Skip to main content
SpringerLink
Log in

Is Curettage and High-speed Burring Sufficient Treatment for Aneurysmal Bone Cysts?

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

Abstract

Background

To decrease the recurrence rate after intralesional curettage for aneurysmal bone cysts, different adjuvant treatments have been recommended. Liquid nitrogen spray and argon beam coagulation have provided the lowest recurrence rates, but unlike the high-speed burr, these adjuvants are not always available in operating rooms.

Questions/purposes

We asked: (1) Is high-speed burring alone sufficient as an adjuvant to curettage with respect to recurrence rates? (2) What is the complication rate from this technique? (3) What are the risk factors for local recurrence?

Methods

A retrospective review of the database of the University Musculoskeletal Tumor Unit and the private files of the senior author (EHW) for a period of 19 years (1993–2011) was performed to identify all patients histologically diagnosed with primary aneurysmal bone cyst. During that period, patients with aneurysmal bone cysts were treated with intralesional curettage, burring, and bone grafting if the lesions showed an adequate cortical wall or a wall with thinned out portions which could be reconstructed with bone grafting. Based on those indications, we treated 54 patients for this condition. Of those, 18 were treated using approaches other than burring because they did not meet the defined indications, and an additional five patients were lost to followup before 2 years, leaving 31 patients for analysis, all of whom were followed up for at least 2 years (mean, 7 years; range, 2–18 years).

Results

Of these 31 patients, one had a recurrence (3.2%). Complications using this approach occurred in three patients (9.7%), and included growth plate deformity (1) and genu varus (2) secondary to collapse of the reconstructed condyle. With only one recurrence, we cannot answer what the risk factors might be for recurrence; however, the one patient with recurrence presented with a large lesion and a pathologic fracture.

Conclusions

Curettage, burring, and bone grafting compare favorably in the literature with other approaches for aneurysmal bone cysts, such as cryotherapy and argon-beam coagulation. We conclude that high-speed burring alone as an adjuvant to intralesional curettage is a reasonable approach to achieving a low recurrence rate for aneurysmal bone cysts.

Level of Evidence

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–D

Similar content being viewed by others

References

  1. Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clin Orthop Relat Res. 1986;204:25–36.

    PubMed  Google Scholar 

  2. Cottalorda J, Bourelle S. Current treatment of primary aneurysmal bone cysts. J Pediatr Orthop B. 2006;15:155–167.

    Article  PubMed  Google Scholar 

  3. Cottalorda J, Kohler R, Chotel F, de Gauzy JS, Lefort G, Louahem D, Bourelle S, Dimeglio A. Recurrence of aneurysmal bone cyst in children: a multicentre study. J Pediatr Orthop B. 2005;14:212–218.

    Article  PubMed  Google Scholar 

  4. Cummings JE, Smith RA, Heck RK Jr. Argon beam coagulation as adjuvant treatment after curettage of aneurysmal bone cysts: a preliminary study. Clin Orthop Relat Res. 2010;468:231–237.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Dormans JD, Hanna BG, Johnston DR, Khurana JS. Surgical treatment and recurrence rate of aneurysmal bone cysts in children. Clin Orthop Relat Res. 2004;421:205–2011.

    Article  PubMed  Google Scholar 

  6. Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Relat Res.1986;204:9–24.

    PubMed  Google Scholar 

  7. Gibbs CP Jr, Hefele MC, Peabody TD, Montag AG, Aithal V, Simon MA. Aneurysmal bone cyst of the extremities: factors related to local recurrence after curettage with a high speed burr. J Bone Joint Surg Am. 1999;81:1671–1678.

    PubMed  Google Scholar 

  8. Lin PP, Brown C, Raymond AK, Deavers MT, Yasko AW. Aneurysmal bone cysts recur at juxtaphyseal locations in skeletally immature patients. Clin Orthop Relat Res. 2008;466:722–728.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mankin HJ, Hornicek FJ, Ortiz-Cruz E, Villafuerte J, Gebhardt MC. Aneurysmal bone cyst: a review of 150 patients. J Clin Oncol. 2005;23:6756–6762.

    Article  PubMed  Google Scholar 

  10. Marcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clin Orthop Relat Res. 1995;311:157–163.

    PubMed  Google Scholar 

  11. Peeters SP, Van der Geest IC, de Rooy JW, Veth RP, Schreuder HW. Aneurysmal bone cyst: the role of cryosurgery as local adjuvant treatment. J Surg Oncol. 2009;100:719–724.

    Article  PubMed  CAS  Google Scholar 

  12. Rapp TB, Ward JP, Alaia MJ. Aneurysmal bone cyst. J Am Acad Orthop Surg. 2012;20:233–241.

    Article  PubMed  Google Scholar 

  13. Rastogi S, Varshney MK, Trikha V, Khan SA, Choudhury B, Safaya R. Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol: a review of 72 cases with long-term follow-up. J Bone Joint Surg Br. 2006;88:1212–1216.

    Article  PubMed  CAS  Google Scholar 

  14. Schreuder HW, Veth RP, Pruszcynski M, Lemmens JA, Koops HS, Molenaar WM. Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting. J Bone Joint Surg Br.1997;79:20–25.

    Article  PubMed  CAS  Google Scholar 

  15. Steffner RJ, Liao C, Stacy G, Atanda A Jr, Attar S, Avedian R, Peabody TD. Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? J Bone Joint Surg Am. 2011;93:e1221–1229.

    Article  PubMed  Google Scholar 

  16. Szendroi M, Cser I, Konya A, Renyi-Vamos A. Aneurysmal bone cyst: a review of 52 primary and 16 secondary cases. Arch Orthop Trauma Surg. 1992;111:318–322.

    Article  PubMed  CAS  Google Scholar 

  17. Vergel de Dios AM, Bond JR, Shives TC, Mcleod RA, Unni KK. Aneurysmal bone cyst: a clinocopathologic study of 238 cases. Cancer.1992;69:2921–2931.

  18. Wang EH, Vergel de Dios AM. Aneurysmal bone cyst. Bone Tumors in Filipinos. Makati City, Philippines: The Bookmark Inc; 2007:18–21.

Download references

Acknowledgments

We acknowledge the help and expertise provided by Ariel Vergel de Dios MD (Department of Pathology, University of the Philippines-Philippine General Hospital) and Alpha Cabic MD (Department of Pathology, University of the Philippines-Philippine General Hospital).

Author information

Authors and Affiliations

  1. Tumor Service, Department of Orthopaedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Ermita, 1000, Manila, Philippines

    Edward H. M. Wang MD, MSc

  2. Department of Orthopaedics, De La Salle University Health Sciences Institute, Dasmarinas City, Philippines

    Michael L. Marfori MD

  3. Tumor Service, Department of Orthopaedics, Philippine General Hospital, University of the Philippines, Manila, Philippines

    Ma Victoria T. Serrano PTRP & Donnel Alexis Rubio MD

Authors
  1. Edward H. M. Wang MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael L. Marfori MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ma Victoria T. Serrano PTRP
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donnel Alexis Rubio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward H. M. Wang MD, MSc.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or 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.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved 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 Philippine General Hospital, University of the Philippines, Manila, Philippines.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, E.H.M., Marfori, M.L., Serrano, M.V.T. et al. Is Curettage and High-speed Burring Sufficient Treatment for Aneurysmal Bone Cysts?. Clin Orthop Relat Res 472, 3483–3488 (2014). https://doi.org/10.1007/s11999-014-3809-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-014-3809-1

Keywords

Search

Navigation