Abstract
BackgroundEndoscopic curettage is considered applicable for the treatment of simple bone cysts with the expectation that it might be less invasive than open curettage. In this study, we investigated the efficacy of endoscopic curettage for the treatment of simple bone cysts. The goal was to investigate the incidence of cyst recurrence and bone healing after endoscopic curettage. Moreover, complications and functionality at the final follow-up were evaluated.MethodsFrom 2003 to 2014, 37 patients with simple bone cysts underwent endoscopic curettage. Twenty-four were male and 13 were female, with a mean age of 14.7 years. Endoscopic curettage was performed with the support of an arthroscope via 7–8 mm holes penetrated by cannulated drills with a small incision. The cysts underwent curettage using angled curettes, rongeurs, and an electrical shaver until the normal bone was observed in the medullary cavity. To investigate the bone healing after endoscopic curettage, we evaluated the consolidation of the cyst at the final evaluation (Modified Neer Classification) and the time to solid union after operation, which was defined as the sufficient thickness of the cortical bone to prevent fracture and allow physical activities.ResultsRecurrence occurred in seven patients (18.9%). A log-rank analysis revealed that contact with the physis was associated with recurrence (p = 0.006). Among 31 patients (83.7%), the consolidation of cyst was considered healed at the final X-ray follow-up period, and in these patients, the mean time taken for solid union of cortical bone thinning was 4.0 months (standard deviation, 2.4). With regard to major complications of endoscopic curettage, a transient radial nerve palsy and two postoperative fractures occurred. The former problem was managed conservatively and the latter problems by transient internal fixation; these problems were managed without any further complications. All patients had a good postoperative function.ConclusionsEndoscopic curettage might be a useful alternative as it is a minimally invasive procedure for the treatment of simple bone cysts. Considering the relatively smaller size of this study, further investigation should be necessary for deducing the reliable conclusion.
Highlights
Endoscopic curettage is considered applicable for the treatment of simple bone cysts with the expectation that it might be less invasive than open curettage
We introduce endoscopic curettage (ESC) for Simple bone cyst (SBC) with the expectation that this procedure will have lower invasiveness and relatively higher success rate compared to other traditional procedures and elaborate on our surgical and clinical outcomes with this treatment approach
As for the bone healing after ESC, we evaluated solid union, which was defined by the method of Hou et al [15]: “the cortical wall thickness was sufficient to prevent further fracture and allowed unrestricted physical activity.”
Summary
Endoscopic curettage is considered applicable for the treatment of simple bone cysts with the expectation that it might be less invasive than open curettage. We investigated the efficacy of endoscopic curettage for the treatment of simple bone cysts. The cystic cavity is filled with serous or serosanguineous fluid and lined by thin fibrovascular connective tissue membrane. The disturbance in growth at the epiphysial plate was considered the cause of cystic cavity [2]. These cysts weaken the cortex, predisposing the bone to pathologic fracture [3]. SBCs are most commonly found in adolescent from birth to 20 years of age [4]
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