Minimally invasive endoscopic treatment for unicameral bone cysts: technique and outcomes in a series of 33 pediatric and adolescent patients

TL;DR

A minimally invasive endoscopic treatment for unicameral bone cysts in children and adolescents shows high healing rates and low complications.

Contribution

A standardized minimally invasive endoscopic protocol combining curettage, sclerotherapy, and injectable bone grafting is introduced for UBCs.

Findings

Complete or partial radiographic healing was achieved in 90.9% of cases.

Complications were minimal, with no pathological fractures or growth plate disturbances observed.

Short hospitalization and excellent cosmetic outcomes were reported.

Abstract

To evaluate the clinical efficacy and safety of a minimally invasive endoscopic protocol—combining curettage, sclerotherapy, and injectable bone grafting—in the treatment of unicameral bone cysts (UBCs).

From March 2019 to August 2024, 33 pediatric and adolescent patients with UBCs were treated using a standardized minimally invasive endoscopic curettage combined with sclerotherapy and injectable bone grafting at our institution. The cohort included 24 males and 9 females, with a mean age of 10.1 years (range 4–20 years). Patients were followed for an average of 48.4 months (range 12–76 months). Radiographic healing rates, functional score, and complications were assessed.

According to the modified Neer classification, complete or partial radiographic healing was achieved in 30 cases (90.9%), while 3 cases experienced persistent or recurrent cyst (9.1%). Almost all patients recovered excellent function. No postoperative pathological fractures or growth plate disturbances were observed during a mean follow-up of 48.4 months. Complications were limited to one episode of transient pain and one case of mild swelling, both self-limiting without intervention. Postoperative hospitalization was brief (mean, 1.2 days), and cosmetic outcomes were excellent, with minimal portal scars, far less conspicuous than those from traditional open procedures.

Endoscopic minimally invasive surgery combining curettage, sclerotherapy, and injectable bone grafting appears to be a safe and effective option for the management of UBCs in children and adolescents, achieving high healing rates and low complication risks. Nevertheless, given the single-arm design and limited sample size, larger controlled studies with long-term follow-up are needed to confirm these findings.

The online version contains supplementary material available at 10.1186/s13018-025-06557-7.

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