Is sclerotherapy better than intralesional excision for treating aneurysmal bone cysts?
BACKGROUND
Minimally invasive approaches such as sclerotherapy have been introduced to treat aneurysmal bone cysts. Sclerotherapy has been associated with reasonable healing rates during the past two decades. However, it is unclear whether sclerotherapy compares with the more traditional extended curettage and bone grafting.


OBJECTIVE
We therefore compared the healing rates and functional scores in patients having percutaneous repetitive sclerotherapy using polidocanol (Group 1) with those with intralesional excision (extended curettage with a high-speed burr) and bone grafting (Group 2) for treatment of aneurysmal bone cyst.


METHODS
We randomly divided 94 patients into two treatment groups. We assessed healing rates (primary outcome measure), pain relief, time to healing and recurrence, hospital stay, and the Enneking functional score. Forty-five patients from Group 1 and 46 from Group 2 were available for study. The minimum followup was 3.2 years (mean, 4.4 years; range, 3.2-6.1 years).


RESULTS
At last followup, 93.3% in Group 1 and 84.8% in Group 2 had achieved healing. Complications in Group 1 were minor and resolved. In Group 2, three patients had deep infections and five had superficial infections, and two had growth disturbances. Although the healing rates were similar, we found higher rates of clinically important complications, worse functional outcomes, and higher hospital burden associated with intralesional excision.


CONCLUSIONS
Repetitive sclerotherapy using polidocanol is a minimally invasive, safer method of treatment for aneurysmal bone cysts compared with intralesional excision and bone grafting. In this preliminary study, we found similar recurrence rates for the two treatment methods, however, this will require confirmation in larger studies.


METHODS
Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedics, Lady Harding Medical College and Associated Hospitals, 110001 New Delhi, India. drmkvarshney@gmail.com
Manish Kumar
MK
Varshney
Shishir
S
Rastogi
Shah Alam
SA
Khan
Vivek
V
Trikha
D000293:Adolescent; D000328:Adult; D017824:Bone Cysts, Aneurysmal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016025:Bone Transplantation / Q000009:adverse effects; D002648:Child; D003475:Curettage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012597:Sclerosing Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols