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.