Minimally Invasive Treatment of Aneurysmal Bone Cysts Utilizing a Modified Sclerograft Technique.
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PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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%). CONCLUSION: 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.