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Bone Marrow Aspirate Concentrate Combined With Demineralized Bone Matrix With Open Curettage vs Mini-Open
Roy Gigi1,2, Amir Sternheim3,2, Omri Merose3,2
1Pediatric Orthopaedic Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Background:
Unicameral bone cysts (UBCs) are common benign pediatric bone lesions prone to pathologic fracture and recurrence. Bone marrow aspirate concentrate combined with demineralized bone matrix (BMAC/DBM) is a biologically active treatment strategy. However, no study has directly compared open curettage combined with BMAC/DBM injection against mini-open trocar-assisted injection (MOTAI) of BMAC/DBM in a long-term cohort.
Methods:
A retrospective comparative study was conducted at a single tertiary referral center. Thirty-five patients treated for UBCs between 2006 and 2019 were included: 20 underwent open curettage with BMAC/DBM injection (curettage group) and 15 received MOTAI (MOTAI group). The primary outcome was the need for an additional surgical intervention. Secondary outcomes included final Neer radiographic classification and a composite functional score at a mean follow-up of 7.8 years.
Results:
The reoperation rate was 15.0% (3/20) in the curettage group vs 66.7% (10/15) in the MOTAI group (Fisher's exact P = .028 after adjustment for age and cyst activity status). On multivariable logistic regression, the MOTAI group had significantly higher odds of undergoing an additional surgical intervention than the curettage group (odds ratio: 9.92, 95% confidence interval: 1.27-77.35 P = .029). Cyst activity status did not independently predict the need for an additional intervention (P = .394). A good radiographic result (Neer grades 1-2) was achieved in 70.0% of the curettage group and 73.3% of the MOTAI group (Fisher's exact P = 1.00). Hardware use did not significantly influence reoperation risk (P = .835). Composite functional scores were excellent in both groups, with no significant difference between them (Benjamini-Hochberg-adjusted P > .80).
Conclusions:
Open curettage with BMAC/DBM significantly reduces the need for additional surgical interventions compared with MOTAI, without compromising the final radiographic or functional outcomes at long-term follow-up. Curettage may be the principal surgical determinant of treatment efficacy in this setting.
Key Concepts:
(1)Open curettage with bone marrow aspirate concentrate combined with demineralized bone matrix lowers reoperation risk vs injection alone in unicameral bone cysts (UBCs).(2)Long-term radiographic and functional outcomes were similar between approaches.(3)Intramedullary hardware alone did not reduce reoperation risk in pediatric UBCs.(4)Active cyst status did not independently predict reoperation after adjustment.(5)Mechanical cyst-wall disruption may be the key surgical driver of cyst healing.
Level Of Evidence:
III, Retrospective Comparative Study.
