Abstract
BackgroundMedial tibial stress syndrome is one of the most common causes of exertional leg pain in runners whereas musculoskeletal tumors and tumor-like lesions are rare encounters in orthopedic sports medicine practice.Unicameral (simple) bone cyst is a well-known tumor-like lesions of the bone typically affecting children and adolescents. Bilateral occurrence is very rare though and has never been reported before in both tibiae. Failing to accurately diagnose a tumorous lesion can entail far-reaching consequences for both patients and physicians.Case presentationWe report the case of large bilateral unicameral bone cysts of the diaphyseal tibiae mimicking medial tibial stress syndrome in a 17-year old professional athlete. This is the first report of symmetric tibial unicameral bone cysts in the literature. The patient complained about persisting shin splint-like symptoms over 5 months despite comprehensive conservative treatment before MRI revealed extensive osteolytic bone lesions in both diaphyseal tibiae. The patient-tailored, less-invasive surgical procedure, allowing the patient to return to his competitive sports level symptom-free 3 months after surgery and to eventually qualify for this years Biathlon Junior World Championships, is outlined briefly. Pathogenesis and various treatment options for this entity will be discussed.ConclusionThis report will help to raise awareness for musculoskeletal tumors as differential diagnosis for therapy-refractory symptoms in young athletes and encourage medical staff involved in sports medicine and athlete support to perform early high quality imaging and initiate sufficient surgical treatment in similar cases. Moreover, our less-invasive surgical procedure aiming for a fast return to sports might be an optimal compromise between traditional open curettage with low risk of recurrence and a soft tissue-saving and bone-sparing minimal-invasive technique.
Highlights
Medial tibial stress syndrome is one of the most common causes of exertional leg pain in runners whereas musculoskeletal tumors and tumor-like lesions are rare encounters in orthopedic sports medicine practice
Our less-invasive surgical procedure aiming for a fast return to sports might be an optimal compromise between traditional open curettage with low risk of recurrence and a soft tissue-saving and bone-sparing minimal-invasive technique
Besides daily workout in the gym for strentgh and endurance, his training schedule included up to 4 h running 6 days per week. Ongoing pain in both of his shins prevented the young athlete from training and competition despite intensive conservative treatment for 5 months
Summary
Other etiologic considerations have to be taken into account: Low-grade osteomyelitis as well as tumors and tumor-like lesions of the bone are suspected to act as precursor-lesion for the origination of UBC by some authors [16–18]. Some authors even postulate open surgery to be rarely justified for the initial treatment of a unicameral bone cyst [19] proposing alternative procedures. Open curretage and autologous grafting of UBCs are more and more replaced by modern techniques with a less invasive approach and reduced morbidity This is, to our best knowledge, the first report of bilateral diaphyseal simple bone cysts of the tibiae. An extensive literature review from Abdel-Wanis [23] revealed 13 reported cases of multiple simple bone cysts before 2001. Case report: unicameral bone cysts in a young patient with acquired generalized lipodystrophy.
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