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Is Sclerotherapy Better than Intralesional Excision for Treating Aneurysmal Bone Cysts?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Minimally invasive approaches such as sclerotherapy have been introduced to treat aneurysmal bone cysts. Sclerotherapy has been associated with reasonable healing rates during the past two decades. However, it is unclear whether sclerotherapy compares with the more traditional extended curettage and bone grafting.

Questions/purposes

We therefore compared the healing rates and functional scores in patients having percutaneous repetitive sclerotherapy using polidocanol (Group 1) with those with intralesional excision (extended curettage with a high-speed burr) and bone grafting (Group 2) for treatment of aneurysmal bone cyst.

Patients and Methods

We randomly divided 94 patients into two treatment groups. We assessed healing rates (primary outcome measure), pain relief, time to healing and recurrence, hospital stay, and the Enneking functional score. Forty-five patients from Group 1 and 46 from Group 2 were available for study. The minimum followup was 3.2 years (mean, 4.4 years; range, 3.2–6.1 years).

Results

At last followup, 93.3% in Group 1 and 84.8% in Group 2 had achieved healing. Complications in Group 1 were minor and resolved. In Group 2, three patients had deep infections and five had superficial infections, and two had growth disturbances. Although the healing rates were similar, we found higher rates of clinically important complications, worse functional outcomes, and higher hospital burden associated with intralesional excision.

Conclusions

Repetitive sclerotherapy using polidocanol is a minimally invasive, safer method of treatment for aneurysmal bone cysts compared with intralesional excision and bone grafting. In this preliminary study, we found similar recurrence rates for the two treatment methods, however, this will require confirmation in larger studies.

Level of Evidence

Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedics, Lady Harding Medical College and Associated Hospitals, 110001, New Delhi, India

    Manish Kumar Varshney MS, DNB, MNAMS, MRCS (Glasgow)

  2. All India Institute of Medical Sciences, New Delhi, India

    Shishir Rastogi MS, DNB (PMR), Shah Alam Khan MS, DNB (Orth), MRCS, FRCS & Vivek Trikha MS

Authors
  1. Manish Kumar Varshney MS, DNB, MNAMS, MRCS (Glasgow)
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  2. Shishir Rastogi MS, DNB (PMR)
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  3. Shah Alam Khan MS, DNB (Orth), MRCS, FRCS
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  4. Vivek Trikha MS
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Correspondence to Manish Kumar Varshney MS, DNB, MNAMS, MRCS (Glasgow).

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that the institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at All India Institute of Medical Sciences.

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Varshney, M.K., Rastogi, S., Khan, S.A. et al. Is Sclerotherapy Better than Intralesional Excision for Treating Aneurysmal Bone Cysts?. Clin Orthop Relat Res 468, 1649–1659 (2010). https://doi.org/10.1007/s11999-009-1144-8

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  • DOI: https://doi.org/10.1007/s11999-009-1144-8

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