eMedicine Specialties > Orthopedic Surgery > Neoplasms

Aneurysmal Bone Cyst: Follow-up

Author: Bart Eastwood, DO, Orthopedic Surgeon, Avera St Anthony's Hospital
Contributor Information and Disclosures

Updated: May 2, 2008

Outcome and Prognosis

The prognosis for an ABC is generally excellent, although some patients need repeated treatments because of recurrence, which is the most common problem encountered when treating an ABC.

The overall cure rate is 90-95%.26,27 A younger age, open growth plates, and a metaphyseal location all have been associated with an increased risk of recurrence.26 The stage of the ABC has not been shown to influence the rate of recurrence; however, most clinicians believe that stage 3 lesions have the highest recurrence rate, other factors being equal. Morphologic types I and II recur more often than types III, IV, and V.

Primary recurrence rates have varied greatly in several different studies. Small studies have shown a benefit to using selective arterial embolization, and some authors advocate it as a first-line treatment. Other authors argue that not enough data on selective embolization exist and that surgery is the first-line treatment. Intralesional excision has the most data to suggest that it is a safe and effective method.

Recurrence rates for different techniques have varied. Some studies have reported recurrence rates as high as 59% with intralesional excision28 and as low as 0% with resection.15 In a summary of studies of different treatment methods, the following rates of recurrence were reported15 :

  • Irradiation – 34 performed with 4 recurrences (11.8% recurrence rate)
  • Irradiation and curettage – 35 performed with 5 recurrences (14.3% recurrence rate)
  • Curettage and bone graft – 484 performed with 149 recurrences (30.8% recurrence rate)
  • Curettage and cryobiopsy – 78 performed with 10 recurrences (12.8% recurrence rate)
  • Marginal resection – 81 performed with 6 recurrences (7.4% recurrence rate)
  • Wide resection – 59 performed with 0 recurrences (0% recurrence rate)

Future and Controversies

Most authors agree that some vascular malformation precedes the appearance of an ABC, but the underlying cause of the vascular malformation is not clear. Approximately 30% of ABCs are associated with other benign and malignant bony tumors. The most common association is with the giant cell tumor; because of this strong association, some authors believe that all ABCs are produced by an accompanying lesion that is then obliterated by the resulting ABC. Others believe that ABCs can develop de novo.

In the future, advancements in osteoinductive materials (eg, genetically engineered bone morphogenic protein) may offer a less invasive treatment of ABC.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Dr H Kurtis Biggs to the development and writing of this article.



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References
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Further Reading

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Keywords

ABC, cystic lesion, primary aneurysmal bone cyst, primary ABC, secondary aneurysmal bone cyst, secondary ABC, giant cell tumor, telangiectatic osteosarcoma

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Contributor Information and Disclosures

Author

Bart Eastwood, DO, Orthopedic Surgeon, Avera St Anthony's Hospital
Bart Eastwood, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Osteopathic Academy of Orthopedics, and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Howard A Chansky, MD, Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center
Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Sean P Scully, MD, PhD, Professor, Department of Orthopedics, University of Miami
Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

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