Injection of Demineralized Bone Matrix With Bone Marrow Concentrate Improves Healing in Unicameral Bone Cyst

Department of Oncology Orthopaedic, Rizzoli Orthopaedic Institute, Bologna, Italy.
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 11/2010; 468(11):3047-55. DOI: 10.1007/s11999-010-1430-5
Source: PubMed

ABSTRACT Unicameral bone cysts are benign lesions that usually spontaneously regress with skeletal maturity; however, the high risk of pathologic fractures often justifies treatment that could reinforce a weakened bone cortex. Various treatments have been proposed but there is no consensus regarding the best procedure.
We compared the healing rates and failures of two methods of cure based on multiple injections of corticosteroid or a single injection of demineralized bone matrix (DBM) in association with bone marrow concentrate (BMC).
We retrospectively reviewed 184 patients who had one of the two treatments for unicameral bone cysts with cortical erosion. Clinical records were reviewed for treatment failures and radiographs for healing in all patients. The minimum followup was 12 months for the Steroids Group (mean, 48 months; range, 12-120 months) and 12 months for the DBM + BMC Group (mean, 20 months; range, 12-28 months).
After one treatment we observed a lower healing rate of cysts treated with multiple injections of steroids compared with the healing after the first injection of DBM + BMC (21% versus 58%, respectively). At last followup, 38% healed with steroids and 71% with DBM + BMC. The rate of failure after one steroid injection was higher than after a single injection of BDM + BMC (63% versus 24%, respectively). We observed no difference in fracture rates after treatment between the two groups.
A single injection of DBM added with autologous bone marrow concentrate appears to provide a higher healing rate with a lower number of failures compared with a single injection of steroids.

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Available from: Luca Cevolani, Aug 29, 2014
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    • "In the series of Di Bella et al. [18], the number of cysts healed during the first year following a single injection of DBM with BM concentrate was 59%, which is higher compared with multiple injections of corticosteroids (21%). Similarly, the final cyst healing rate was higher, with fewer injections (71% versus 38%, with 1.1 injections on average). "
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    ABSTRACT: Introduction: There is no consensus on when and how to treat unicameral bone cysts (UBCs), partly because of a lack of knowledge of the aetiology. Purpose: To review the different treatment techniques for UBCs and to describe our results with a single injection of autogenous bone marrow (BM) mixed with demineralised bone matrix (DBM) in very young children. Patients and methods: We reviewed five patients under the age of 8 years with UBCs treated by percutaneous aspiration and a single injection of BM associated with DBM. The cyst was located in the proximal humerus in four patients and in the proximal femur in one patient. Assessment of the need for surgery was based on the clinical and radiographic suspicion of new pathological fractures. The administration of a second injection, when necessary, was based on the surgeon's judgement regarding the risk of fracture. The mean follow-up after first injection was 41 months. Results: There were no complications related to the procedure, except a non-displaced fracture, which healed without problems. All patients were pain free and progressively resumed their activities without restriction until a new fracture occurred in two cases. According to Capanna's classification, only one case healed completely (grade 1), one lesion was classified as grade 2, and there were three recurrences at 11, 12 and 27 months after initial treatment (grade 3). The final outcome was treatment failure for three out of the five patients. Two patients were treated with a second injection and one patient is waiting for surgery. Conclusion: A single injection of aspirated autogenous BM mixed with DBM in very young children with active UBCs at risk of fracture is very simple, comfortable and safe. Nevertheless, the results seem to be unpredictable and are probably more dependent on the natural evolution of the cyst than on the treatment. Further comparative studies with larger sample numbers are needed.
    Injury 10/2014; 45 Suppl 4:S28-35. DOI:10.1016/S0020-1383(14)70007-5 · 2.14 Impact Factor
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    • "Recent studies have reported effectiveness and high healing rates with the use of autologous bone marrow and/or demineralized bone matrix percutaneous infiltration. Di Bella et al. [14] compared multiple injections of corticosteroids with a single injection of demineralized bone matrix in association with bone marrow concentrate. They demonstrated advantages of higher healing and lower failure rates. "
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    ABSTRACT: Despite the great amount of research concerning bone cysts, there is still no commonly accepted method of treatment. The aim of this study was to evaluate the effectiveness managing bone cyst with hybrid external fixator by distraction osteogenesis. Between 1982 and 2009, 25 patients with unicameral (20 patients) and aneurismal (five patients) bone cysts were treated using this method. Eighteen patients had a history of pathological fracture at the same location. Cysts were located in the humerus, femur, tibia, and radius. Median follow-up was 48 (range 31-91) months. Results were evaluated on plain radiographs according to the classification system of Capanna et al. Functional assessment was done using the modified system recommended by Enneking et al. In our study group of 25 bone cysts, 15 were classified as completely healed and nine as healed with residual radiolucency. Recurrence was observed in one patient. Absence of response to treatment was not observed. All patients had excellent functional outcomes, except one with recurrence who was rated poor. As bone cysts are found in long bones in 90-95 % of patients, and taking into account our achieved positive results in almost all patients, we recommend this method of distraction osteogenesis as a treatment option. It is an effective, economical method of treatment, which eliminates deformity and restores bone length, especially in patients with pathologic fractures.
    Journal of Orthopaedics and Traumatology 10/2013; 15(2). DOI:10.1007/s10195-013-0272-9
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    • "Since autologous bone marrow grafting for UBC treatment was introduced by Lokiec in 1996 [31], the injection of bone marrow alone or in combination with DBM has been proposed as an alternative to steroid injection. The injection of bone marrow provides osteoprogenitor cells and DBM could stimulate new bone formation owing to its osteoinductive and osteoconductive properties [5,14,32]. Recently, many authors have evaluated the effectiveness of DBM as a graft substitute and it is applied in many surgical grafting procedures including spinal fusion, joint reconstructive surgery, trauma and oral/maxillofacial surgery. With respect to the use of DBM in UBC treatment, the effectiveness as a graft material after intramedullary decompression has been evaluated by some authors [7,10,11,29,33] Kanellopoulos et al [13] and Rougraff et al [14] reported about 90% success rate after a single procedure using a mixture of DBM and autologous bone marrow and it took six to nine months to achieve cortical remodeling radiographically. "
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    ABSTRACT: Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts. Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1 years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months). Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up. A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.
    BMC Musculoskeletal Disorders 07/2012; 13:134. DOI:10.1186/1471-2474-13-134 · 1.72 Impact Factor
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