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Injection of Demineralized Bone Matrix With Bone Marrow Concentrate Improves Healing in Unicameral Bone Cyst

  • Symposium: Highlights of the ISOLS/MSTS 2009 Meeting
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Unicameral bone cysts are benign lesions that usually spontaneously regress with skeletal maturity; however, the high risk of pathologic fractures often justifies treatment that could reinforce a weakened bone cortex. Various treatments have been proposed but there is no consensus regarding the best procedure.

Questions/purposes

We compared the healing rates and failures of two methods of cure based on multiple injections of corticosteroid or a single injection of demineralized bone matrix (DBM) in association with bone marrow concentrate (BMC).

Methods

We retrospectively reviewed 184 patients who had one of the two treatments for unicameral bone cysts with cortical erosion. Clinical records were reviewed for treatment failures and radiographs for healing in all patients. The minimum followup was 12 months for the Steroids Group (mean, 48 months; range, 12–120 months) and 12 months for the DBM + BMC Group (mean, 20 months; range, 12–28 months).

Results

After one treatment we observed a lower healing rate of cysts treated with multiple injections of steroids compared with the healing after the first injection of DBM + BMC (21% versus 58%, respectively). At last followup, 38% healed with steroids and 71% with DBM + BMC. The rate of failure after one steroid injection was higher than after a single injection of BDM + BMC (63% versus 24%, respectively). We observed no difference in fracture rates after treatment between the two groups.

Conclusions

A single injection of DBM added with autologous bone marrow concentrate appears to provide a higher healing rate with a lower number of failures compared with a single injection of steroids.

Level of Evidence

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

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Acknowledgments

We thank Elettra Pignotti for contributions regarding statistical analysis and Enrico Lucarelli for manuscript review.

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Authors and Affiliations

  1. Department of Oncology Orthopaedic, Rizzoli Orthopaedic Institute, Bologna, Italy

    Claudia Di Bella MD, Tommaso Frisoni MD, Luca Cevolani MD & Davide Donati MD

  2. Bone Regeneration Laboratory, Codivilla-Putty Research Institute, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy

    Claudia Di Bella MD, Barbara Dozza PhD, Tommaso Frisoni MD, Luca Cevolani MD & Davide Donati MD

Authors
  1. Claudia Di Bella MD
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  2. Barbara Dozza PhD
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  3. Tommaso Frisoni MD
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  5. Davide Donati MD
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Correspondence to Davide Donati MD.

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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 his or her 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 the Rizzoli Orthopaedic Institute, Bologna, Italy.

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Di Bella, C., Dozza, B., Frisoni, T. et al. Injection of Demineralized Bone Matrix With Bone Marrow Concentrate Improves Healing in Unicameral Bone Cyst. Clin Orthop Relat Res 468, 3047–3055 (2010). https://doi.org/10.1007/s11999-010-1430-5

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