Treatment Of Aneurysmal Bone Cysts Research Articles

Percutaneous image-guided treatment of aneurysmal bone cysts: is there a superior treatment option?

Aneurysmal bone cysts (ABCs) are often treated with intralesional surgery (curettage) with or without adjuvant treatments. Side effects and conflicting results regarding recurrence rates do not suggest one clearly superior therapy. Percutaneous therapeutic options including sclerotherapy and thermal ablation have gained popularity as potential alternatives. The purpose of this retrospective review is to report this institution's experience and results of various image-guided minimally invasive treatments in a single institution series of cases referred to interventional radiology by orthopedic surgery after surgical failure or in patients with anatomically challenging ABCs. This study identified all patients ≤18years old who received percutaneous therapy for an ABC, including cryoablation, doxycycline sclerotherapy, microwave ablation or a combination of these modalities. Procedural details, complications, imaging follow-up and clinical follow-up were analyzed. A total of 21 patients received 41 procedures, with major complications seen in 7.7% (3/39) of procedures involving cryoablation or doxycycline sclerotherapy. Patients receiving cryoablation required an average of 1.7 procedures (median: 1 procedure, range: 1-4 procedures) while patients receiving doxycycline sclerotherapyrequired an average of 3 procedures (median: 2 procedures, range: 1-6 procedures). Patients were followed clinically and with computed tomography or magnetic resonance imaging (average: 23.9months, range: 3.9-68.3months). Follow-up imaging demonstrated improvement in 17 (85%) patients. Clinically, 93.8% (15/16) of patients who presented with fracture or pain had markedly reduced or absent pain as well as no fractures. Percutaneous image-guided treatment of ABCs demonstrates a favorable efficacy and safety profile. Adding cryoablation may lead to fewer total procedures than using doxycycline sclerotherapy alone.

Surgical treatment of aneurysmal bones cysts

Introduction. Bone cysts are one of the most common tumor-like bone diseases of childhood, most often occurring in the 1st and 2nd decade of life. According to the world medical literature, there is still no consensus on the best methods of treating bone cysts.Aim – to evaluate the effectiveness of surgical treatment of aneurysmal bone cysts (ABC) in children with the use of allografts of biological (animal and human) origin.Materials and methods. This study included 56 pediatric patients with ABC treated at The National Medical Research Center for Children’s Health, Russia, Moscow. 37 patients with aneurysmal bone cysts (29 active ABC, 8 inactive ABC) underwent surgical treatment. Our follow-up period ranged from 12 months to 80 months. In the postoperative period, the examination was carried out at a period of 3, 6, 12, 18, 24 months and then once a year, while assessing: the presence/absence of the recurrence (radiologically), the timing of functional recovery of the operated segment, the timing of X-ray reconstruction of the graft, the assessment of physical and emotional components of the patients’ quality of life were evaluated using the PedsQL questionnaire at admission and within 12 months from the date of surgery.Results and discussion. In 37 cases of surgical treatment of ABC with the use of allografts of biological origin, the recurrence presented in 7 patients (19%) – these patients, who had an active ABC, required repeated surgical interventions. The average time of complete bone repair in the lesion site ranged from 9 months to 22 months (14 months on average). Functional recovery of the operated segments was on average 10 months for the upper extremities and 12 months for the lower extremities.Conclusion. The use of allografts of biological origin is effective in the case of inactive aneurysmal bone cysts. In case of active ABC the effectiveness of bone grafting with allografts of biological origin is reduced.

Sclerotherapy for Aneurysmal Bone Cyst: A Single-Center Experience.

IntroductionSclerotherapy offers an alternative to surgery to treat an aneurysmal bone cyst (ABC). The present study's main objective was to assess the radiological efficacy of sclerotherapy in the healing of the cyst cavity secondary to biopsy-proven ABC on X-rays and assess clinical efficacy on pain, recurrence, and complications.Materials and methodsBetween 2016 and 2018, 26 patients (12 females, 14 males) with biopsy-proven ABC treated by sclerotherapy were included. All patients received an injection of polidocanol 3% intralesional as standard treatment under fluoroscopic guidance. Ossification was assessed on plain X-ray, and the pain was evaluated on a visual analog scale (VAS).ResultsOssification was complete in 24 (92.3%) patients and partial in two (7.7%) patients. Eighteen patients (70%) were pain-free at the end of three months. There was an improvement in the VAS score, and clinically, there was a significant reduction in pain and swelling. Two patients developed recurrence within two years of follow-up, treated successfully by the re-application of intralesional polidocanol 3% injection.DiscussionSclerotherapy provides an effective, minimally invasive treatment for ABC and is particularly useful for deep lesions, challenging access for surgery and potentially damaging vital structures. The use of percutaneous polidocanol 3% under fluoroscopic control seems to improve the risk/benefit ratio. Its clinical and radiological efficacy makes sclerotherapy an alternative treatment option in ABC. Level of evidenceIV, prospective study

The role of percutaneous transarterial embolization in the management of spinal bone tumors: a literature review.

Spinal bone tumors include a heterogeneous broad of primary or metastatic lesions that may present as incidental findings or manifest with painful symptoms and pathological fractures. Optimal management of spine bone lesions is often difficult and treatment algorithms are usually solidly based on surgery. We aimed to evaluate the contribution of trans-arterial embolization in this field, with particular attention to the procedure efficacy, technical difficulties and complications. We present a literature review on the role of trans-arterial embolization in the management of spinal bone tumors, both primary and metastatic, evaluating its contribution as preoperative treatment, palliative procedure and standalone curative strategy. Trans-arterial embolization provides an important contribution to reducing surgery hemorrhagic risks, offering a better visualization of the operating field, and possibly increasing tumor susceptibility to chemotherapy or radiation therapy. Nonetheless, it plays an important part in pain palliation, with the unquestionable advantage of being easily repeatable in case of necessity. Its curative role as a standalone therapy is still subject of debate, and at the present time, satisfactory results have been recorded only in the treatment of aneurysmal bone cysts. Percutaneous trans-arterial embolization has established as a highly useful minimally invasive procedure in the management of spinal bone lesions, particularly as adjuvant preoperative therapy and palliative treatment.

Is sclerotherapy with polidocanol a better treatment option for aneurysmal bone cyst compared to conventional curettage and bone grafting?

BackgroundThe standard treatment of Aneurysmal bone cyst is curettage and grafting and is associated with high morbidity. Hence minimal invasive alternative treatment methods such as sclerotherapy are gaining much popularity. Though sclerotherapy has been attributed to reasonable cure rates, undetermined tissue diagnosis often impedes with initiation of treatment. This study examines if sclerotherapy with polidocanol based on clinic-radiological picture is comparable with the standard intralesional curettage and bone grafting. Attempting biopsy and treatment simultaneously based on the clinico-radiological presentation makes this study unique. MethodsWe divided 48 patients into two treatment groups. Group 1 treated with percutaneous sclerotherapy using polidocanol and group 2 those treated with extended curettage and bone grafting. We assessed time to healing and recurrence, pain relief, and radiological outcome using modified Neer's criteria for the radiological healing of the bone cysts. 31 patients from Group 1 and 17 from Group 2 were available for study. The minimum follow-up was 2 years. ResultsAt last follow-up, 100% in Group 1 and 82% in Group 2 had achieved complete healing and there was no statistical difference in outcome at 24 months (p = 0.255). Complications in Group 1 were injection site necrosis, pain and hypopigmentation, all of which resolved spontaneously. In Group 2, three patients had recurrence. Despite similar healing rates, we found higher incidence of clinically pertinent complications, poor functional outcomes and increased cost of treatment associated with intralesional excision.Three cases were excluded from sclerotherapy group as the final diagnosis turned up to be secondary ABC. ConclusionsPercutaneous sclerotherapy using polidocanol is a highly effective, cost efficient and safe treatment option with good cosmesis and reduced morbidity. In this study, we found comparable outcomes for both treatment methods however this will require confirmation in larger studies.

Efficacy of Sclerotherapy With Polidocanol (Ethoxysclerol) in Primary Aneurysmal Bone Cysts in Children and Adolescents.

Aneurysmal bone cysts (ABC) are rare benign osseous lesions that can be locally aggressive. Traditionally, curettage with or without bone grafting is the treatment of choice. Recent data suggest that percutaneous sclerotherapy is a safe alternative to surgery. We present our experience with percutaneous sclerotherapy. Primary study aims were success rate, risk factors for treatment failure, and complications. In this single-center retrospective study (January 2003 to June 2019), 70 patients were treated with percutaneous sclerotherapy for primary ABC at various skeletal sites. Median age was 11 years (range: 3 to 17 y). Median follow-up was 40 months (range 18 to 144 mo). Clinical and radiologic assessments were performed until cyst healing. Successful healing was seen in 58 of 70 patients (83%) after 1 or more injections with polidocanol. In 12 patients (17%), definitive curettage was performed after previous sclerotherapy, which was considered failure of primary sclerotherapy treatment. Trends toward increased risk for >3 treatments or treatment failure included age younger than 5, epiphyseal plate involvement, and lower leg lesions. The only complication was anaphylaxis in 1 patient shortly after injection of polidocanol/contrast agent and ropivacaine, with full recovery after short resuscitation. Our results show that percutaneous sclerotherapy with polidocanol has high efficacy in the treatment of primary ABC, with a low complication rate. Our only complication may have been an immediate allergic reaction to polidocanol/contrast agent or ropivacaine. Trends toward increased risk for treatment failure were age younger than 5, epiphyseal plate involvement, and lower leg lesions. Level IV-therapeutic study.

Musculoskeletal Interventional Radiology in the Pediatric Population: State of the Art.

Interventional radiology procedures have been proven to be as effective as traditional surgery but usually are characterized by lower morbidity rates. In this article, the most diffuse IR treatments for pediatric lesions are reviewed with the aim of describing main advantages and drawbacks. Ablation procedures (in particular RFA and MRgFUS) are widely used for the management of osteoid osteoma and osteoblastoma whereas intracystic injection of methylprednisolone acetate is performed for simple bone cysts. Sclerosing agents and where possible, selective arterial embolization are used for treatment of aneurysmal bone cysts and other vascular malformations. In the management of malignant muscoloskeletal tumors, the role interventional radiology is mainly represented by percutaneous biopsies, and by adiuvant selective embolizations in presence of hypervascular lesions to be submitted to surgery.

Use of Liquid Nitrogen as A local Adjuvant to Decrease Recurrence after Extended Curettage, and Reconstruction by Autogenous Bone Graft for Treatment of Aneurysmal bone Cyst: Our Updated Experience

Background: Aneurysmal bone cyst [ABC] can be managed by curettage and different bone grafts. However, the recurrence rate is high, and different adjuvants had been proposed to reduce recurrence. The use of liquid nitrogen could be used as an adjuvant. Aim of the work: To present our experience with liquid nitrogen use as an adjuvant in ABC's management. Patients and Methods: Twenty-five patients with ABC had been evaluated. All were treated by extended curettage followed by liquid nitrogen for two cycles and reconstruction of the cavity by a bone graft. Radiological and functional outcomes had been documented, and any complications had been registered. Results: Femur was the most common site for ABC. The graft was obtained from iliac crest for all patients, mainly corticocancellous [68.0%]. The ABC grade was grade 2 among [80.0%] and grade 3 among [20.0%]. Graft union achieved in all patients in an average of 6.52±2.27 months. The mean follow-up duration was [44.52±16.81 months; range 24- 72 months], and all patients were alive and completely free from the disease. The functional score ranged from 70% to 94%, [average of 85.12±7.32%]. Recurrence rate [8.0%] and wound infection had been recorded in another two patients [treated conservatively and completely resolved within days]. Conclusion: Extended curettage of ABC with adjuvant cryotherapy had good results with a lower recurrence rate. The additional use of a bone graft allowed for consolidation in all cases with a short time for cyst healing.

Bone Marrow Concentrate in the Treatment of Aneurysmal Bone Cysts: A Case Series Study

Introduction A recent attractive option regarding mesenchymal stem cells (MSC) application is the treatment of bone cystic lesions and in particular aneurysmal bone cysts (ABC), in order to stimulate intrinsic healing. We performed a retrospective evaluation of the results obtained at our institution. Methods The study group consisted of 46 cases with an average follow-up of 33 months. Forty-two patients underwent percutaneous treatment as the first approach; four patients had curettage as first treatment. In all cases, autologous bone marrow concentrate (BMC) was associated too. The healing status was followed up through a plain radiograph 45 days and 2 months after the procedure. Results and Conclusions. At the final follow-up, thirty-six patients healed with a Neer type II aspect, nine healed with a type I aspect, and one patient was not classified having total hip arthroplasty. Bone marrow concentrate is easy to obtain and to manipulate and can be immediately available in a clinical setting. We can assert that the use of BMC must be encouraged being harmless and having an unquestionable high osteogenic and healing potential in bone defects.

Primary Aneurysmal Bone Cyst of the Spine in Children: Updated Outcomes of a Modern Surgical Technique.

Aneurysmal bone cysts (ABC) are benign but locally aggressive lesions. Treating children with spinal ABC poses risks due to the proximity of the lesion to the spinal cord and the need to preserve spinal stability after surgery. This study reports the updated outcomes of a uniform aggressive initial surgical technique for the treatment of spinal ABC in children. Twenty-nine cases of spinal ABC were collected from a tertiary pediatric tumor center over a 24-year period (January 1990-September 2014). The study patients were divided into 2 groups based on the performed procedure: a traditional approach consisting of curettage and bone grafting (group 1) and a 4-step approach consisting of intralesional curettage, high-speed bur, electrocautery, and bone grafting (group 2). The study population was composed of 12 males and 17 females with a mean age of 12.2 years at the time of diagnosis and a mean postoperative follow-up of 4.03 years. Twenty-one patients underwent the 4-step approach, while 8 patients were treated with the traditional technique. The recurrence rate was 50% (4/8 patients) with the traditional technique (group 1) and 19% (4/21) in the 4-step technique (group 2) (P = .164). Regardless of the technique used, the presence of sensory symptoms at the time of presentation was a statistically significant factor for recurrence (P = .016). We suggest that addressing spinal ABC in pediatric patients with a 4-step approach is a safe technique that may decrease long-term recurrence and reoperation rates compared to the traditional technique of intralesional curettage and bone grafting. 4.

Treatment of primary aneurysmal bone cyst of patella with percutaneous intralesional sclerotheraphy using 3% polidocanol: A case report

Introduction: Patella is an uncommon site for primary tumour of bone. Aneurysmal bone cyst account for 1 % of any primary bone lesion and its occurrence in patella is very rare. Material and method: A case report of 20 years old male patient came with complain of pain in right knee joint with swelling from last 1 year with no history of trauma. On examination there was localised tender swelling present in the anterior aspect of knee over patella with full range of movement. On investigating routine investigations were unremarkable. X-ray right knee joint shows expansile osteolytic lesion with cortical thinning. MRI shows a large cyst with fluid level suggestive of aneurysmal bone cyst. 3 injections of 2ml of 3% polidocanol given 1 month apart intralesionally under fluoroscopy guidance. Clinical, functional and radiological follow-up for 3 consecutive months was done. Discussion: Percutaneous sclerotherapy with 3% polidocanol is a safe alternative to conventional surgery for the treatment of Aneurysmal bone cyst. Conclusion: Percutaneous sclerotherapy is emerging as an excellent method of treatment for aneurysmal bone cyst, and obviates the potential functional disabilities with other method of treatment.

Tailored treatment of aneurysmal bone cyst of the scapula: en bloc resection for the body and extended curettage for the neck and acromion

The acromion and neck of the scapula are essential components of shoulder function, but the body section is less critical. We treated aneurysmal bone cysts (ABCs) of the neck and ‏acromion with extended curettage and ABCs of the body with en bloc resection.‏ This article reports on local recurrence and the functional outcomes of this approach. Seventeen patients with primary ABCs of the scapula were included in this retrospective study. We treated 10 patients with extended curettage and bone grafting and 5 patients with en bloc resection. In 2 cases, both the body and neck were involved. We treated these patients with a combination of curettage and resection. We used the Musculoskeletal Tumor Societyscore for functional assessment of outcomes. The mean age of the patients was 20.5 ± 7.4 years. One local recurrence occurred in patients who underwent extended curettage and bone grafting (1 of 12 cases, 8.3%). No recurrence was observed in patients who underwent en bloc resection alone. The mean Musculoskeletal Tumor Society score was 27.9 ± 1 in patients who underwent curettage alone and 24.86 ± 0.7 in patients who underwent en bloc resection alone or in combination with curettage (P < .001). Despite the higher risk of local recurrence after curettage, this method can be selected for the treatment of ABCs of the acromion and neck of the scapula to minimize shoulder disability. For the body of the scapula, en bloc resection is a more reasonable treatment, despite a higher rate of functional impairment.

Aneurysmal bone cyst: results of an off label treatment with Denosumab

BackgroundThe treatment of aneurysmal bone cysts (ABCs) has evolved and less invasive methods have been tried. Denosumab is a monoclonal antibody which inhibits osteoclasts. It has been shown to be effective in giant cell tumour of bone (GCT) of bone and hence promises some effect also in ABC. We report on 6 patients treated with Denosumab and compare our results to the cases already published.MethodsData of 6 patients with ABCs and patients whose treatment included Denosumab were retrospectively analyzed. Denosumab was used at a dose of 120 mg on days 1, 8, 15 and 29, and every 4 weeks thereafter. In some of these patients the dose was reduced at the end of the treatment. Clinical and radiological responses were evaluated.ResultsIn 4 female and 2 male patients with a mean age of 17 years (range: 6–30 years) the lesions were located in the sacrum (2), in distal radius, distal femur, talus and pelvis. One of the sacral lesions healed after 12 months and has stayed stable for 3 years since. The second patient received 2 years of therapy with recalcification, but recurred 1 year later and is under renewed therapy. The pelvic lesion improved but recurred. This patient has a 13-years history of intermittent therapy including surgery, two pregnancies and remains in a stable situation. The lesion of the talus did not improve with Denosumab after surgery and was complicated by destruction of the ankle joint with osteoarthritis. Recurrent lesions of the distal femur and the distal radius, previously treated by curettage and bone grafting healed under Denosumab and have remained stable for 2 and 3 years, respectively. One case of severe hypercalcemia was observed in a 7-year old child 6 months after discontinuation of Denosumab.ConclusionDenosumab provides a treatment option for ABCs in anatomically critical locations. Adjuvant application might reduce the rate of local recurrence. In young patients, severe rebound hypercalcemia months after discontinuation of Denosumab may occur.

Spinal Aneurysmal Bone Cysts (ABCs): Optimal Management.

AimTo review the published literature on the treatment of aneurysmal bone cysts (ABCs).MethodA systematic review of the English literature to April 2019 for all articles, with a minimum of three patients and 2-year follow-up, reporting on the treatment of spinal ABCs. The various treatment options were compared for the rates of recurrence, complications and mortality.ResultsTwenty-one articles and 272 patients (mean age 16.9 years, range 3–67) were included in this review. The overall recurrence rate for ABCs following all treatments is 12.8%. This is highest in those lesions described as being treated with isolated surgiflo injection into the lesion (100%), decompression/laminectomy (42.3%), partial excision/resection (35.7%) and curettage alone (25.0%). Radiotherapy alone or in conjunction with operative intervention offers excellent cure rates. Adjuncts to operative intervention, including cryotherapy or phenol reduce the recurrence rates, whereas embolization does not. The most common complications are persistent neurological deficits, spinal deformity, and continued pain. The overall mortality rates are low (1.5%). The reoperation rates are higher in surgical than non-surgical treatments and most are performed for progressive deformity.DiscussionABCs are highly radiosensitive. However, with the unknown longer-term risk of radiotherapy, surgical treatments, ideally with complete resection, and the use of adjunctive therapies such as cryotherapy or phenol, offer the best chance of cure. SAE is a useful adjunct to reduce intraoperative bleeding, but this study suggests that it only modestly improves recurrence rates. Newer techniques including bisphosphonate and doxycycline administration offer potential benefits, but their efficacy requires further investigation.

Sclerotherapy with Polidocanol for Treatment of Aneurysmal Bone Cyst

Sclerotherapy with Polidocanol for Treatment of Aneurysmal Bone Cyst

Challenges in the Diagnosis and Treatment of Aneurysmal Bone Cyst in Patients with Unusual Features.

Objectives Aneurysmal bone cyst (ABC) is a benign but locally aggressive tumor. It has several challenging features. The aim of this study is to identify challenges in the diagnosis and treatment of ABC especially in patients with unusual features. Methods This retrospective study involved medical record review of primary ABC patients with one or more of the following features: unusual clinical presentation with a mass or a pathological fracture especially at an unusual age, rare locations, radiological findings suggesting other diagnoses especially sarcoma, and a nondiagnostic histopathology of biopsy samples. Results 25 patients (17 males and 8 females) were included. Most patients were either younger than 10 or older than 20 years. 10 patients presented with a mass or a pathological fracture. Unusual locations include the scapula, the olecranon, the hamate, the calcaneus, and the first metatarsal bone. Extension into the epiphysis occurred in 2 patients with proximal fibula and olecranon ABCs. Two separate synchronous cysts existed in the proximal epiphysis and middiaphysis of one humerus. Radiological imaging suggested other primary diagnoses in 8 patients. Core needle biopsy was diagnostic in only 2 of 7 patients. The main treatment was intralesional resection/curettage with bone grafting. Wide resection was performed in 4 patients. Recurrence rate was 28%. Recurrence risk factors included the following: age less than 10 years, male gender, and proximal femur location. Late recurrence occurred in 3/7 patients. One patient with asymptomatic radiological recurrence showed subsequent spontaneous resolution one year later. Conclusions This study presented multiple unusual features of ABC including: unusual age, rare locations, and nondiagnostic radiological and histopathological findings. These features can complicate the diagnosis and management. Given these features, especially with pathological fractures, a well-planned incision, the use of frozen section examination, and the application of either external fixation or plate osteosynthesis for fracture fixation can be recommended.

Treatment of aneurysmal bone cyst with percutaneous sclerotherapy using single dose of polidocanol : A case report

Treatment of aneurysmal bone cyst with percutaneous sclerotherapy using single dose of polidocanol : A case report

Multidisciplinary management of spinal aneurysmal bone cysts: A single-center experience.

The management of spinal aneurysmal bone cysts (ABCs) is complex and often requires multimodality therapy, including surgical intervention to stabilize the axial skeleton, and avoid neurologic injury or death. With en bloc resection, ABCs have a recurrence rate of 12%, which increases to >50% with subtotal resection. The use of doxycycline sclerotherapy has been reported to reduce the recurrence rate of non-spinal ABCs to 5% at >24 month follow-up. We retrospectively reviewed our institutional results for sodium tetradecyl sulfate (STS)/doxycycline sclerotherapy and surgical intervention for spinal ABCs, to assess our treatment paradigm for these tumors and inform our future approach to these lesions. Three cervical, two thoracic and two lumbar spine ABCs were treated in seven patients with spine-exclusive disease at our institution from 2011 to the present. The most common presenting complaint was pain. Each patient was retrospectively reviewed for clinical symptomology, number of treatments, technique and clinical follow-up. Qualitative assessment of improvement was based on the most recent clinical evaluation. The cohort underwent a mean of three treatment sessions (range 2-15). All were treated with STS and/or doxycycline. Five patients underwent surgical intervention at some point, either before or following sclerotherapy. After the last sclerotherapy session, four patients reported stable or improved pain symptoms, while two reported progressive pain that required surgical intervention for that indication. One patient, who underwent both multiple rounds of sclerotherapy and surgical resection, died due to acute on chronic cervical spine collapse with cord compression and inability to control disease. We report our experience in the treatment of spinal column ABCs. Stabilization or improvement in pain was seen in four patients, while the remainder had progressive disease. Our multidisciplinary approach allows patients to receive the most appropriate treatment at presentation and thereafter, for symptom amelioration or spinal stability. Important future goals are to quantitatively assess changes in symptoms over time and to incorporate a reproducible radiographic endpoint for the assessment of treatment efficacy.

Aneurysmal bone cysts of the clavicle: a comparison of extended curettage and segmental resection with bone reconstruction

Although curettage of an aneurysmal bone cyst (ABC) of the clavicle has a high rate of local recurrence, segmental resection is often avoided for treatment as it causes functional impairment and shoulder deformity. We evaluated the rate of local recurrence and functional outcomes of extended curettage vs. segmental resection with bone reconstruction for the treatment of clavicular ABC. A total of 14 patients with clavicular ABC were studied. Extended curettage and segmental resection with bone reconstruction were done for 6 and 8 patients, respectively. The number of local recurrences and postoperative complications was recorded for each group. The function of the shoulder was assessed using the Constant-Murley score. The mean age of the patients was 26.2 ± 14.7 years (range, 4-56 years). At a mean follow-up of 60 ± 37.6 months, 2 recurrences developed, both in the curettage group. Two postoperative complications (1 infection and 1 nonunion) were also recorded, both in the segmental resection group. The mean Constant-Murley score was 88.2 ± 3.4 in the extended curettage group and 87.3 ± 2.4 in the segmental resection group (P = .85). Considering the comparable function of the shoulder in curettage and segmental resection with bone reconstruction in clavicular ABC, we recommend the latter approach because of the lower recurrence rate, albeit with a higher rate of potential complications.

Aneurysmal bone cyst treated with percutaneous doxycycline: is a single treatment sufficient?

The purpose of this case series is to report on the effectiveness of a single percutaneous injection of doxycycline as a primary treatment for aneurysmal bone cyst (ABC). A retrospective cohort study was conducted on seven patients diagnosed with ABC at various anatomical sites, with the intention to treat by a single percutaneous injection of doxycycline. Mean patient age was 14years. Signs of treatment response were seen in six of seven patients after one injection. Three of the seven received a second treatment, despite signs of response. Another had expansion of the lesion after treatment, requiring excision. In total, three patients had a single injection of doxycycline as their sole treatment and another three showed signs of response after a single injection. A single percutaneous injection of doxycycline should be considered a viable primary treatment option for ABC.