title: Treatment of Unicameral Bone Cysts of the Calcaneus: A Systematic Review.
abstract: The calcaneus is the most common tarsal affected by unicameral bone cysts (UBCs); however, the treatment of calcaneal UBCs remains controversial. The purpose of the present systematic review was to evaluate the treatment modalities for calcaneal UBCs. A systematic review was performed using clinical studies of calcaneal UBCs with a minimum of 1 year of follow-up and level I to IV evidence. Ten studies with 171 patients (181 cysts) were selected. Heel pain and radiographic cyst consolidation were the primary outcomes. A series of Z tests were used to compare the outcomes in the nonoperative and operative groups, cannulated screw and bone augmentation groups, and autografting and allografting groups. All patients treated with open curettage and bone augmentation had significant improvements in heel pain (p < .001). Only 1.1% ± 1.0% of the cysts treated conservatively had healed on radiographs compared with 93.0% ± 13.0% of the cysts after surgery (p < .001). A greater percentage of patients treated with bone augmentation had preoperative heel pain and resolution of that pain than did patients treated with cannulated screws (p < .001). Autografting had a significantly greater percentage of radiographic cyst consolidation than did allografting (97.4% ± 11.1% versus 85.1% ± 15.8%, p < .001, Z = 3.5). Objective outcomes data on calcaneal UBCs are relatively sparse. The results of the present review suggest that open curettage with autograft bone augmentation is the most effective procedure. We would encourage future comparative clinical studies to elucidate differences in UBC treatment modalities.
authors: Resident, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors: David M
authors: DM
authors: Levy
authors: Resident, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors: Christopher E
authors: CE
authors: Gross
authors: Attending Physician and Assistant Professor, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL. Electronic address: david.garras@rushortho.com.
authors: David N
authors: DN
authors: Garras
mesh_terms: D064591:Allografts; D064592:Autografts; D001845:Bone Cysts / Q000000981:diagnostic imaging / Q000628:therapy*; D001863:Bone Screws; D016025:Bone Transplantation; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000601:surgery*; D002130:Calcium Phosphates; D002133:Calcium Sulfate; D003475:Curettage; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D010146:Pain / Q000209:etiology / Q000601:surgery; D059408:Pain Management; D011859:Radiography
chemical_list: D002130:Calcium Phosphates; D005938:Glucocorticoids; C020243:calcium phosphate; D002133:Calcium Sulfate
keywords: bone graft; cannulated screw; curettage; radiograph; simple bone cyst; tarsal