Possible pathogenesis of calcaneal bone cysts
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ORTHOPAEDIC SURGERY
Possible pathogenesis of calcaneal bone cysts Manabu Hoshi1 · Naoto Oebisu1 · Tadashi Iwai1 · Akiyoshi Shimatani1 · Naoki Takada1 · Masanari Aono1 · Makoto Ieguchi1 · Masatsugu Takami1 · Hiroaki Nakamura1 Received: 25 May 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Introduction Recent literature indicates that calcaneal bone cysts have different clinical features compared to long bone cysts. Yet, previous studies have mainly focused on pathogenesis of long bone cysts. In this study, the pathogenesis of calcaneal bone cysts was investigated from radiological and pathological findings. Materials and methods Patients comprised 18 males and 6 females diagnosed with calcaneal bone cysts at a median age ± standard deviation of 13.0 ± 3.6 years. Plain radiographs, computed tomography, magnetic resonance imaging, cystography, bone scintigraphy, and pathology were reviewed. Results All cysts occupied the central triangular area of the bone, with six extending posteriorly and two developing anteriorly. Fifteen of 20 cases (75%) showed the expanded foramen structures at the anterior margin of the posterior facet. According to cystography, four cysts showed absence of leakage to subtalar joint. Cystic fluid caused chronic haemorrhaging in 18 cases and pathologically detected cholesterol clefts were noted in 14 cases. Discussion The location of the expanded foramen structures was consistent with the nutrient foramens of the sinus tarsi artery in the unaffected population. Hence, initial cysts may originate from the collapse of the sinus tarsi artery. Subsequent haemorrhage may extend into the central triangle area, which is biomechanically free of stress. Because of poor bone remodelling, degenerative change of the haemorrhage is prolonged. The results of this study showed that circulation collapse of the sinus tarsi artery and mechanical factors are important in the formation of calcaneal bone cysts. Keywords Solitary bone cyst · Pathogenesis · Calcaneus · Foramen structure · Sinus tarsi artery
Introduction Solitary bone cysts are benign, fluid-filled, skeletal lesions mainly seen in the long bone metaphyseal regions of the proximal humerus and femur (long bone cysts). These long bone cysts usually arise during the first two decades of life. These expansive cysts lead to thinning and weakening of the affected bone, sometimes producing a mechanical fragility that leads to subsequent pathological fractures. Although various treatment methods have been proposed, no definitive treatment protocol has been successful [1]. In addition to the long bone, the calcaneus is also a common site for solitary bone cysts (calcaneal bone cysts), but these lesions are * Manabu Hoshi [email protected]‑cu.ac.jp 1
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1‑4‑3 Asahi‑Machi, Abeno‑ku, Osaka 545‑8585, Japan
usually discovered later in life than the long bone cysts [2]. Most calcaneal bone cysts tend to present as asymptomatic and are incidental
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