Minimally Invasive Treatment of Aneurysmal Bone Cysts Utilizing a Modified Sclerograft Technique

Aneurysmal bone cysts (ABCs) are locally aggressive expansile bone tumors that typically present near the metaphysis and are commonly encountered in the pediatric population. This study presents the results of a single staged procedure, which is a modification of the Sclerograft procedure (chemical sclerotherapy combined with regenerative bone grafting) used to treat unicameral bone cysts (UBCs), as an alternative treatment paradigm.

This retrospective, single-institution study included patients with MRI-confirmed primary aneurysmal bone cysts of the appendicular skeleton treated between 2020 and 2025. Eligible patients underwent mechanical disruption with doxycycline sclerotherapy (± cryoablation) and regenerative bone grafting. Demographics, lesion characteristics, prior treatments, imaging, and clinical outcomes were analyzed.

The final cohort included 27 patients (15 females, 12 males) with a mean age of 10.6 years. The primary outcome was the reintervention rate. Patients underwent a median of 1 procedure (range 1-3; mean 1.33) over a median follow-up of 1.88 years (range 0.5-5.8 years). 7 of 27 (25.9%) required at least one additional procedure due to radiographic (Modified Neer Grade 3-4) and symptomatic recurrence. Median time to retreatment was 12.2 months (IQR 6.8-19.4). Radiographs were the primary follow-up imaging modality (92.6%).

The modified Sclerograft technique is a feasible, single-session treatment option for primary aneurysmal bone cysts with promising results that warrant further study as a possible alternative to the historical paradigm of serial sclerotherapy. Utilizing regenerative bone graft facilitates bone formation and permits the majority of follow-up to be performed with plain radiographs.