Arthroscopically Assisted Surgical Treatment of a Calcaneal Bone Cyst in an Athlete
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http://orcid.org/0000-0002-4386-3290
Abstract
Introduction: Solitary bone cysts are benign, fluid-filled lesions that can occur in the calcaneus. If surgical treatment is necessary, they are most often treated with open surgery with curettage and autologous grafting or bioceramic filling. We report on a unicameral bone cyst (UBC) that was treated arthroscopically.
Case Description: An 18-year-old male collegiate football player presented with progressive heel pain for several months. There was tenderness to deep palpation in the posterior plantar hindfoot without sensory and motor deficits. X-rays showed a radiolucent cystic lesion, magnetic resonance image confirmed a cystic structure with low T1 and high-signal T2 intensity with homogenous intensity, and computerized tomography scan and technetium bone scan suggested possible pathologic fracture. Imaging was consistent with a calcaneal bone cyst. Several options were presented and he had minimally invasive curettage and grafting using the arthroscope.
Following normal preparation, the lesion was localized under fluoroscopy and an incision was made just distal to the fibular tip. The peroneal tendons were identified and protected and a spinal needle was inserted. Clear fluid was noted and pressure measurement was consistent with a simple cyst. Contrast was injected showing a unicameral space. Biopsy was performed using a trephine and intraoperative pathology confirmed the lesion was a UBC. Using the two-portal technique, the cavity was sequentially curetted using the arthroscope and a second portal for visualization. Using fluoroscopic guidance, it was meticulously debrided with arthroscopic curettes and pituitary rongeurs before being lavaged with multiple liters of fluid. Bleeding cancellous surfaces were noted throughout the bone cavity, then the cavity was packed with morselized cortical cancellous graft and demineralized bone allograft. At 12 months follow-up, physical exam and x-ray examination showed that it was well-healed.
Conclusion: This minimally invasive form of treatment may have advantages over open curettage and warrants further study and consideration.
Article Details
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References
2. Dormans JP, Sankar WN, Moroz L, Erol B. Percutaneous intramedullary decompression, curettage, and grafting with medical-grade calcium sulfate pellets for unicameral bone cysts in children: a new minimally invasive technique. Journal of pediatric orthopedics. 2005;25:804-811.
3. Glaser DL, Dormans JP, Stanton RP, Davidson RS. Surgical management of calcaneal unicameral bone cysts. Clinical orthopaedics and related research. 1999:231-237.
4. Innami K, Takao M, Miyamoto W, Abe S, Nishi H, Matsushita T. Endoscopic surgery for young athletes with symptomatic unicameral bone cyst of the calcaneus. The American journal of sports medicine. 2011;39:575-581.
5. Lui TH. Endoscopic curettage and bone grafting of huge talar bone cyst with preservation of cartilaginous surfaces: Surgical planning. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. 2014;20:248-252.
6. Moreau G, Letts M. Unicameral bone cyst of the calcaneus in children. Journal of pediatric orthopedics. 1994;14:101-104.
7. Park IH, Micic ID, Jeon IH. A study of 23 unicameral bone cysts of the calcaneus: open chip allogeneic bone graft versus percutaneous injection of bone powder with autogenous bone marrow. Foot Ankle Int. 2008;29:164-170.
8. Pogoda P, Priemel M, Linhart W, Stork A, Adam G, Windolf J, Rueger JM, Amling M. Clinical relevance of calcaneal bone cysts: a study of 50 cysts in 47 patients. Clinical orthopaedics and related research. 2004:202-210.
9. Polat O, Saglik Y, Adiguzel HE, Arikan M, Yildiz HY. Our clinical experience on calcaneal bone cysts: 36 cysts in 33 patients. Arch Orthop Trauma Surg. 2009;129:1489-1494.
10. Pretell-Mazzini J, Murphy RF, Kushare I, Dormans JP. Unicameral bone cysts: general characteristics and management controversies. The Journal of the American Academy of Orthopaedic Surgeons. 2014;22:295-303.
11. Rougraff BT, Kling TJ. Treatment of active unicameral bone cysts with percutaneous injection of demineralized bone matrix and autogenous bone marrow. The Journal of bone and joint surgery. American volume. 2002;84-a:921-929.
12. Scaglietti O, Marchetti PG, Bartolozzi P. The effects of methylprednisolone acetate in the treatment of bone cysts. Results of three years follow-up. The Journal of bone and joint surgery. British volume. 1979;61-b:200-204.
13. Smith RW, Smith CF. Solitary unicameral bone cyst of the calcaneus. A review of twenty cases. The Journal of bone and joint surgery. American volume. 1974;56:49-56.
14. Tsuchiya H, Abdel-Wanis ME, Uehara K, Tomita K, Takagi Y, Yasutake H. Cannulation of simple bone cysts. The Journal of bone and joint surgery. British volume. 2002;84:245-248.