Is percutaneous injection of bone marrow concentrate, demineralized bone matrix and PRF an alternative to curettage and bone grafting for treating aneurysmal bone cyst?

Abstract

To determine the efficacy and safety of a single injection with autologous bone marrow concentrate (BMC) combined with demineralized bone matrix (DBM) and platelet‐rich fibrin (PRF) compared to curettage and bone grafting for treating aneurysmal bone cysts (ABC). Two hundred thirty‐nine patients were treated with curettage and bone grafting (Curettage Group), and 21 with percutaneous injection of DBM associated with autologous BMC and PRF (DBM + BMC + PRF Group). All patients attended the outpatient clinic to assess ABC healing and clinical results at the first 3, 6, 9 and 18 months after surgery and then annually in the absence of symptoms. The mean follow‐up was 42 months for the Curettage Group (range 6–180 months) and 28 months for the DBM + BMC + PRF Group (range, 6–85 months). Out of the 21 patients who had injection with BMC, DBM, and PRF, 17 (80%) require no additional treatment and they were considered healed. Of the 239 patients treated with curettage and bone grafting after core needle or open biopsy, 177 (74%) were considered healed after the first treatment. Injection in comparison with curettage presented the same risk for local recurrence. The overall rate of local recurrence for all patients was 25%. Univariate and multivariate analyses showed a significant difference in local recurrence rates in patients younger than 15 years, and for the cyst located in the long bones of the lower limbs than the cyst located in the long bones of the upper limbs.

Aneurysmal bone cyst: Is selective arterial embolization effective as curettage and bone grafting?

“…In fact, we reported that the rate of recurrence after a single treatment was 19% in a series of 21 patients 30 …”

“…Even if curettage with or without bone grafting persist to be the most widely used treatment for ABCs, [23][24][25] many surgical and nonsurgical options have been proposed over the years to reduce the risk of recurrence as high-speed bur, 16 large cortical window, 26 adjuvant therapy, 22,27,28 doxycycline foam ablation, 14,15 and bone marrow injection technique. 29,30 These new therapies are based on an improved understanding of the nonneoplastic nature of the lesion. However, until now, there was no consensus regarding the best procedure.…”

“…In fact, we reported that the rate of recurrence after a single treatment was 19% in a series of 21 patients. 30 Curettage is still considered the standard of cure for ABC, but his recurrence rate ranging from 3% to 37% in the literature. 25,26,36,37 We found a recurrence rate of 24.7% in the curettage group.…”

Do’s and Don’ts in Primary Aneurysmal Bone Cysts of the Proximal Femur in Children and Adolescents: Retrospective Multicenter EPOS Study of 79 Patients

“…2), systemic therapies, radiofrequency ablation, embolization, percutaneous injectable bone substitutes, wide resections, and if deemed necessary, a wide range of osteosynthesis. [2][3][4][13][14][15][16][17] Treatment strategies depend on location, size, symptoms, impending and present pathologic fractures, local considerations, and individual preferences. Because of this heterogeneity, there is no consensus or guideline.…”

“…1), bone marrow injections, cryotherapy, decompression, curopsy (ie, biopsy and curettage), curettage with or without filling and/or chemical adjuvants and/or high-speed burring (Fig. 2), systemic therapies, radiofrequency ablation, embolization, percutaneous injectable bone substitutes, wide resections, and if deemed necessary, a wide range of osteosynthesis 2–4,13–17. Treatment strategies depend on location, size, symptoms, impending and present pathologic fractures, local considerations, and individual preferences.…”