Abstract
Introduction
Recent literature indicates that calcaneal bone cysts have different clinical features compared to long bone cysts. Yet, previous studies have mainly focused on pathogenesis of long bone cysts. In this study, the pathogenesis of calcaneal bone cysts was investigated from radiological and pathological findings.
Materials and methods
Patients comprised 18 males and 6 females diagnosed with calcaneal bone cysts at a median age ± standard deviation of 13.0 ± 3.6 years. Plain radiographs, computed tomography, magnetic resonance imaging, cystography, bone scintigraphy, and pathology were reviewed.
Results
All cysts occupied the central triangular area of the bone, with six extending posteriorly and two developing anteriorly. Fifteen of 20 cases (75%) showed the expanded foramen structures at the anterior margin of the posterior facet. According to cystography, four cysts showed absence of leakage to subtalar joint. Cystic fluid caused chronic haemorrhaging in 18 cases and pathologically detected cholesterol clefts were noted in 14 cases.
Discussion
The location of the expanded foramen structures was consistent with the nutrient foramens of the sinus tarsi artery in the unaffected population. Hence, initial cysts may originate from the collapse of the sinus tarsi artery. Subsequent haemorrhage may extend into the central triangle area, which is biomechanically free of stress. Because of poor bone remodelling, degenerative change of the haemorrhage is prolonged. The results of this study showed that circulation collapse of the sinus tarsi artery and mechanical factors are important in the formation of calcaneal bone cysts.
Similar content being viewed by others
References
Kadhim M, Thacker M, Kadhim A, Holmes L Jr (2014) Treatment of unicameral bone cyst: systematic review and meta analysis. J Child Orthop 8:171–191
Polat O, Sağlik Y, Adigüzel HE, Arikan M, Yildiz HY (2009) Our clinical experience on calcaneal bone cysts: 36 cysts in 33 patients. Arch Orthop Trauma Surg 129:1489–1494
Pogoda P, Priemel M, Linhart W, Stork A, Adam G, Windolf J, Rueger JM, Amling M (2004) Clinical relevance of calcaneal bone cysts: a study of 50 cysts in 47 patients. Clin Orthop Relat Res 424:202–210
Takada J, Hoshi M, Oebisu N, Ieguchi M, Kakehashi A, Wanibuchi H, Nakamura H (2014) A comparative study of clinicopathological features between simple bone cysts of the calcaneus and the long bone. Foot Ankle Int 35:374–382
Cohen J (1960) Simple bone cysts Studies of cyst fluid in six cases with a theory of pathogenesis. J Bone Jt Surg Am 42-A:609–616
Cohen J (1970) Etiology of simple bone cyst. J Bone Jt Surg Am 52:1493–1497
Diard F, Hauger O, Moinard M, Brunot S, Marcet B (2007) Pseudo-cysts, lipomas, infarcts and simple cysts of the calcaneus: are there different or related lesions? JBR-BTR 9:315–324
Neer CS 2nd, Francis KC, Marcove RC, Terz J, Carbonara PN (1966) Treatment of unicameral bone cyst. A follow-up study of one hundred seventy-five cases. J Bone Jt Surg Am 48:731–745
Mirra JM, Bernard GW, Bullough PG, Johnston W, Mink G (1978) 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 135:295–307
Chigira M, Maehara S, Arita S, Udagawa E (1983) The aetiology and treatment of simple bone cysts. J Bone Jt Surg Br 65:633–637
Vasilev V, Andreeff I, Sokolov T, Vidinov N (1987) Clinical-morphological and electron-microscopic studies of the growth plate in solitary bone cysts. Arch Orthop Trauma Surg 106:232–237
Gerasimov AM, Toporova SM, Furtseva LN, Berezhnoy AP, Vilensky EV, Alekseeva RI (1991) The role of lysosomes in the pathogenesis of unicameral bone cysts. Clin Orthop Relat Res 266:53–63
Komiya S, Minamitani K, Sasaguri Y, Hashimoto S, Morimatsu M, Inoue A (1993) 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 287:204–211
Komiya S, Tsuzuki K, Mangham DC, Sugiyama M, Inoue A (1994) Oxygen scavengers in simple bone cysts. Clin Orthop Relat Res 308:199–206
Komiya S, Kawabata R, Zenmyo M, Hashimoto S, Inoue A (2000) Increased concentrations of nitrate and nitrite in the cyst fluid suggesting increased nitric oxide synthesis in solitary bone cysts. J Orthop Res 18:281–288
Yu J, Chang SS, Suratwala S, Chung WS, Abdelmessieh P, Lee HJ, Yang J, Lee FY (2005) Zoledronate induces apoptosis in cells from fibro-cellular membrane of unicameral bone cyst (UBC). J Orthop Res 23:1004–1012
Ramirez A, Abril JC, Touza A (2012) Unicameral bone cyst: radiographic assessment of venous outflow by cystography as a prognostic index. J Pediatr Orthop B 21:489–494
Aarvold A, Smith JO, Tayton ER, Edwards CJ, Fowler DJ, Gent ED, Oreffo RO (2012) The role of osteoblast cells in the pathogenesis of unicameral bone cysts. J Child Orthop 6:339–346
Smith RW, Smith CF (1974) Solitary unicameral bone cyst of the calcaneus. A review of twenty cases. J Bone Jt Surg Am 56:49–56
Van Linthoudt D, Lagier R (1978) Calcaneal cysts. A radiological and anatomico-pathological study. Acta Orthop Scand 49:310–316
Andermahr J, Jubel A, Prokop A, Kasper HU, Eisner A, Rehm KE, Koebke J (2004) The calcaneal cyst—pathogenesis and intraosseous vascularization of the calcaneus. Fuß Sprunggelenk 2:219–225
Elias I, Zoga AC, Raikin SM, Schweitzer ME, Morrison WB (2007) Incidence and morphologic characteristics of benign calcaneal cystic lesions on MRI. Foot Ankle Int 28:707–714
Andermahr J, Helling HJ, Rehm KE, Koebke Z (1999) The vascularization of the os calcaneum and the clinical consequences. Clin Orthop Relat Res 363:212–218
Jaffe H, Lichtenstein L (1942) Solitary unicameral bone cyst. With emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg 44:1004–1025
Dota T, Nakamura K, Saheki M, Sasaki Y (1963) Cholesterol granuloma. Ann Otol 72:346–356
Acknowledgements
None.
Funding
There is no funding source.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hoshi, M., Oebisu, N., Iwai, T. et al. Possible pathogenesis of calcaneal bone cysts. Arch Orthop Trauma Surg 140, 1303–1310 (2020). https://doi.org/10.1007/s00402-019-03299-0
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-019-03299-0