Metatarsal Aneurysmal Bone Cysts Treated With En Bloc Resection and Reconstruction With Fibular Allograft

Area of Science:

• Orthopaedic Oncology
• Surgical Reconstruction
• Bone Tumors

Background:

• Primary metatarsal aneurysmal bone cysts (ABCs) often recur after curettage and bone grafting.
• Traditional treatments have limitations, especially in short tubular bones.

Purpose of the Study:

• To evaluate the long-term outcomes of en bloc resection and fibular allograft reconstruction for metatarsal ABCs.
• To assess the efficacy and safety of this surgical technique in a specialized orthopaedic oncology center.

Main Methods:

• Retrospective review of 19 patients with metatarsal ABCs treated between 2004 and 2020.
• En bloc resection followed by reconstruction with fibular allograft.
• Radiographic healing, Toronto Extremity Salvage Score (TESS), and Musculoskeletal Tumor Society (MSTS) score were used for outcome assessment.

Main Results:

• No local recurrence was observed in any patient.
• Average healing time was 10.2 weeks, with high TESS (94.52) and MSTS (28.42) scores.
• Complications included one allograft fracture and two repeat surgeries for infection and nonunion.

Conclusions:

• En bloc resection with fibular allograft is a successful surgical strategy for primary metatarsal ABCs.
• This method demonstrates a low recurrence rate and preserves significant limb function.
• It is a recommended approach for active and invasive metatarsal ABCs based on the Enneking classification.