Injection of Demineralized Bone Matrix With Bone Marrow Concentrate Improves Healing in Unicameral Bone Cyst

Abstract

Background Unicameral bone cysts are benign lesions that usually spontaneously regress with skeletal maturity; however, the high risk of pathologic fractures often justifies treatment that could reinforce a weakened bone cortex. Various treatments have been proposed but there is no consensus regarding the best procedure. Questions/purposes We compared the healing rates and failures of two methods of cure based on multiple injections of corticosteroid or a single injection of demineralized bone matrix (DBM) in association with bone marrow concentrate (BMC). Methods We retrospectively reviewed 184 patients who had one of the two treatments for unicameral bone cysts with cortical erosion. Clinical records were reviewed for treatment failures and radiographs for healing in all patients. The minimum followup was 12 months for the Steroids Group (mean, 48 months; range, 12-120 months) and 12 months for the DBM + BMC Group (mean, 20 months; range, 12-28 months).Results After one treatment we observed a lower healing rate of cysts treated with multiple injections of steroids compared with the healing after the first injection of DBM + BMC (21% versus 58%, respectively). At last followup, 38% healed with steroids and 71% with DBM + BMC. The rate of failure after one steroid injection was higher than after a single injection of BDM + BMC (63% versus 24%, respectively). We observed no difference in fracture rates after treatment between the two groups.

Non-Operative Treatment Versus Steroid Injections in the Management of Unicameral Bone Cysts

“…Small lesions in non-weight bearing bones can be treated expectantly, but operative treatment should be considered in cases with large cysts situated in high stress areas 1,2 . Surgical options include aspiration of cystic fluid with injection of steroids or curettage and bone grafting with or without internal fixation [3][4][5][6][7] . Recently, synthetic calcium sulphate with bone morphogenetic protein for cyst filler and placement of cannulated screw for continuous fluid drain have been reported to have good success [3][4][5][6] .…”

“…Surgical options include aspiration of cystic fluid with injection of steroids or curettage and bone grafting with or without internal fixation [3][4][5][6][7] . Recently, synthetic calcium sulphate with bone morphogenetic protein for cyst filler and placement of cannulated screw for continuous fluid drain have been reported to have good success [3][4][5][6] . Pathological fractures in the upper extremity can be treated non-operatively as the fracture itself may initiate healing.…”

“…Two-thirds of UBC patients present with a fracture, which stimulates the cyst to heal 1,2 . The preferred method of treatment remains controversial 3,4,5,6 . In the past, treatment consisted of curettage and bone grafting with a recurrence rate of approximately 30%.…”

“…In the past, treatment consisted of curettage and bone grafting with a recurrence rate of approximately 30%. At present, the mainstay of treatment is minimally invasive and has a significant success rate: steroid injections; administration of autologous bone marrow, decalcified bone matrix or sclerosing agent; and minimally invasive stabilisation 3,4,5,6 .…”

Mesenchymal stem cells in osteoarticular pediatric diseases: an update

“…Several studies have compared percutaneous steroid injection with percutaneous native bone marrow, but no improvements were seen after the inclusion of bone marrow (37)(38)(39). When native or concentrate bone marrow was mixed with allogeneic demineralized bone, a 56-89% healing rate was described (40,41). It is important to note that according to our analysis of the available literature, steroids are the only evidence-based treatment for SBCs at the moment.…”