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Excisional Curettage of Benign Cystic Lesions

Ibe, Izuchukwu K. MD1; Alder, Kareme D. BS2; Henderson, Shasta E. MD3; Yu, Kristin E. BA2; Lee, Francis Y. MD, PhD1

JBJS Essential Surgical Techniques: September 25, 2019 - Volume 9 - Issue 3 - p e24
doi: 10.2106/JBJS.ST.18.00036
Subspecialty Procedures
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Disclosures

Background: There are many treatment modalities for benign cystic lesions of bone, but all methods, except for total resection, are plagued with varying rates of recurrence1. Thorough curettage with the use of a high-speed burr, however, has demonstrated a low recurrence rate of 12% and has been suggested to be the best method for the treatment of benign cystic lesions. Approximately 90% of aneurysmal bone cysts can be controlled adequately with this treatment alone2.

Description: Treatment of benign cystic lesions of bone with the use of excisional curettage requires careful preoperative planning and patient positioning before the initial incision is made. The initial incision must be carefully planned to expose the entire lesion without violating multiple compartments unnecessarily. A sizeable cortical window must then be made using a high-speed burr followed by evacuation of all cystic contents via curettage. The cavity is copiously irrigated before an adjuvant is used, and the lesion is stabilized, if necessary, before closing.

Alternatives: There are many types of alternatives to curettage, such as wide resection, radiation, and embolization of feeding vessels.

Rationale: In orthopaedics, as in all medical specialties, many interventions and techniques have been rendered obsolete and, ultimately, replaced by newer, safer, and more efficient ones. The appeal of curettage has remained because of its procedural simplicity and adaptability in the management of a plethora of diseases such as benign cystic lesions of bone. Additionally, curettage, unlike wide resection, radiation, and embolization of feeding vessels, is minimally invasive and often definitive in nature when used as a treatment modality2. Lastly, curettage grants the performing surgeon the ability to maintain a contained cavity that can be treated with a variety of adjuvant therapies3-17. These reasons listed above make curettage a viable option for the surgical treatment of benign cystic lesions such as giant cell tumors of bone, aneurysmal bone cysts, unicameral bone cysts, chondromyxoid fibromas, and symptomatic nonossifying fibromas.

1Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, Connecticut

2Yale University School of Medicine, New Haven, Connecticut

3Department of Orthopaedics, Pennsylvania State University, Hershey, Pennsylvania

Investigation performed at the Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut

Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A255).

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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