Curettage and graft alleviates athletic-limiting pain in benign lytic bone lesions.
BACKGROUND
Solitary bone cysts (SBC), nonossifying fibromas (NOF), and fibrous dysplasia (FD) create benign intramedullary lytic bone lesions. They are typically asymptomatic and treated conservatively. We present a series of lesions that caused performance-limiting pain in young athletes, a symptom phenomenon and possible treatment indication that has been poorly described in the literature.


OBJECTIVE
We asked whether intralesional curettage and defect grafting of these lesions would alleviate pain in young athletes and permit their return to unrestricted athletic activities.


METHODS
We retrospectively identified 29 patients (30 lesions) who underwent curettage and grafting for SBC (12 patients), NOF (nine), or FD (eight). All patients had pain predominantly with athletic involvement. The mean age of the patients was 18 years (range, 12-31 years). Tumor locations were the femur (eight lesions), humerus (seven), tibia (six), fibula (five), pubic ramus (two), ulna (one), and calcaneus (one). Signs/symptoms were pain alone (24 patients) and pain plus fracture (five). Surgery involved curettage and packing with allograft cancellous chips, bone substitute, or demineralized bone matrix. Two patients required internal fixation. The mean followup was 21 months (range, 2-114 months).


RESULTS
Twenty-four patients had no pain and five had occasional mild pain at last followup. All patients resumed full activity at a mean of 3.3 months (range, 1.5-8.3 months), excluding two who required repeat surgery.


CONCLUSIONS
Our observations suggest curettage and packing with bone graft/substitute can provide pain relief and allow full athletic recovery for young athletes with benign lytic bone lesions.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Moretti
Vincent M
VM
Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 301 S 8th Street, Philadelphia, PA 19106-6192, USA. vincent.moretti@uphs.upenn.edu
Slotcavage
Rachel L
RL
Crawford
Eileen A
EA
Lackman
Richard D
RD
Ogilvie
Christian M
CM
D000293:Adolescent; D000328:Adult; D054874:Athletic Performance; D001845:Bone Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016025:Bone Transplantation; D002648:Child; D003475:Curettage; D005350:Fibroma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005357:Fibrous Dysplasia of Bone / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000209:etiology / Q000601:surgery; D006801:Humans; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D015143:Philadelphia; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
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