UNASSIGNED: The objective was to describe the technique and clinical outcome of microwave thermal ablation (MWA) and perfusion combined with synthetic bone substitutes in treating unicameral bone cysts (UBCs) in adolescents.
UNASSIGNED: A total of 14 consecutive patients were enrolled by percutaneous MWA and saline irrigation combined with synthetic bone substitutes. Clinical follow-up included the assessment of pain, swelling, and functional mobility. Radiological parameters included tumor volume, physis-cyst distance, cortical thickness of the thinnest cortical bone, and the Modified Neer classification system.
UNASSIGNED: The mean follow-up was 28.9 months (26-52 months). All UBCs were primary, and all patients underwent the MWA, saline perfusion, and reconstruction combined with a synthetic bone substitute session, except for one patient (7.1%) who required a second session. All patients had good clinical results at the final follow-up. Satisfactory cyst healing was achieved in 13 cases according to radiological parameters. Tumor volume decreased from a mean of 49.7 cm3 before surgery treatment to 13.9 cm3 at the final follow-up (p < 0.01). The physis-cyst distance increased from a mean of 3.17-4.83 cm at the final follow-up (p < 0.01). Cortical thickness improved from a mean of 1.1 mm to 2.0 mm at the final follow-up (p < 0.01). According to the proposed radiological criteria, our results were considered successful (Grading I and II) in 13 patients (92.9%) at the final follow-up.
UNASSIGNED: Percutaneous microwave ablation combined with a bone graft substitute is a minimally invasive, effective, safe, and cost-effective approach to treating primary bone cysts in the limbs of adolescents.

Elastic stable intramedullary nailing (ESIN) internal fixation is used clinically to treat pathological fractures of bone cysts in children. However, one of the most important complications was removal difficulty. In this study, we aim to analyse the factors which can influence ESIN removal in healed bone cysts in children. From April 2014 to November 2020, the clinical data of 49 children who underwent elastic stable intramedullary nail removal for pathological fractures of the bone cysts in our hospital were retrospectively analysed. The following data, including age, sex, pathological fracture site, with bone graft, number of ESINs, ESIN indwelling time, and extraosseous length of ESIN were collected, and univariate analysis and logistic regression analysis was performed. The frequency of difficulty in ESIN extraction was 44.90% (22/49). The univariate logistic regression analysis showed that age,ESIN indwelling time,with bone garft and extraosseous length of ESIN may be correlated with the difficulty in removing ESIN (P < 0.05), while sex, pathological fracture site, number of ESIN may not be correlated with the difficulty in removing ESIN (P > 0.05).The multivariate logistic regression analysis showed that the ESIN indwelling time was the independent influencing factor for difficulty in removing ESIN (P < 0.05). The factors influencing the ESIN removal in healed bone cysts in children include over 11.79 years old, the long indwelling time of the ESIN(over 10.5 months),with bone graft and short extraosseous length of ESIN(≤ 0.405 cm). These factors influencing ESIN removal in healed bone cysts in children should be considered.

UNASSIGNED: The purpose of this study was to assess the success rate and functional outcomes of bone grafting for periprosthetic bone cysts following total ankle arthroplasty (TAA). Additionally, we evaluated the rate of graft incorporation and identified associated predisposing factors using CT scan.
UNASSIGNED: We reviewed a total of 37 ankles (34 patients) that had undergone bone grafting for periprosthetic bone cysts. A CT scan was performed one year after bone grafting to check the status of graft incorporation. For accurate analysis of cyst volumes and their postoperative changes, 3D-reconstructed CT scan processed with 3D software was used. For functional outcomes, variables such as the Ankle Osteoarthritis Scale score and the visual analogue scale for pain were measured.
UNASSIGNED: Out of 37 ankles, graft incorporation was successful in 30 cases. Among the remaining seven cases, four (10.8%) exhibited cyst re-progression, so secondary bone grafting was needed. After secondary bone grafting, no further progression has been noted, resulting in an overall 91.9% success rate (34 of 37) at a mean follow-up period of 47.5 months (24 to 120). The remaining three cases (8.1%) showed implant loosening, so tibiotalocalcaneal arthrodesis was performed. Functional outcomes were also improved after bone grafting in all variables at the latest follow-up (p < 0.05). The mean incorporation rate of the grafts according to the location of the cysts was 84.8% (55.2% to 96.1%) at the medial malleolus, 65.1% (27.6% to 97.1%) at the tibia, and 81.2% (42.8% to 98.7%) at the talus. Smoking was identified as a significant predisposing factor adversely affecting graft incorporation (p = 0.001).
UNASSIGNED: Bone grafting for periprosthetic bone cysts following primary TAA is a reliable procedure with a satisfactory success rate and functional outcomes. Regular follow-up, including CT scan, is important for the detection of cyst re-progression to prevent implant loosening after bone grafting.

The aim of this study is to evaluate the surgical treatment with the best healing rate for patients with proximal femoral unicameral bone cysts (UBCs) after initial surgery, and to determine which procedure has the lowest adverse event burden during follow-up.
This multicentre retrospective study was conducted in 20 tertiary paediatric hospitals in France, Belgium, and Switzerland, and included patients aged < 16 years admitted for UBC treatment in the proximal femur from January 1995 to December 2017. UBCs were divided into seven groups based on the index treatment, which included elastic stable intramedullary nail (ESIN) insertion with or without percutaneous injection or grafting, percutaneous injection alone, curettage and grafting alone, and insertion of other orthopaedic hardware with or without curettage.
A total of 201 patients were included in the study. The mean age at diagnosis was 8.7 years (SD 3.9); 77% (n = 156) were male. The mean follow-up was 9.4 years (SD 3.9). ESIN insertion without complementary procedure had a 67% UBC healing rate after the first operation (vs 30% with percutaneous injection alone (p = 0.027), 43% with curettage and grafting (p = 0.064), and 21% with insertion of other hardware combined with curettage (p < 0.001) or 36% alone (p = 0.014)). ESIN insertion with percutaneous injection presented a 79% healing rate, higher than percutaneous injection alone (p = 0.017), curettage and grafting (p = 0.028), and insertion of other hardware combined with curettage (p < 0.001) or alone (p = 0.014). Patients who underwent ESIN insertion with curettage had a 53% healing rate, higher than insertion of other hardware combined with curettage (p = 0.009). The overall rate of postoperative complications was 25% and did not differ between groups (p = 0.228). A total of 32 limb length discrepancies were identified.
ESIN insertion, either alone or combined with percutaneous injection or curettage and grafting, may offer higher healing rates than other operative procedures. Limb length discrepancy remains a major concern, and might be partly explained by the cyst\'s location and the consequence of surgery. Therefore, providing information about this risk is crucial.

Subchondral bone cysts after cartilage repair are abnormal cavities that develop near the site of repaired cartilage defects and may communicate with the joint cavity.Research indicates that they may be associated with factors such as elevated external hydraulic pressure, bone bruising due to abnormal stress, internal inflammation, and inadequate blood supply.These cysts are closely linked to bone marrow edema.It has been observed that cysts following cartilage repair frequently occur after various procedures, including bone marrow stimulation, autologous or allogeneic osteochondral transplantation, and autologous chondrocyte transplantation.They represent a significant pathological change post-cartilage repair, influencing the process, quality, and outcome of the repair.Consequently, they have become an important parameter for evaluating the effectiveness of cartilage repair.This article provides a review of studies on the occurrence, development mechanisms, and pathological structures of subchondral bone cysts after cartilage repair using different techniques.It explores the clinical implications and potential of utilizing these cysts to assess the success of cartilage repair, enhancing understanding in this field.Such insights are expected to lay a foundation for the prevention and treatment of subchondral bone cysts following various cartilage repair procedures.
软骨修复术后软骨下骨囊肿指在软骨缺损修复部位附近的软骨下骨内出现的、可能与关节腔连通的异常空洞。其发生可能与外部高液压、异常应力下的骨挫伤、内部炎症和血供不足等因素有关，且与骨髓水肿密切关联。软骨下骨囊肿可出现于多种关节软骨修复术后，如骨髓刺激、自体或异体骨软骨移植、自体软骨细胞移植等，对软骨修复进程、质量和结局有重要影响。软骨下骨囊肿因此，逐渐成为评估软骨修复效果的参考指标之一。本文对不同软骨修复术后软骨下骨囊肿的发生、发展机制和病理结构等研究进行综述，探讨应用软骨下骨囊肿评估软骨修复效果的临床意义和潜力，提高对软骨修复术后骨囊肿的认识，期望为不同软骨修复术后软骨下骨囊肿的预防和治疗提供依据。.

OBJECTIVE: The aim of this study was to evaluate and compare different surgical treatment modalities for simple bone cysts (SBC) of the humerus regarding their effectiveness and recurrence rate.
METHODS: In this retrospective study, patients who received surgical treatment for previously untreated primary SBCs of the humerus were analyzed. Demographic data, cyst-specific as well as treatment-specific parameters, complications, treatment failures, and recurrence rates were collected and correlated with different treatment modalities. Observed procedures were categorized as open procedure (n=20) or osteosynthesis alone (n=3). For the open procedure group, four subgroups could be defined.
RESULTS: Twenty-three patients were included. The mean age at diagnosis was 11.6 ± 2.5 years, and the mean postoperative follow-up was 3.9 ± 2.6 years (range 1.0-10.3). After surgical intervention, a total of five (21.7%) patients showed at least one recurrence. Fracture occurred in three (13.0%) cases. The incidence of treatment failure was significantly higher in the curettage, allograft, adjuvants group, with five (83.3%) of six cases showing recurrence, than in the other subgroups (≤ 25.0%) including the osteosynthesis alone group (p=.024). For the open procedure group, the failure-free survival rates were 80.0% after two years and 50.4% after five years. For the three cases treated by osteosynthesis alone, no failures were observed.
CONCLUSIONS: Open procedures showed similar failure rates except for the subgroup using curettage, allograft, and adjuvants which showed significantly higher treatment failure. Promising results were observed in the group which received solely osteosynthesis without cyst excision or filling, as no treatment failure was observed here.

UNASSIGNED: To provide a comprehensive overview of the surgical treatments of osteochondral lesion of talus (OLT) and offer valuable insights for clinical practice.
UNASSIGNED: The advantages and limitations of surgical treatments for OLT were comprehensively summarized through an extensive review of domestic and abroad relevant literature in recent years.
UNASSIGNED: Currently, there exist numerous surgical treatments for the OLT, all of which can yield favorable outcomes. However, each method possesses its own set of merits and demerits. The short-term effectiveness of bone marrow stimulation in treating primary OLT with a diameter less than 15 mm is evident, but its long-term effectiveness diminishes over time. Autologous osteochondral transplantation (AOT) and osteochondral allograft transplantation (OAT) are suitable for OLT with large defects and subchondral bone cysts. However, incomplete anatomical matching between the donor and recipient bones may results in the formation of new subchondral bone cysts, while AOT also presents potential complications at the donor site. In contrast to AOT and OAT, particulated juvenile cartilage allograft transplantation obviates the need for additional osteotomy. Furthermore, juvenile cartilage exhibits enhanced potential in delivering active chondrocytes to the site of cartilage defect, surpassing that of adult cartilage in tissue repair efficacy. Cell transplantation has demonstrated satisfactory effectiveness; however, it is associated with challenges such as the requirement for secondary surgery and high costs. Autologous matrix-induced chondrogenesis technology has shown promising effectiveness in the treatment of primary and non-primary OLT and OLT with large defect and subchondral bone cysts. However, there is a scarcity of relevant studies, most of which exhibit low quality. Adjuvant therapy utilizing biological agents represents a novel approach to treating OLT; nevertheless, due to insufficient support from high-quality studies, it has not exhibited significant advantages over traditional treatment methods. Furthermore, its long-term effectiveness remain unclear.
UNASSIGNED: The optimal choice of surgical treatment for OLT is contingent not only upon the characteristics such as nature, size, and shape but also takes into consideration factors like advancements in medical technology, patient acceptance, economic status, and other pertinent aspects to deliver personalized treatment.
UNASSIGNED: 总结距骨骨软骨损伤（osteochondral lesion of talus，OLT）外科治疗方法，为临床治疗提供参考。.
UNASSIGNED: 广泛查阅国内外近年相关研究文献，总结OLT各外科治疗方法的优势和局限性。.
UNASSIGNED: 目前治疗OLT的手术方式较多，均能获得良好疗效，但也各有利弊。骨髓刺激术治疗损伤直径<15 mm的原发性OLT能在短期内改善症状，但远期疗效欠佳。自体骨软骨移植（autologous osteochondral transplantation，AOT）、同种异体骨软骨移植（osteochondral allograft transplantation，OAT）适用于损伤面积较大并伴有软骨下骨囊变的OLT，然而骨与骨之间不完全解剖匹配可能会形成新的软骨下骨囊变，其中AOT还存在供体部位并发症问题。与AOT、OAT不同，同种异体幼年软骨微粒移植无需进行额外截骨术，且幼年软骨能向软骨缺损部位输送有活力的软骨细胞，修复组织能力优于成年软骨。细胞移植术治疗OLT可取得满意疗效，但存在需两次手术、价格昂贵等问题。自体基质诱导软骨形成技术治疗原发性及非原发性OLT、大面积病变和伴有软骨下骨囊变的OLT都表现出满意效果，但目前相关研究较少且大多质量不高。生物制剂辅助治疗是治疗OLT的新方式，但疗效缺少高质量研究支持，对比传统治疗手段也未显现出明显优势。.
UNASSIGNED: OLT外科治疗方法的选择不仅取决于其性质、大小、形态，还应考虑医疗技术水平以及患者接受程度、经济状况等因素，以提供个性化治疗。.

OBJECTIVE: Simple bone cysts (SBCs) are the most common benign bone lesions in childhood. There are many different methods in the treatment of SBCs. There is no consensus on which method to use in the treatment. In this study, we compared the results of allogeneic bone graft or synthetic bone graft in addition to fl exible intramedullary nail (FIN) for SBC located in the humerus.
METHODS: This retrospective study comparing the data of 19 (group 1: 8 curettage, allograft and FIN; group 2: 11 curettage, synthetic graft and FIN) patients with a mean age of 11.4 (6 to 26; seven female, twelve male) who were surgically treated in our hospital for humeral SBC between April 2014 and January 2020. Patient data included age, sex, anatomical side, stage of the cyst, pathological fracture, previous treatments and complications.
RESULTS: The mean follow-up period was 33.7 months (12 to 61). The average last follow-up Musculoskeletal Tumor Society functional scores for groups 1 and 2 were 27.8 (20 to 30) and 28.6 (21 to 30) (P > 0.05). Complete or signifi cant partial radiographic healing rates were achieved in group 1 (75%) compared with group 2 (81.9%). The reoperation rates for groups 1 and 2 were 62.5% (5/8; three for nails removed, two for recurrence) and 36.3% (4/11; two for nails removed, two for recurrence). One patient in group 2 had a 15° varus deformity due to recurrence. No other complications were observed.
CONCLUSIONS: The combination of curettage-grafonage FIN is a common treatment method in recent years, as it provides early cyst healing and limb mobilization in SBCs located in the upper extremity. For defects after curettage of the bone cysts, allogeneic or synthetic grafts (granule b-tricalcium phospate) which have similar results in terms of healing can be used as an alternative to each other.
BACKGROUND: allografts, bone cysts, bone nails, synthetic grafts, humerus.

UNASSIGNED: Whether arthroscopic microfracture is effective in treating cystic osteochondral lesions of the talus (OLTs) remains controversial. In this study, outcome parameters in patients with small and shallow subchondral cysts are compared to patients without cysts with the hypothesis that equivalent outcomes may be found after primary microfracture treatment.
UNASSIGNED: From 2018 to 2021, all 50 OLTs treated with arthroscopic microfracture in the authors\' hospital were retrospectively reviewed for eligibility. Single unilateral symptomatic lesions were included and divided into the cyst and noncyst groups, whereas kissing lesions and arthritic lesions were excluded. Numeric rating scale (NRS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores, Tegner activity level scores, Foot and Ankle Ability Measure (FAAM) scores, and magnetic resonance (MR) imaging results were used to describe outcomes.
UNASSIGNED: A total of 35 patients were included, 16 in the cyst group and 19 in the noncyst group. The patient characteristics were similar between the 2 groups (P > .05). In the cyst group the average cysts depth was 5.0 ± 1.3 mm. After a mean follow-up duration of 36.2 ± 10.2 months, no significant differences were found between the 2 groups in NRS, AOFAS, FAAM, or Tegner score improvement (P > .05). Three patients (19%) in the cyst group had no NRS score improvement.
UNASSIGNED: OLTs with small and shallow subchondral cysts can be treated with arthroscopic microfracture and achieve similar outcomes as noncystic lesions. A few cystic lesions may not respond to microfracture treatment.
UNASSIGNED: Level III, retrospective comparative study.

Objective: To investigate the radiologic, pathologic, and molecular features of simple bone cysts (SBC), and their differential diagnoses. Methods: Fourteen cases of SBC were collected at the Department of Pathology, the First Affiliated Hospital of Nanjing Medical University from 2017 to 2022, and fluorescence in situ hybridization (FISH) was performed for retrospective analysis. Results: There were 14 patients, including 7 females and 7 males, with age range of 7 to 45 (median 29) years. The most common complaint was pain, including 4 cases with pathological fracture and 5 with history of previous trauma. The tumor size ranged from 3.4 to 13.5 (median 5.6) cm. The lesion involved the femur (n=4), humerus (n=5) and iliac bone (n=5). Radiologic diagnoses included SBC, aneurysmal bone cyst, and giant cell tumor of the bone or its combination with aneurysmal bone cyst-like region and fibrous dysplasia. Histologically, the cyst walls of the lesions were composed of fibrous tissue, fibrin-like collagen deposits, bone-like matrix and occasional woven bone. The lesional cells were spindled to ovoid, with scattered osteoclast-like giant cells, foamy histiocytes, hemosiderin deposits and cholesterol clefts. In 6 cases there were nodular fasciitis-like areas. Immunohistochemically, the spindled to ovoid cells were positive for SMA, EMA and SATB2 in varying degrees. FISH detection was performed in all 14 cases and EWSR1/FUS rearrangement were found in 9 cases. One case of FUS::NFATC2 fusion was detected by next-generation sequencing. Nine cases of SBC with the rearrangement were more cellular, and there were more mitotic figures in the recurrent FUS::NFATC2 fusion tumor. Clinical follow-up was obtained in all 14 cases with the time ranging from 5 to 105 (mean 46) months. Amongst them, the tumor with FUS::NFATC2 rearrangement had local recurrence twice after the first local excision, but had no more recurrence or metastasis 34 months after the subsequent segmental resection. The other 13 cases had no recurrence. Conclusions: EWSR1 or FUS rearrangement is most commonly identified in SBC, suggesting that SBC might be a neoplastic disease. In cases where the radiologic appearance and histomorphology are difficult to differentiate from aneurysmal bone cyst, FISH detection can aid in the definitive diagnosis.
目的： 探讨单纯性骨囊肿（simple bone cyst，SBC）的临床影像学、病理形态学、分子遗传学特点、诊断及鉴别诊断。 方法： 收集南京医科大学第一附属医院病理学部2017—2022年诊断为SBC的病例14例，行荧光原位杂交（FISH），回顾性分析影像学、病理学及分子遗传学特征。 结果： 14例SBC中，男性7例，女性7例，年龄7~45岁（中位年龄29岁）。临床表现以局限性疼痛最为常见，其中4例伴有病理性骨折，5例伴有既往创伤史。最大径3.4~13.5 cm（中位5.6 cm），累及肱骨（5例）、髂骨（5例）、股骨（4例）。影像学诊断有SBC、动脉瘤性骨囊肿、骨巨细胞瘤、骨巨细胞瘤合并动脉瘤性骨囊肿样区域，以及纤维结构不良。形态学上，低倍镜下囊壁由纤维结缔组织构成，可以见到纤维蛋白样沉积物，部分有骨样基质及编织骨的形成。高倍镜下，囊壁可见呈胖梭形、卵圆形病变细胞，散在的破骨样巨细胞，堆积的泡沫样组织细胞，含铁血黄素的沉积以及胆固醇裂隙，6例可见类似结节性筋膜炎样的形态。免疫表型上，囊壁内衬细胞可见平滑肌肌动蛋白、上皮细胞膜抗原、SATB2不同程度的表达。14例均行FISH检测，发现9例涉及FUS或ESRW1基因的重排，其中1例行二代测序发现FUS：：NFATC2融合。9例发生重排的SBC细胞密度略高，其中FUS：：NFATC2融合患者复发标本可见核分裂象。14例随访5~105个月（平均46个月），其中FUS：：NFATC2重排患者术后2次局部复发，第2次复发后行瘤段切除术34个月未复发，其余13例均无复发。 结论： SBC中有很大一部分存在EWSR1或FUS的重排，提示SBC可能是一个肿瘤性疾病。当影像学和形态学特征对于鉴别诊断SBC和动脉瘤性骨囊肿困难时，可结合FISH检测辅助鉴别。.