The Journal of Bone and Joint Surgery (American). 2008;90:722-730.
doi:10.2106/JBJS.G.00620
© 2008 The Journal of Bone and Joint Surgery, Inc.
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A Randomized Clinical Trial Comparing Intralesional Bone Marrow and Steroid Injections for Simple Bone Cysts

James G. Wright, MD, MPH1, Suzanne Yandow, MD2, Sandra Donaldson, BA3, Lisa Marley, BA4 on Behalf of The Simple Bone Cyst Trial Group*

1 Department of Surgery, The Hospital for Sick Children, 1218-555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: james.wright{at}sickkids.ca
2 Central Texas Pediatric Orthopedics, 1301 Barbara Jordan Boulevard, Suite 300, Austin, TX 78723. E-mail address: smyandow{at}ctpomd.com
3 Division of Orthopaedic Surgery, The Hospital for Sick Children, S107-555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address: sandra.donaldson{at}sickkids.ca
4 Shriners Hospital for Children, Fairfax Road at Virginia Street, Intermountain, Salt Lake City, UT 84103. E-mail address: ldmarley{at}comcast.net

* The Simple Bone Cyst Trial Group included D. Stephens, J. Crim, K.A. Murray, B. Alman, D. Armstrong, G. Baird, R.M. Bernstein, J. Boakes, J. Bollinger, K. Carroll, P. Caskey, W. Cole, J. D'Astous, R. Durkin, H. Epps, D. Feldman, R. Ferguson, J. Fisk, K. Guidera, D. Grogan, D. Hedden, A. Howard, M.A. James, B. Joseph, H. Kim, J. Lubicky, R. Lyon, R. McCall, J. McCarthy, C. Mehlman, M. Murphy-Zane, U. Narayanan, C. Novick, C. Ono, N.Y. Otsuka, E. Raney, J. Sanders, D. Scher, P. Schoenecker, P. Smith, A. Stans, S. Sundberg, V. Talwalkar, J. Tavares, C. Tylkowski, H. van Bosse, K. Walker, J. Walker, J.G. Wright, and S. Yandow.

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Arthur Huene Award, Pediatric Orthopaedic Society of North America (POSNA) research grant, Salter Chair in Surgical Research, and Shriners Hospitals for Children. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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: Simple bone cysts are common benign lesions in growing children that predispose them to fracture and are sometimes painful. The purpose of this trial was to compare rates of healing of simple bone cysts treated with intralesional injections of bone marrow with rates of healing of those treated with methylprednisolone acetate.

Methods: Of ninety patients randomly allocated to treatment with either a bone-marrow or a methylprednisolone acetate injection, seventy-seven were followed for two years. The primary outcome, determined by a radiologist who was blind to the type of treatment, was radiographic evidence of healing. The cyst was judged to be either not healed (grade 1 [a clearly visible cyst] or grade 2 [a cyst that was visible but multilocular and opaque]) or healed (grade 3 [sclerosis around or within a partially visible cyst] or grade 4 [complete healing with obliteration of the cyst]). Patient function was assessed with use of the Activity Scale for Kids, and pain was assessed with the Oucher Scale.

Results: Sixteen (42%) of the thirty-eight cysts treated with methylprednisolone acetate healed, and nine (23%) of the thirty-nine cysts treated with bone marrow healed (p = 0.01). There was no significant difference between the treatment groups (p > 0.09) with respect to function, pain, number of injections, additional fractures, or complications.

Conclusions: Although the rate of healing of simple bone cysts was low following injection of either bone marrow or methylprednisolone, the latter provided superior healing rates.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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