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The Journal of Bone and Joint Surgery (American) 84:921-929 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Treatment of Active Unicameral Bone Cysts with Percutaneous Injection of Demineralized Bone Matrix and Autogenous Bone Marrow

Bruce T. Rougraff, MD and Thomas J. Kling, MD

Investigation performed at Orthopaedics Indianapolis, Indianapolis, Indiana

Bruce T. Rougraff, MD
Thomas J. Kling, MD
Orthopaedics Indianapolis, 8450 Northwest Boulevard, Indianapolis, IN 46278

No benefits in any form have been received or will be received from a commerical party related directly or indirectly to the subject of this article. No funds were received in support of this study.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: The treatment of unicameral bone cysts varies from open bone-grafting procedures to percutaneous injection of corticosteroids or bone marrow. The purpose of this study was to evaluate the feasibility and effectiveness of percutaneous injection of a mixture of demineralized bone matrix and autogenous bone marrow for the treatment of simple bone cysts.

Methods: Twenty-three patients with an active unicameral bone cyst were treated with trephination and injection of allogeneic demineralized bone matrix and autogenous bone marrow. The patients were followed for an average of fifty months (range, thirty to eighty-one months), at which time pain, function, and radiographic signs of resolution of the cyst were assessed.

Results: The average time until the patients had pain relief was five weeks, and the average time until the patients returned to full, unrestricted activities was six weeks. Bone-healing at the site of the injection was first seen radiographically at three to six months. No patient had a pathologic fracture during this early bone-healing stage. Cortical remodeling was seen radiographically by six to nine months, and after one year the response was usually complete, changing very little from then on. Five patients required a second injection because of recurrence of the cyst, and all five had a clinically and radiographically quiescent cyst after an average of thirty-six additional months of follow-up. Seven of the twenty-three patients had incomplete healing manifested by small, persistent radiolucent areas within the original cyst. None of these cysts increased in size or resulted in pain or fracture.

Conclusions: Percutaneous injection of allogeneic demineralized bone matrix and autogenous bone marrow is an effective treatment for unicameral bone cysts.


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