Joint reconstruction using tricortical iliac crest bone graft block for intra-articular extension of aneurysmal bone cyst of distal tibia in a skeletally mature patient – a case report and review of literature.

Joint reconstruction using tricortical iliac crest bone graft block for intra-articular extension of aneurysmal bone cyst of distal tibia in a skeletally mature patient – a case report and review of literature. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Joint reconstruction using tricortical iliac crest bone graft block for intra-articular extension of aneurysmal bone cyst of distal tibia in a skeletally mature patient – a case report and review of literature. Shaswat Mishra, Manish Jain, Vishal Lalchandani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5348654/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Aneurysmal Bone Cysts (ABC) are known to be largely limited to the metaphysis. Epiphyseal extension of the lesion, that too in a skeletally mature patient, has rarely been reported. Further, literature regarding management of these lesion, where sclerotherapy failed, is scarce. We describe a case of distal tibia ABC with intra-articular extension, where prior sclerotherapy failed, managed with curettage and iliac crest allograft block reconstruction of the joint with excellent functional outcome. Method: The authors report a case of a 20-year-old lady presenting with swelling and pain in her ankle joint. X-rays and MRI showed an ABC in the distal tibia with extension to the joint. Biopsy confirmed the diagnosis which was followed by sclerotherapy, but the lesion recurred in a year’s time. Surgery in the form of excision, curettage, joint reconstruction using tricortical iliac crest bone autograft block was done which was fixed with plate osteosynthesis. Result and Discussion: Patient under follow up at 3 years shows excellent clinical outcome, no evidence of recurrence, able to perform out her personal and professional activities with no restrictions. Addressing such a case is a very difficult task, and in a financially constrained scenario such as ours, brings its own set of challenges. This novel technique of ankle joint reconstruction using iliac crest graft has not been described elsewhere in literature. Such cases of joint involvement in ABCs are very rare, and literature on management of such lesion is even more scarce. Therefore, they need reporting to help in formulating better treatment protocols in such difficult scenarios. Conclusion: The reconstructive of the ankle joint with tricortical iliac crest bone grafting in ABC of distal tibia with joint involvement can provide excellent clinical and radiological outcomes. Aneurysmal bone cyst intra-articular extension ankle joint reconstruction iliac crest tri-cortical bone graft joint preservation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 INTRODUCTION Aneurysmal bone cysts are benign, aggressive bone tumours that frequently develop in the long bones, particularly the femur (6.9%), tibia (10.5%), and humerus (7%), as well as the posterior elements of spine (3.5%) [ 1 , 2 ] . These are more prevalent in the first two decades of life before skeletal maturation. [ 1 ] It can either exist as a primary (approximately 70% of instances) or as a secondary bone lesion (about 30% of cases), depending on whether a pre-existing osseous lesion can be identified. [ 3 ] Theories on the pathophysiology of ABC range from a genetically predisposed bone malignancy to a post-traumatic, reactive vascular malformation. The aneurysmal bone cyst has been compared to a "blood-filled sponge" because it is made up of blood-filled, anastomosing cavernomatous areas that are separated by a cyst-like wall made of large cells that resemble osteoclasts, fibroblasts, myofibroblasts, and osteoid and woven bone. A distinctive reticulated lacy chondroid-like substance, sometimes known as a calcified matrix with a chondroid aura, is observed in around one-third of cases. [ 4 ] The pathogenetic process for ABCs that is most frequently acknowledged includes a local circulatory disturbance that causes a considerable rise in venous pressure as well as the development of a dilated and expanded vascular bed inside the affected bone region. However, the identification of recurring chromosomal abnormalities in recent years has cast doubt on this conventional wisdom. [ 1 , 4 ] Although ABC most frequently affects the metaphysis, expansion into the epiphysis is possible because to the condition's locally aggressive character, which can cause the growth plate to close prematurely and result in deformity. [ 5 ] Primary epiphyseal ABC, however, is a very uncommon condition and ever more so in skeletally mature individuals. [ 6 ] Patient and her attenders were informed that the data would be submitted for publication purposes and a written, informed consent was taken. Medical Ethics committee approval was taken for the study. CASE REPORT A 20-year-old female patient presented to our OPD with complaints of pain and insidiously, progressive swelling around her left ankle since preceding 8 months. She had no history of any trauma, fever or any constitutional symptoms or systemic involvement. On presentation, she had a 4 x 3 cm swelling over anterior aspect of ankle, which was firm in consistency, there was tenderness and crackling felt on pressure. Range of motion was essentially unhindered but was painful at the extremities of movement and weight bearing. There was no evidence of inflammation or infection overlying the skin. There was no evidence of any neurovascular deficit. Upon presentation, the American Foot and Ankle Score was 67 [ 6 ] . Plain radiographs (Fig. 1 ) revealed an eccentric expansile lytic lesion in the epiphysio-metaphyseal region of distal aspect of tibia. It involved the lateral aspect of the distal tibia, the margins were not clearly demarcated, the fibula, medial malleolar region, rest of the tibia and talus appeared normal. Magnetic resonance imaging (MRI) of the ankle joint (Fig. 2 ) revealed an expansile, eccentric lesion 4 x 2.5 x 3.1 cm arising in the epiphysio-metaphyseal region of the distal tibia involving the articular surface with multiple septations and blood-fluid levels with cortical break involving the inferior and lateral aspect of distal tibia with expansion into the soft tissues. A provisional diagnosis of ABC was given on MRI reporting. Histopathological examination was done through the aide of CT guided biopsy and confirmed the diagnosis of Aneurysmal bone cyst. Sclerotherapy was chosen as the initial modality of treatment but lesion recurred at 1 year follow-up. Subsquently, decision was made to opt for operative management. Feeding arteries to the ABC namely from the Anterior tibial artery [ATA], the Posterior tibial artery [PTA] and the peroneal artery were embolised by the Intervention Radiology team, 1 day prior to the surgery to minimise intra-operative blood loss [ 7 ] . Surgical intervention was planned in the form of curettage and reconstruction. The tumour was exposed through the anterolateral approach and separated from the bed of normal tissue through meticulous dissection, and the tumour block curetted. For reconstruction of the ankle joint, a combination of autograft and allograft was used. Ipsilateral side Iliac crest bone graft (Fig. 3 ) was harvested to accommodate the gap left after excision, 2 block grafts measuring 4 x 3 x 1.5 cm was harvested and finessed to match the contour of the defect, aligned antero-posteriorly, upside down(Fig. 4 ), drill holes were made of a single side and were opposed to each other and the graft was placed in a position where the crest was facing the defective articular surface, the rest of the void was filled with morselised allograft and the joint stabilised with 7 hole titanium distal tibia anterolateral plate osteosynthesis(Fig. 5 ). Homeostasis was achieved and wound closed in layers. Ankle range of motion exercises were initiated from post-op day 1. Toe touch weight bearing was started at 8 weeks and full weight bearing at 3 months (Fig. 6 ). Patient is now under follow up for 3 years (Fig. 7 ) with good clinical results (Fig. 8 ), no evidence of recurrence and resumption of her personal and professional activities and had an American Foot and Ankle Score of 93. The National Library of Medicine of the Institutes of Health's PubMed search engine ( http://www.ncbi.nlm.nih.gov/pubmed ) was used to conduct a thorough literature search. The following keyword combinations were used: "Aneurysmal bone cyst," "ABC," "Epiphysis," and "Distal tibia." The search was restricted to articles in English with no date restrictions (Table 1 ). Table 1 Review Of Literature Serial No Authors Year Complaints Management Conclusion 1 Chan et al[1] 2009 3 year old male patient with right knee pain and swelling since 3 weeks Managed with curettage, burring, cauterisation and phenol painting of cyst wall. Recurrence found at 3 months, underwent same management and at 1 year post operative period has shown no signs of recurrence or deformity 2 Kapila et al[3] 2015 5 year old boy presents with pain and swelling in left wrist since 6 months Lesion was excised en bloc and fibula graft osteosynthesis done with K wire 1 year follow up showed no deformity, good range of motion and no recurrence 3 Servet et al[8] 2014 13 year old male presents with pain and swelling in right ankle for 6 months ABC was found in distal tibia epiphysis and curettage was done Patient was followed up for 2 years and had good range of motion and no recurrence 4 Harmesh et al[9] 2004 22 year old woman presents with pain and swelling of medial aspect of left ankle Mass was curetted and packed with iliac crest bone graft along with fibula strut graft and plate osteosynthesis done On follow up at 1 year, range of motion was good with no evidence of recurrence DISCUSSION Although Jaffe and Leichstein initially characterised it in 1942, the actual etiology is still a mystery [ 8 ] . It is the only osseous tumour in the body whose name is derived from radiographic characteristics rather than histologic characteristics. This is inaccurate since an aneurysmal bone cyst's histologic appearance is neither similar to that of an aneurysm nor that of a cyst [ 9 ] . A subperiosteal, metaphyseal eccentric lesion with elevation and inflation of the periosteum and gradual erosion of the cortex is how ABC appears on radiographs in the long bones. The best way to evaluate ABCs is using a computed tomography or MRI, which reveals a noticeable thinning of the cortex over the location with only minor periosteal reaction [ 10 ] . An Aneurysmal bone cyst extending into the epiphysis is very rare and we could find only 3 such case reports in literature which included one in the distal ulna [ 4 ], proximal tibia [ 1 ] and distal tibia [ 10 ], but all of them were in the skeletally immature patients whereas our case is of a skeletally mature one. According to a recent study, some ABCs may have a particular chromosomal abnormality, most frequently a translocation. There have also been a few reports of malignant transition into osteosarcoma. The study demonstrated that somatic mutations influence ABC formation and that bands 16q22 and 17p13 may include genes crucial to this process. Additionally, this translocation can be viewed as an ABC pathognomonic [ 11 ] . Campanna classified these tumours based on radiographic appearance [ 12 ] . The histopathology of ABCs was initially described by Dabska and Buraczewski as a cavernous vascular tumour with intralesional communication cavitations but no blood clots. Microscopic examination of ABC often reveals haemorrhagic tissue with cavitary gaps divided by fibrous septa made up mostly of spindle cells, inflammatory cells, and a limited number of giant cells. It is possible to see osteoid development with or without osteoblastic rimming [ 13 ] . Currently, the main procedures employed include curettage and the insertion of a bone graft or polymethylmethacrylate [PMMA] [ 14 ] . Use of other modalities like bone substitutes, sclerosing therapy and other materials have shown less than promising results compared to conventional methods and higher recurrences [ 15 ] . There have been reports of unsuccessful treatments that involved puncturing the bone wall with cannulated needles and injecting methylprednisolone acetate into the cyst [ 16 ] . Radiation therapy was effective in causing cyst ossification, but there is a chance that it will also cause sarcoma, growth arrest, and limb-length discrepancy. This process has now been nullified [ 17 ] . Lesions that are not active can just be observed and not treated. Sometimes, these lesions respond to only a biopsy or curettage and resolve without recurring [ 17 ] . The patient described had a of the distal tibia epiphysio-metaphyseal junction, since the tumour had breached and eroded the articular surface, simple curettage would not have done justice since it was a weight bearing joint and would have caused further complications. The diagnosis of any tumour should be confirmed with clinical, radiological and histological correlation as was done for our patient. The preservation of function of the ankle joint was an option presented to the patient and her party and should be considered as first line of management for a benign lesion in which limb salvage can be attempted without the need for anu adjunct therapy, which is not feasible in a financially constrained situation. CONCLUSION Heeding to the extensive research of our authors, this is only case of epiphyseal extension of an ABC in a skeletally mature patient with tibio-talar joint destruction. This was successfully managed with curettage and reconstruction with Iliac Crest Autograft and morselised allograft with plate osteosynthesis. The main highlight being meticulous planning catering to the need of the individual case, procurement of the necessary bone graft or substitutes and reconstruction of joint spaces when and where deficient. Complete excision of the lesion to prevent its recurrence cannot be stressed upon. This technique is also a cost-effective method to treat such cases with excellent long-term results. Abbreviations ABC- Aneurysmal Bone Cyst MRI- magnetic resonance imaging PMMA- Polymethylmethacrylate ATA- Anterior tibial artery PTA- Posterior tibial artery Declarations Clinical trial number : not applicable No funding declaration to be made Conflict of interest : The corresponding author and the other authors state that there is no conflict of interest. Ethical Standard Statement : This article does not contain any studies with human or animal subjects performed by the any of the authors. Informed Consent: Written informed consent was taken from the patient and her attendees. Competing interests : None References Chan G, Arkader A, Kleposki R, Dormans JP. Case report: primary aneurysmal bone cyst of the epiphysis. Clinical Orthopaedics and Related Research®. 2010 Apr;468:1168-72. Mendenhall WM, Zlotecki RA, Gibbs CP, Reith JD, Scarborough MT, Mendenhall NP. Aneurysmal bone cyst. American Journal of Clinical Oncology. 2006 Jun 1;29(3):311-5. Cottalorda J, Bourelle S. Modern concepts of primary aneurysmal bone cyst. Archives of Orthopaedic and Trauma Surgery. 2007 Feb;127:105-14. Kapila R, Sharma R, Sohal YS, Singh D, Singh S. Primary epiphyseal aneurysmal bone cyst of distal ulna. Journal of Orthopaedic Case Reports. 2015 Oct;5(4):85. Parvizi J. High yield orthopaedics E-Book. Elsevier Health Sciences; 2010 Jul 19. Mani SB, Brown HC, Nair P, Chen L, Do HT, Lyman S, Deland JT, Ellis SJ. Validation of the Foot and Ankle Outcome Score in adult acquired flatfoot deformity. Foot & ankle international. 2013 Aug;34(8):1140-6. Green JA, Bellemore MC, Marsden FW. Embolization in the treatment of aneurysmal bone cysts. Journal of Pediatric Orthopaedics. 1997 Jul 1;17(4):440-3. Mohaidat ZM, Al-Gharaibeh SR, Aljararhih ON, Nusairat MT, Al-Omari AA. Challenges in the diagnosis and treatment of aneurysmal bone cyst in patients with unusual features. Advances in orthopedics. 2019 Aug 4;2019. Goss LR, Walter JH. Pediatric aneurysmal bone cyst of the distal tibia. Journal of the American Podiatric Medical Association. 1997 Mar 1;87(3):136-40. Kerimoglu S, Çitlak A, Kerimoglu G, Turgutalp H. Primary aneurysmal bone cyst of the distal tibial epiphysis: a case report. Journal of Pediatric Orthopaedics B. 2014 May 1;23(3):266-9. Kapoor H, Singh D, Bhatia N, Chaudhary D, Singh AK. Distal tibial aneurysmal bone cyst treatment by using a proximal fibular autologous bone graft: a case report. The Journal of foot and ankle surgery. 2004 May 1;43(3):179-84. Campanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clinical Orthopaedics and Related Research (1976-2007). 1986 Mar 1;204:25-36. Dabska M, Buraczewski J. Aneurysmal bone cyst. Pathology, clinical course and radiologic appearances. Cancer. 1969 Feb;23(2):371-89. Marcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clinical Orthopaedics and Related Research®. 1995 Feb 1;311:157-63. Dubois J, Chigot V, Grimard G, Isler M, Garel L. Sclerotherapy in aneurysmal bone cysts in children: a review of 17 cases. Pediatric radiology. 2003 Jun;33:365-72. Scaglietti O, Marchetti PG, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clinical Orthopaedics and Related Research®. 1982 May 1;165:33-42. Clough JR, Price CH. Aneurysmal bone cyst: pathogenesis and long term results of treatment. Clinical Orthopaedics and Related Research (1976-2007). 1973 Nov 1;97:52-63. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5348654","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":374820203,"identity":"9ea36b8f-4f01-4045-a8e4-1824110b3e2d","order_by":0,"name":"Shaswat Mishra","email":"data:image/png;base64,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","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Shaswat","middleName":"","lastName":"Mishra","suffix":""},{"id":374820207,"identity":"ad6b2dd0-b064-40f7-b708-c20b685098ee","order_by":1,"name":"Manish Jain","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Manish","middleName":"","lastName":"Jain","suffix":""},{"id":374820208,"identity":"d05c3adb-68f0-4ddf-9b5e-c9b8a8378951","order_by":2,"name":"Vishal Lalchandani","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Vishal","middleName":"","lastName":"Lalchandani","suffix":""}],"badges":[],"createdAt":"2024-10-28 16:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5348654/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5348654/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70507780,"identity":"c5db9893-64c5-4ae8-85a5-c6e0e630e9e8","added_by":"auto","created_at":"2024-12-03 23:56:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":264926,"visible":true,"origin":"","legend":"\u003cp\u003ePre- operative radiographs\u003c/p\u003e\n\u003cp\u003eStandard antero-posterior and lateral plain radiographs of the left ankle joint, showing an eccentric, expansile, lytic lesion in the distal aspect of tibia destroying the articular surface.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/81a6d79b2326a8a9c9fba886.png"},{"id":70507000,"identity":"f9936fa2-146d-49bf-b2de-94bdc74b0bcc","added_by":"auto","created_at":"2024-12-03 23:48:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":365345,"visible":true,"origin":"","legend":"\u003cp\u003eMagnetic resonance imaging [MRI]\u003c/p\u003e\n\u003cp\u003eT2 proton weighted imaging of the left ankle showing a 4 x 2.5 x 3.1 cm lesion arising in the epiphysio-metaphyseal region of the distal tibia involving the articular surface with multiple\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/d87c917a45baadc95e0f2c9a.png"},{"id":70506997,"identity":"b75ca504-f41b-4268-a261-1e7ceed7879e","added_by":"auto","created_at":"2024-12-03 23:48:42","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":300124,"visible":true,"origin":"","legend":"\u003cp\u003eIliac Crest Bone Grafting\u003c/p\u003e\n\u003cp\u003ePrecise iliac crest bone graft taken of the required dimensions to fill the void post lesion excision taken from the ipsilateral iliac bone with scale for reference, taken using standard incision over the iliac crest.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/aaab5b909fd69349cc45ca45.png"},{"id":70506993,"identity":"1abe3721-74db-4ebc-a897-ea0fb4c75166","added_by":"auto","created_at":"2024-12-03 23:48:42","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":525952,"visible":true,"origin":"","legend":"\u003cp\u003eReconstruction of ankle joint\u003c/p\u003e\n\u003cp\u003eThe iliac crest bone graft is cut into 2 pieces of required dimensions and packed into the void with the crest facing caudally, and rest of the void filled with morselised allograft to provide the bone graft as a scaffold construct.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/b9f5d468bee894bace3a8389.png"},{"id":70508241,"identity":"a477c784-efca-4872-a4ae-8b8428f3c68a","added_by":"auto","created_at":"2024-12-04 00:04:42","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":830311,"visible":true,"origin":"","legend":"\u003cp\u003eGraft fixation and Plate application.\u003c/p\u003e\n\u003cp\u003eThe graft is fixed in its position with the help of an anterolateral distal tibia titanium plate. The talar head can be visualised below the plate as a white structure.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/721948b7ae57b19bf643f5ee.png"},{"id":70506994,"identity":"f47657b3-0a9e-4ca9-ab75-136ce06ee84b","added_by":"auto","created_at":"2024-12-03 23:48:42","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":367272,"visible":true,"origin":"","legend":"\u003cp\u003ePost operative radiograph at 3months\u003c/p\u003e\n\u003cp\u003eStandard anteroposterior and lateral radiographs of the left ankle joint. Visible callus formation seen, the graft shows no gross displacement, the ankle joint seems to be aligned with no evidence of resolution of the graft of tibio-talar arthritis.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/59bf16e4c63224d540a11ab6.png"},{"id":70509237,"identity":"b7fb1628-e51a-408a-af40-f6f9a6668fde","added_by":"auto","created_at":"2024-12-04 00:12:42","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":334498,"visible":true,"origin":"","legend":"\u003cp\u003ePost operative radiograph at 3 years\u003c/p\u003e\n\u003cp\u003eStandard anteroposterior and lateral radiographs of the left ankle joint. Well-formed callus assuming the shape of the distal tibia, graft uptake well done, ankle joint well aligned with no evidence of tibio-talar arthritis.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/f819609ae6d94d59daa87ec4.png"},{"id":70506999,"identity":"36e88002-c32b-4825-b6c0-7e3288c029bf","added_by":"auto","created_at":"2024-12-03 23:48:42","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":777199,"visible":true,"origin":"","legend":"\u003cp\u003eClinical outcome\u003c/p\u003e\n\u003cp\u003eA clinical photograph showing the patient standing on her toes without support and a posterior view showing alignment of the ankle.\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/4b239037be07f65ce6c6f0d9.png"},{"id":84953685,"identity":"3e099ae1-fee7-45a5-87ac-b13c5b62cfe3","added_by":"auto","created_at":"2025-06-19 07:47:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":5843870,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5348654/v1/218d39d1-b735-47df-a700-729302919b9d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Joint reconstruction using tricortical iliac crest bone graft block for intra-articular extension of aneurysmal bone cyst of distal tibia in a skeletally mature patient – a case report and review of literature.","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAneurysmal bone cysts are benign, aggressive bone tumours that frequently develop in the long bones, particularly the femur (6.9%), tibia (10.5%), and humerus (7%), as well as the posterior elements of spine (3.5%) \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. These are more prevalent in the first two decades of life before skeletal maturation.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIt can either exist as a primary (approximately 70% of instances) or as a secondary bone lesion (about 30% of cases), depending on whether a pre-existing osseous lesion can be identified.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTheories on the pathophysiology of ABC range from a genetically predisposed bone malignancy to a post-traumatic, reactive vascular malformation.\u003c/p\u003e \u003cp\u003eThe aneurysmal bone cyst has been compared to a \"blood-filled sponge\" because it is made up of blood-filled, anastomosing cavernomatous areas that are separated by a cyst-like wall made of large cells that resemble osteoclasts, fibroblasts, myofibroblasts, and osteoid and woven bone. A distinctive reticulated lacy chondroid-like substance, sometimes known as a calcified matrix with a chondroid aura, is observed in around one-third of cases.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe pathogenetic process for ABCs that is most frequently acknowledged includes a local circulatory disturbance that causes a considerable rise in venous pressure as well as the development of a dilated and expanded vascular bed inside the affected bone region. However, the identification of recurring chromosomal abnormalities in recent years has cast doubt on this conventional wisdom. \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough ABC most frequently affects the metaphysis, expansion into the epiphysis is possible because to the condition's locally aggressive character, which can cause the growth plate to close prematurely and result in deformity. \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e Primary epiphyseal ABC, however, is a very uncommon condition and ever more so in skeletally mature individuals.\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePatient and her attenders were informed that the data would be submitted for publication purposes and a written, informed consent was taken. Medical Ethics committee approval was taken for the study.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA 20-year-old female patient presented to our OPD with complaints of pain and insidiously, progressive swelling around her left ankle since preceding 8 months. She had no history of any trauma, fever or any constitutional symptoms or systemic involvement.\u003c/p\u003e \u003cp\u003eOn presentation, she had a 4 x 3 cm swelling over anterior aspect of ankle, which was firm in consistency, there was tenderness and crackling felt on pressure. Range of motion was essentially unhindered but was painful at the extremities of movement and weight bearing. There was no evidence of inflammation or infection overlying the skin. There was no evidence of any neurovascular deficit. Upon presentation, the American Foot and Ankle Score was 67\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePlain radiographs (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) revealed an eccentric expansile lytic lesion in the epiphysio-metaphyseal region of distal aspect of tibia. It involved the lateral aspect of the distal tibia, the margins were not clearly demarcated, the fibula, medial malleolar region, rest of the tibia and talus appeared normal.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eMagnetic resonance imaging (MRI) of the ankle joint (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) revealed an expansile, eccentric lesion 4 x 2.5 x 3.1 cm arising in the epiphysio-metaphyseal region of the distal tibia involving the articular surface with multiple septations and blood-fluid levels with cortical break involving the inferior and lateral aspect of distal tibia with expansion into the soft tissues. A provisional diagnosis of ABC was given on MRI reporting.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHistopathological examination was done through the aide of CT guided biopsy and confirmed the diagnosis of Aneurysmal bone cyst. Sclerotherapy was chosen as the initial modality of treatment but lesion recurred at 1 year follow-up. Subsquently, decision was made to opt for operative management.\u003c/p\u003e \u003cp\u003eFeeding arteries to the ABC namely from the Anterior tibial artery [ATA], the Posterior tibial artery [PTA] and the peroneal artery were embolised by the Intervention Radiology team, 1 day prior to the surgery to minimise intra-operative blood loss \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSurgical intervention was planned in the form of curettage and reconstruction. The tumour was exposed through the anterolateral approach and separated from the bed of normal tissue through meticulous dissection, and the tumour block curetted. For reconstruction of the ankle joint, a combination of autograft and allograft was used.\u003c/p\u003e \u003cp\u003eIpsilateral side Iliac crest bone graft (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) was harvested to accommodate the gap left after excision, 2 block grafts measuring 4 x 3 x 1.5 cm was harvested and finessed to match the contour of the defect, aligned antero-posteriorly, upside down(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), drill holes were made of a single side and were opposed to each other and the graft was placed in a position where the crest was facing the defective articular surface, the rest of the void was filled with morselised allograft and the joint stabilised with 7 hole titanium distal tibia anterolateral plate osteosynthesis(Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Homeostasis was achieved and wound closed in layers.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAnkle range of motion exercises were initiated from post-op day 1. Toe touch weight bearing was started at 8 weeks and full weight bearing at 3 months (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Patient is now under follow up for 3 years (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e) with good clinical results (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e), no evidence of recurrence and resumption of her personal and professional activities and had an American Foot and Ankle Score of 93.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe National Library of Medicine of the Institutes of Health's PubMed search engine (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/pubmed\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/pubmed\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e was used to conduct a thorough literature search. The following keyword combinations were used: \"Aneurysmal bone cyst,\" \"ABC,\" \"Epiphysis,\" and \"Distal tibia.\" The search was restricted to articles in English with no date restrictions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReview Of Literature\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerial No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComplaints\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConclusion\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChan et al[1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 year old male patient with right knee pain and swelling since 3 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eManaged with curettage, burring, cauterisation and phenol painting of cyst wall.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRecurrence found at 3 months, underwent same management and at 1 year post operative period has shown no signs of recurrence or deformity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKapila et al[3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 year old boy presents with pain and swelling in left wrist since 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLesion was excised en bloc and fibula graft osteosynthesis done with K wire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 year follow up showed no deformity, good range of motion and no recurrence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eServet et al[8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 year old male presents with pain and swelling in right ankle for 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eABC was found in distal tibia epiphysis and curettage was done\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePatient was followed up for 2 years and had good range of motion and no recurrence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHarmesh et al[9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 year old woman presents with pain and swelling of medial aspect of left ankle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMass was curetted and packed with iliac crest bone graft along with fibula strut graft and plate osteosynthesis done\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOn follow up at 1 year, range of motion was good with no evidence of recurrence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAlthough Jaffe and Leichstein initially characterised it in 1942, the actual etiology is still a mystery \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. It is the only osseous tumour in the body whose name is derived from radiographic characteristics rather than histologic characteristics. This is inaccurate since an aneurysmal bone cyst's histologic appearance is neither similar to that of an aneurysm nor that of a cyst \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA subperiosteal, metaphyseal eccentric lesion with elevation and inflation of the periosteum and gradual erosion of the cortex is how ABC appears on radiographs in the long bones. The best way to evaluate ABCs is using a computed tomography or MRI, which reveals a noticeable thinning of the cortex over the location with only minor periosteal reaction \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAn Aneurysmal bone cyst extending into the epiphysis is very rare and we could find only 3 such case reports in literature which included one in the distal ulna \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e],\u003c/sup\u003e proximal tibia \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e and distal tibia \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e],\u003c/sup\u003e but all of them were in the skeletally immature patients whereas our case is of a skeletally mature one.\u003c/p\u003e \u003cp\u003eAccording to a recent study, some ABCs may have a particular chromosomal abnormality, most frequently a translocation. There have also been a few reports of malignant transition into osteosarcoma. The study demonstrated that somatic mutations influence ABC formation and that bands 16q22 and 17p13 may include genes crucial to this process. Additionally, this translocation can be viewed as an ABC pathognomonic \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Campanna classified these tumours based on radiographic appearance \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The histopathology of ABCs was initially described by Dabska and Buraczewski as a cavernous vascular tumour with intralesional communication cavitations but no blood clots. Microscopic examination of ABC often reveals haemorrhagic tissue with cavitary gaps divided by fibrous septa made up mostly of spindle cells, inflammatory cells, and a limited number of giant cells.\u003c/p\u003e \u003cp\u003eIt is possible to see osteoid development with or without osteoblastic rimming \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Currently, the main procedures employed include curettage and the insertion of a bone graft or polymethylmethacrylate [PMMA]\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Use of other modalities like bone substitutes, sclerosing therapy and other materials have shown less than promising results compared to conventional methods and higher recurrences \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. There have been reports of unsuccessful treatments that involved puncturing the bone wall with cannulated needles and injecting methylprednisolone acetate into the cyst \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Radiation therapy was effective in causing cyst ossification, but there is a chance that it will also cause sarcoma, growth arrest, and limb-length discrepancy. This process has now been nullified \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLesions that are not active can just be observed and not treated. Sometimes, these lesions respond to only a biopsy or curettage and resolve without recurring \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. The patient described had a of the distal tibia epiphysio-metaphyseal junction, since the tumour had breached and eroded the articular surface, simple curettage would not have done justice since it was a weight bearing joint and would have caused further complications.\u003c/p\u003e \u003cp\u003eThe diagnosis of any tumour should be confirmed with clinical, radiological and histological correlation as was done for our patient. The preservation of function of the ankle joint was an option presented to the patient and her party and should be considered as first line of management for a benign lesion in which limb salvage can be attempted without the need for anu adjunct therapy, which is not feasible in a financially constrained situation.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eHeeding to the extensive research of our authors, this is only case of epiphyseal extension of an ABC in a skeletally mature patient with tibio-talar joint destruction. This was successfully managed with curettage and reconstruction with Iliac Crest Autograft and morselised allograft with plate osteosynthesis. The main highlight being meticulous planning catering to the need of the individual case, procurement of the necessary bone graft or substitutes and reconstruction of joint spaces when and where deficient. Complete excision of the lesion to prevent its recurrence cannot be stressed upon. This technique is also a cost-effective method to treat such cases with excellent long-term results.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eABC- Aneurysmal Bone Cyst\u003c/p\u003e\n\u003cp\u003eMRI- magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003ePMMA- Polymethylmethacrylate\u003c/p\u003e\n\u003cp\u003eATA- Anterior tibial artery\u003c/p\u003e\n\u003cp\u003ePTA- Posterior tibial artery\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u003c/p\u003e\n\u003cp\u003eNo funding declaration to be made\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e: \u0026nbsp; The corresponding author and the other authors state that there is no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Standard Statement\u003c/strong\u003e: This article does not contain any studies with human or animal subjects performed by the any of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e Written informed consent was taken from the patient and her attendees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eChan G, Arkader A, Kleposki R, Dormans JP. Case report: primary aneurysmal bone cyst of the epiphysis. Clinical Orthopaedics and Related Research\u0026reg;. 2010 Apr;468:1168-72.\u003c/li\u003e\n \u003cli\u003eMendenhall WM, Zlotecki RA, Gibbs CP, Reith JD, Scarborough MT, Mendenhall NP. Aneurysmal bone cyst. American Journal of Clinical Oncology. 2006 Jun 1;29(3):311-5.\u003c/li\u003e\n \u003cli\u003eCottalorda J, Bourelle S. Modern concepts of primary aneurysmal bone cyst. Archives of Orthopaedic and Trauma Surgery. 2007 Feb;127:105-14.\u003c/li\u003e\n \u003cli\u003eKapila R, Sharma R, Sohal YS, Singh D, Singh S. Primary epiphyseal aneurysmal bone cyst of distal ulna. Journal of Orthopaedic Case Reports. 2015 Oct;5(4):85.\u003c/li\u003e\n \u003cli\u003eParvizi J. High yield orthopaedics E-Book. Elsevier Health Sciences; 2010 Jul 19.\u003c/li\u003e\n \u003cli\u003eMani SB, Brown HC, Nair P, Chen L, Do HT, Lyman S, Deland JT, Ellis SJ. Validation of the Foot and Ankle Outcome Score in adult acquired flatfoot deformity. Foot \u0026amp; ankle international. 2013 Aug;34(8):1140-6.\u003c/li\u003e\n \u003cli\u003eGreen JA, Bellemore MC, Marsden FW. Embolization in the treatment of aneurysmal bone cysts. Journal of Pediatric Orthopaedics. 1997 Jul 1;17(4):440-3.\u003c/li\u003e\n \u003cli\u003eMohaidat ZM, Al-Gharaibeh SR, Aljararhih ON, Nusairat MT, Al-Omari AA. Challenges in the diagnosis and treatment of aneurysmal bone cyst in patients with unusual features. Advances in orthopedics. 2019 Aug 4;2019.\u003c/li\u003e\n \u003cli\u003eGoss LR, Walter JH. Pediatric aneurysmal bone cyst of the distal tibia. Journal of the American Podiatric Medical Association. 1997 Mar 1;87(3):136-40.\u003c/li\u003e\n \u003cli\u003eKerimoglu S, \u0026Ccedil;itlak A, Kerimoglu G, Turgutalp H. Primary aneurysmal bone cyst of the distal tibial epiphysis: a case report. Journal of Pediatric Orthopaedics B. 2014 May 1;23(3):266-9.\u003c/li\u003e\n \u003cli\u003eKapoor H, Singh D, Bhatia N, Chaudhary D, Singh AK. Distal tibial aneurysmal bone cyst treatment by using a proximal fibular autologous bone graft: a case report. The Journal of foot and ankle surgery. 2004 May 1;43(3):179-84.\u003c/li\u003e\n \u003cli\u003eCampanacci M, Capanna R, Picci P. Unicameral and aneurysmal bone cysts. Clinical Orthopaedics and Related Research (1976-2007). 1986 Mar 1;204:25-36.\u003c/li\u003e\n \u003cli\u003eDabska M, Buraczewski J. Aneurysmal bone cyst. Pathology, clinical course and radiologic appearances. Cancer. 1969 Feb;23(2):371-89.\u003c/li\u003e\n \u003cli\u003eMarcove RC, Sheth DS, Takemoto S, Healey JH. The treatment of aneurysmal bone cyst. Clinical Orthopaedics and Related Research\u0026reg;. 1995 Feb 1;311:157-63.\u003c/li\u003e\n \u003cli\u003eDubois J, Chigot V, Grimard G, Isler M, Garel L. Sclerotherapy in aneurysmal bone cysts in children: a review of 17 cases. Pediatric radiology. 2003 Jun;33:365-72.\u003c/li\u003e\n \u003cli\u003eScaglietti O, Marchetti PG, Bartolozzi P. Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medrol) and a discussion of results achieved in other bone lesions. Clinical Orthopaedics and Related Research\u0026reg;. 1982 May 1;165:33-42.\u003c/li\u003e\n \u003cli\u003eClough JR, Price CH. Aneurysmal bone cyst: pathogenesis and long term results of treatment. Clinical Orthopaedics and Related Research (1976-2007). 1973 Nov 1;97:52-63.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Aneurysmal bone cyst, intra-articular extension, ankle joint reconstruction, iliac crest tri-cortical bone graft, joint preservation","lastPublishedDoi":"10.21203/rs.3.rs-5348654/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5348654/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eAneurysmal Bone Cysts (ABC)\u003cstrong\u003e \u003c/strong\u003eare known to be largely limited to the metaphysis. Epiphyseal extension of the lesion, that too in a skeletally mature patient, has rarely been reported. Further, literature regarding management of these lesion, where sclerotherapy failed, is scarce. We describe a case of distal tibia ABC with intra-articular extension, where prior sclerotherapy failed, managed with curettage and iliac crest allograft block reconstruction of the joint with excellent functional outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eThe authors report a case of a 20-year-old lady presenting with swelling and pain in her ankle joint. X-rays and MRI showed an ABC in the distal tibia with extension to the joint. Biopsy confirmed the diagnosis which was followed by sclerotherapy, but the lesion recurred in a year’s time. Surgery in the form of excision, curettage, joint reconstruction using tricortical iliac crest bone autograft block was done which was fixed with plate osteosynthesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult and Discussion: \u003c/strong\u003ePatient under follow up at 3 years shows excellent clinical outcome, no evidence of recurrence, able to perform out her personal and professional activities with no restrictions. Addressing such a case is a very difficult task, and in a financially constrained scenario such as ours, brings its own set of challenges. This novel technique of ankle joint reconstruction using iliac crest graft has not been described elsewhere in literature. Such cases of joint involvement in ABCs are very rare, and literature on management of such lesion is even more scarce. Therefore, they need reporting to help in formulating better treatment protocols in such difficult scenarios.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe reconstructive of the ankle joint with tricortical iliac crest bone grafting in ABC of distal tibia with joint involvement can provide excellent clinical and radiological outcomes.\u003c/p\u003e","manuscriptTitle":"Joint reconstruction using tricortical iliac crest bone graft block for intra-articular extension of aneurysmal bone cyst of distal tibia in a skeletally mature patient – a case report and review of literature.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-03 23:48:37","doi":"10.21203/rs.3.rs-5348654/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"302366af-51f5-4628-80e8-dd13edb3677f","owner":[],"postedDate":"December 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-19T07:39:15+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-03 23:48:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5348654","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5348654","identity":"rs-5348654","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}