Endoscopic resection and allografting for benign osteolytic lesions of the calcaneus.
BACKGROUND
Both unicameral bone cysts and intra-osseous lipoma of the calcaneus are rare entities which are mostly diagnosed due to unspecific heel pain, pathologic fracture or as an incidental finding. Minimally-invasive ossoscopy with endoscopic resection of the tumor followed by grafting can potentially minimize risks of open surgery and speed up convalescence. The objective of this study is to present a simple, safe and cost-effective surgical technique for endoscopic surgical treatment of benign osteolytic lesions of the calcaneus.


METHODS
We present our modifications to previously described techniques of endoscopic curettage with a particular focus on intraosseous lipoma. The key point for grafting is the use of a funnel-shaped ear speculum facilitating the plombage with allogenic cancellous bone chips.


METHODS
Between June 2013 and January 2015 ten consecutive patients underwent ossoscopy of the calcaneus. There were 4 cases of intraosseous lipoma and 6 cases of unicameral bone cyst. In a retrospective study, radiological results were analyzed using the Glutting-Classification, functional outcome was recorded with the AOFAS Hindfoot score.


RESULTS
Radiographic follow-up and functional outcome showed good to excellent results. All lesions radiologically classified as "healed". AOFAS score (max. 100 pts) ranged from 74 to 100 (ø94.4 ± 9.3).


CONCLUSIONS
This technique is a simple and safe procedure for benign osteolytic bone lesions of the calcaneus. Compared to its alternatives, grafting with allogenic cancellous bone might prove favourable in this localization for several reasons: Osteointegration, handling, availability and costs. Our preliminary investigations show promising results although further clinical and radiographic results are needed.
Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675 Munich, Germany.
Andreas
A
Toepfer
Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675 Munich, Germany.
Ulrich
U
Lenze
Department for Orthopaedic Surgery and Traumatology, University Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Ludger
L
Gerdesmeyer
Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675 Munich, Germany.
Florian
F
Pohlig
Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, Ismaningerstr. 22, 81675 Munich, Germany.
Norbert
N
Harrasser
Bone tumor; Calcaneal bone cyst; Foot tumor; Intraosseous lipoma; Lipoma of bone; Minimally-invasive surgery; Ossoscopy; Osteolysis; Simple bone cyst; Unicameral bone cyst