 20 years were treated surgically for humeral or femoral unicameral bone cysts with either injection of corticosteroids (steroids), curettage plus bone grafting (curettage), or a combination injection of steroids, demineralized bone matrix, and bone marrow aspirate (SDB) at Children’s Hospital of Boston and Massachusetts General Hospital (mean followup, 7.3 years; range, 1 month–27 years). Outcomes included treatment failure (defined clinically as subsequent pathologic fracture or need for retreatment to prevent pathologic fracture) and complications. Information was obtained from medical records and by telephone questionnaire. After one treatment, 84% of cysts treated with steroids experienced failed treatment versus 64% with curettage and 50% with SDB. For unicameral bone cysts requiring retreatment (regardless of first treatment), 76% retreated with steroids had failed treatment versus 63% with curettage and 71% with SDB. Curettage was associated with the lowest rate of posttreatment pathologic fractures and highest rate of pain and other complications. Multivariate logistic regression indicated treatment with steroids alone and younger age were independent predictors of failure. We believe SDB is a reasonable first treatment for unicameral bone cysts in the humerus and femur in patients younger than 20 years, being less invasive yet comparable to curettage in preventing recurrence.

Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.



We thank Kevin A. Raskin, MD, and Henry J. Mankin, MD, for valuable help and assistance.


  1. 1.
    Ahn JI, Park JS. Pathological fractures secondary to unicameral bone cysts. Int Orthop. 1994;18:20–22.PubMedCrossRefGoogle Scholar
  2. 2.
    Altman DG. Practical Statistics for Medical Research. London, UK: Chapman and Hall; 1991:371–384.Google Scholar
  3. 3.
    Bumci I, Vlahovic T. Significance of opening the medullar canal in surgical treatment of simple bone cyst. J Pediatr Orthop. 2002;22:125–129.PubMedCrossRefGoogle Scholar
  4. 4.
    Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986;204:25–36.PubMedGoogle Scholar
  5. 5.
    Chang C, Stanton RP, Glutting J. Unicameral bone cysts treated by injection of bone marrow or methylprednisolone. J Bone Joint Surg Br. 2002;84:407–412.PubMedCrossRefGoogle Scholar
  6. 6.
    Chigira M, Maehara S, Arita S, Udagawa E. The aetiology and treatment of simple bone cysts. J Bone Joint Surg Br. 1983;65:633–637.PubMedGoogle Scholar
  7. 7.
    Chigira M, Shimizu T, Arita S, Watanabe H, Heshiki A. Radiological evidence of healing of a simple bone cyst after hole drilling. Arch Orthop Trauma Surg. 1986;105:150–153.PubMedCrossRefGoogle Scholar
  8. 8.
    Cohen J. Simple bone cysts: studies of cyst fluid in six cases with a theory of pathogenesis. J Bone Joint Surg Am. 1960;42:609–616.PubMedGoogle Scholar
  9. 9.
    Cohen J. Intramedullary nailing for the treatment of unicameral bone cysts. J Bone Joint Surg Am. 2001;83:1279–1280.PubMedGoogle Scholar
  10. 10.
    de Palma L, Santucci A. Treatment of bone cysts with methylprednisolone acetate: a 9 to 11 year follow-up. Int Orthop. 1987;11:23–28.PubMedCrossRefGoogle Scholar
  11. 11.
    de Sanctis N, Andreacchio A. Elastic stable intramedullary nailing is the best treatment of unicameral bone cysts of the long bones in children?: prospective long-term follow-up study. J Pediatr Orthop. 2006;26:520–525.PubMedGoogle Scholar
  12. 12.
    Fahey JJ, O’Brien ET. Subtotal resection and grafting in selected cases of solitary unicameral bone cyst. J Bone Joint Surg Am. 1973;55:59–68.PubMedGoogle Scholar
  13. 13.
    Farber JM, Stanton RP. Treatment options in unicameral bone cysts. Orthopedics. 1990;13:25–32.PubMedGoogle Scholar
  14. 14.
    Garceau GJ, Gregory CF. Solitary unicameral bone cyst. J Bone Joint Surg Am. 1954;36:267–280.PubMedGoogle Scholar
  15. 15.
    Gebhart M, Blaimont P. Contribution to the vascular origin of the unicameral bone cyst. Acta Orthop Belg. 1996;62:137–143.PubMedGoogle Scholar
  16. 16.
    Harris EK, Albert A. Survivorship Analysis for Clinical Studies. New York, NY: Marcel Dekker; 1991:29–49.Google Scholar
  17. 17.
    Hosmer DW, Lemeshow S. Applied Logistic Regression. 2nd ed. New York, NY: John Wiley and Sons; 2000:11–64.Google Scholar
  18. 18.
    Jaffe HL, Lichtenstein L. Solitary unicameral bone cyst: with emphasis on the roentgen picture, the pathologic appearance and the diagnosis. Arch Surg. 1942;4:1004–1025.Google Scholar
  19. 19.
    Kanellopoulos AD, Yiannakopoulos CK, Soucacos PN. Percutaneous reaming of simple bone cysts in children followed by injection of demineralized bone matrix and autologous bone marrow. J Pediatr Orthop. 2005;25:671–675.PubMedCrossRefGoogle Scholar
  20. 20.
    Katz MH. Multivariable Analysis: A Practical Guide for Clinicians. 2nd ed. New York, NY: Cambridge University Press; 2006:96–136.Google Scholar
  21. 21.
    Killian JT, Wilkinson L, White S, Brassard M. Treatment of unicameral bone cyst with demineralized bone matrix. J Pediatr Orthop. 1998;18:621–624.PubMedCrossRefGoogle Scholar
  22. 22.
    Komiya S, Minamitani K, Sasaguri Y, Hashimoto S, Morimatsu M, Inoue A. Simple bone cyst: treatment by trepanation and studies on bone resorptive factors in cyst fluid with a theory of its pathogenesis. Clin Orthop Relat Res. 1993;287:204–211.PubMedGoogle Scholar
  23. 23.
    Lokiec F, Ezra E, Khermosh O, Wientroub S. Simple bone cysts treated by percutaneous autologous marrow grafting: a preliminary report. J Bone Joint Surg Br. 1996;78:934–937.PubMedCrossRefGoogle Scholar
  24. 24.
    Mackley JT, Joyce MJ. Unicameral bone cyst (simple bone cyst). Orthop Clin North Am. 1989;20(3):407–415.Google Scholar
  25. 25.
    McKay DW, Nason SS. Treatment of unicameral bone cysts by subtotal resection without grafts. J Bone Joint Surg Am. 1977;59:515–519.PubMedGoogle Scholar
  26. 26.
    Mirra JM, Bernard GW, Bullough PG, Johnston W, Mink G. Cementum-like bone production in solitary bone cysts (so-called “cementoma” of long bones): report of three cases. Electron microscopic observations supporting a synovial origin to the simple bone cyst. Clin Orthop Relat Res. 1978;135:295–307.Google Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Neer CS 2nd, Francis KC, Marcove RC, Terz J, Carbonara PN. Treatment of unicameral bone cyst: a follow-up study of one hundred seventy-five cases. J Bone Joint Surg Am. 1966;48:731–745.Google Scholar
  29. 29.
    Oppenheim WL, Galleno H. Operative treatment versus steroid injection in the management of unicameral bone cysts. J Pediatr Orthop. 1984;4:1–7.PubMedGoogle Scholar
  30. 30.
    Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.PubMedCrossRefGoogle Scholar
  31. 31.
    Roposch A, Saraph V, Linhart WE. Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones. J Bone Joint Surg Am. 2000;82:1447–1453.PubMedGoogle Scholar
  32. 32.
    Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow. J Bone Joint Surg Am. 2002;84:921–929.PubMedGoogle Scholar
  33. 33.
    Santori F, Ghera S, Castelli V. Treatment of solitary bone cysts with intramedullary nailing. Orthopedics. 1988;11:873–878.PubMedGoogle Scholar
  34. 34.
    Scaglietti O, Marchetti PG, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clin Orthop Relat Res. 1982;165:33–42.PubMedGoogle Scholar
  35. 35.
    Shindell R, Huurman WW, Lippiello L, Connolly JF. Prostaglandin levels in unicameral bone cysts treated by intralesional steroid injection. J Pediatr Orthop. 1989;9:516–519.PubMedGoogle Scholar
  36. 36.
    Shinozaki T, Arita S, Watanabe H, Chigira M. Simple bone cysts treated by multiple drill-holes: 23 cysts followed 2–10 years. Acta Orthop Scand. 1996;67:288–290.PubMedCrossRefGoogle Scholar
  37. 37.
    Snyder BD, Hauser-Kara DA, Hipp JA, Zurakowski D, Hecht AC, Gebhardt MC. Predicting fracture through benign skeletal lesions with quantitative computed tomography. J Bone Joint Surg Am. 2006;88:55–70.PubMedCrossRefGoogle Scholar
  38. 38.
    Spence KF, Sell KW, Brown RH. Solitary bone cyst: treatment with freeze-dried cancellous bone allograft: a study of one hundred seventy-seven cases. J Bone Joint Surg Am. 1969;51:87–96.PubMedGoogle Scholar
  39. 39.
    Spence KF Jr, Bright RW, Fitzgerald SP, Sell KW. Solitary unicameral bone cysts: treatment with freeze-dried crushed cortical-bone allograft: a review of one hundred and forty-four cases. J Bone Joint Surg Am. 1976;58:636–641.PubMedGoogle Scholar
  40. 40.
    Virchow R. Uber die Bildung von Knochencysten. Monatsberichte der Koniglich Preussischen Akademie der Wissenschafen. 1876;Suppl:369–381.Google Scholar
  41. 41.
    Wilkins RM. Unicameral bone cysts. J Am Acad Orthop Surg. 2000;8:217–224.PubMedGoogle Scholar
  42. 42.
    Yandow SM, Lundeen GA, Scott SM, Coffin C. Autogenic bone marrow injections as a treatment for simple bone cyst. J Pediatr Orthop. 1998;18:616–620.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Anthony D. Sung
    • 1
  • Megan E. Anderson
    • 2
    • 3
    • 4
  • David Zurakowski
    • 3
  • Francis J. Hornicek
    • 5
  • Mark C. Gebhardt
    • 3
    • 4
  1. 1.Harvard Medial SchoolBostonUSA
  2. 2.BostonUSA
  3. 3.Children’s Hospital BostonBostonUSA
  4. 4.Beth Israel Deaconess Medical CenterBostonUSA
  5. 5.Massachusetts General HospitalBostonUSA

Personalised recommendations