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.

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 the management of these lesions, where sclerotherapy failed, is scarce. We describe a case of distal tibia ABC with intra-articular extension, managed with curettage and iliac crest allograft auto-graft block reconstruction of the joint with excellent functional outcome.

Case report: The authors report a case of a 20-year-old lady presenting with swelling and pain in her ankle joint. X-rays and magnetic resonance imaging 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. Surgery in the form of excision, curettage, and joint reconstruction using tricortical iliac crest bone autograft block was done which was fixed with plate osteosynthesis.

Result and discussion: The patient under follow-up at 3 years shows excellent clinical outcome, no evidence of recurrence, able to perform out carry out her personal and professional activities with no restrictions. Addressing such a case is a difficult task, and in a financially constrained patient scenario such as ours, brings its own set of challenges. Such cases of joint involvement in ABCs are very rare, and literature on the management of such lesions is even more scarce. Therefore, they need reporting to help 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.