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Curettage and Graft Alleviates Athletic-Limiting Pain in Benign Lytic Bone Lesions

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

Abstract

Background

Solitary bone cysts (SBC), nonossifying fibromas (NOF), and fibrous dysplasia (FD) create benign intramedullary lytic bone lesions. They are typically asymptomatic and treated conservatively. We present a series of lesions that caused performance-limiting pain in young athletes, a symptom phenomenon and possible treatment indication that has been poorly described in the literature.

Questions/purposes

We asked whether intralesional curettage and defect grafting of these lesions would alleviate pain in young athletes and permit their return to unrestricted athletic activities.

Patients and Methods

We retrospectively identified 29 patients (30 lesions) who underwent curettage and grafting for SBC (12 patients), NOF (nine), or FD (eight). All patients had pain predominantly with athletic involvement. The mean age of the patients was 18 years (range, 12–31 years). Tumor locations were the femur (eight lesions), humerus (seven), tibia (six), fibula (five), pubic ramus (two), ulna (one), and calcaneus (one). Signs/symptoms were pain alone (24 patients) and pain plus fracture (five). Surgery involved curettage and packing with allograft cancellous chips, bone substitute, or demineralized bone matrix. Two patients required internal fixation. The mean followup was 21 months (range, 2–114 months).

Results

Twenty-four patients had no pain and five had occasional mild pain at last followup. All patients resumed full activity at a mean of 3.3 months (range, 1.5–8.3 months), excluding two who required repeat surgery.

Conclusions

Our observations suggest curettage and packing with bone graft/substitute can provide pain relief and allow full athletic recovery for young athletes with benign lytic bone lesions.

Level of Evidence

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

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 301 S 8th Street, Philadelphia, PA, 19106-6192, USA

    Vincent M. Moretti MD, Rachel L. Slotcavage MD, Eileen A. Crawford MD & Richard D. Lackman MD

  2. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Christian M. Ogilvie MD

Authors
  1. Vincent M. Moretti MD
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  2. Rachel L. Slotcavage MD
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  3. Eileen A. Crawford MD
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  4. Richard D. Lackman MD
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  5. Christian M. Ogilvie MD
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Corresponding author

Correspondence to Vincent M. Moretti MD.

Additional information

One or more of the authors (RLS, VMM, EAC) received funding in the form of a research fellowship from Stryker Orthopaedics, Mahwah, NJ. One of the authors (RDL) is a consultant for Stryker Orthopaedics, Mahwah, NJ.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the University of Pennsylvania, Philadelphia, PA, USA.

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Moretti, V.M., Slotcavage, R.L., Crawford, E.A. et al. Curettage and Graft Alleviates Athletic-Limiting Pain in Benign Lytic Bone Lesions. Clin Orthop Relat Res 469, 283–288 (2011). https://doi.org/10.1007/s11999-010-1374-9

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  • DOI: https://doi.org/10.1007/s11999-010-1374-9

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