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CASE REPORT
Year : 2014  |  Volume : 14  |  Issue : 2  |  Page : 165-167

Aneurysmal bone cyst of patella, a rare case report


Department of Orthopaedics and Pathology, JNMC Sawangi, India

Date of Web Publication9-Oct-2014

Correspondence Address:
Akash Saoji
C/O Vikas Mahajan, Mahajan Children HospitalWest Park Road, Dhantoli, Nagpur - 440 012, Maharashtra
India
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DOI: 10.4103/1319-6308.142377

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  Abstract 

Aneurysmal bone cysts (ABCs) are uncommon lesions accounting for less than 1% of reported primary bone tumors.   Of all the ABCs occurring in the body, less than 1% are seen in the patella. We report an extremely rare case of ABC of the right patella in a 20-year-old male patient who presented to our hospital with pain and swelling in the right knee since 4 months. Radiograph and computerised tomography (CT) scan were suggestive of osteolytic lesion involving whole of the patella without soap bubble appearance and with thinning of articular cortex. Whole of patella was involved. Patient was managed with total patellectomy and quadriceps and patellar tendon approximation and suturing. Physiotherapy and mobilization started. Patient was followed for 4 years with painless full range of movement, with no signs of local recurrence. Level of clinical evidence - 4 (highlight Query)

  Abstract in Arabic 

كييسة أم الدمّ العظمية
تعدّ كييسة أم الدم حالة نادرة تظهر على أقلّ من 1% من أورام العظام الأولية المكتشفة. وأقلّ من 1% من هذه الحالات تظهر على الجسم و أقل من 1% يظهر على عظم الرضفة . وفي هذه المقالة نذكر حالة نادرة للغاية لمريض في العشرين من عمره جاء يشكو من ألم و تورم في الركبة اليمنى استمر لمدة أربعة أشهر ؛ وقد أظهر التصوير الإشعاعي و التصوير المقطعي الحاسوبي (CT) إصابة عظمية على كل الرضفة دون ظهور فقاعة مع ترقق قشرة المفصل وقد خضع المريض لجراحة لاستئصال الرضفة وتثبيت الوتر الرضفي ، بعد ذلك خضع المريض لجلسات من العلاج الطبيعي والحركة . وبمتابعة المريض لمدة أربع سنوات تأكد أنه تخلص من الألم واستعاد حركته كاملة . دون أن تتكرر أعراض المرض .

Keywords: Aneurysmal bone cyst, excision, patella


How to cite this article:
Saoji A, Saindane K, Godghate N, Godghate N, Saoji S. Aneurysmal bone cyst of patella, a rare case report . Saudi J Sports Med 2014;14:165-7

How to cite this URL:
Saoji A, Saindane K, Godghate N, Godghate N, Saoji S. Aneurysmal bone cyst of patella, a rare case report . Saudi J Sports Med [serial online] 2014 [cited 2021 Jun 25];14:165-7. Available from: https://www.sjosm.org/text.asp?2014/14/2/165/142377


  Introduction Top


Aneurysmal bone cyst (ABC) is a very uncommon lesion. It accounts for less than 1% of reported primary bone tumors. [9] less than 1% are seen in the patella. [1],[3] ABC is usually seen in young age group between 10 and 20 years. Etiopathology of ABC is still not very clear. The various differential diagnoses are giant cell tumor, osseous tuberculosis, enchondroma, and hemangioma. Plane radiograph and computed tomography (CT) scan showing single homogenous osteolytic lesion without septae is suggestive of ABC. Here we discuss the case of a 20-year-male with ABC patella managed with total patellectomy. Postoperative physiotherapy could achieve the normal range of movement of knee joint and strength of quadriceps muscle.

Management of ABC depends on site and size of the lesion. ABC patella management varies from conservative to operative. Intralesional curettage and bone grafting to total patellectomy are the modality of treatment.


  Case report Top


A 20-year-old male patient presented to our hospital with pain and swelling over right knee joint since 4 months with no restriction of movement. There was no history of trauma and associated symptoms. Radiograph and CT scan was showing involvement of whole of patella with homogenous osteolytic lesion extending up to articular cortex and thinning of cortex. There was no evidence of any pathological fracture seen.

There was no septae in the lesion. So radiographic imaging was suggestive of ABC of patella.

Management plan was to excise whole of the patella as total involvement. Total patellectomy was performed under spinal anesthesia under tourniquet. Quadriceps and patellar tendon end to end anastomosis was achieved. Postoperative cylindrical cast was applied in extension for 6 weeks. Gradual physiotherapy and knee bending exercises was started and full range of knee movement was achieved over next 6 weeks.

Patient was followed for 4 years with no complaint and recurrence of ABC bone and had normal physical function. [Figure 1] showing preoperative radiograph of patella with osteolytic lesion.
Figure 1: Preoperative radiograph

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[Figure 2] showing preoperative compute tomography (CT) scan of knee showing thinning of the cortex.
Figure 2: Preoperative compute tomography scan of knee

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[Figure 3] showing Excised patella outer surface.
Figure 3: Excised patella outer surface

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  Discussion Top


ABC accounts for less than 1% of reported primary bone tumors. [2] Exact etiology of this lesion is not known. Long bones are affected more commonly. Flat bone ABC accounts for less than 5% of all the ABCs. [5] ABC of patella accounts for less than 1% of all the ABCs. [1] This lesion can be primary or secondary to giant cell tumor [4] and chondroblastoma. [7],[8] The symptomatology is varied according to the location. Patients can present with pain, swelling, and sometimes pathological fracture. [2] Differential diagnosis are giant cell tumor, bone tuberculosis, and enchondroma. [6] Radiograph of ABC appears as a homogenous osteolytic lesion without septae inside as in giant cell tumor. Irregular destruction is seen in infective lesion-like tuberculosis. CT scan and magnetic resonance imaging (MRI) can give better idea about the diagnosis. MRI is more useful in ABC with pathological fracture and knowing the extent of the lesion. [10] Histopathology is confirmatory for diagnosis. Bone cavity with free hematogenous collection is suggestive of ABC.

Treatment of ABC depends on site and extent of the lesion. Purpose of the treatment is curetting the cavity and filling the space with bone substance. [11],[12] Pathological fracture should be managed with osteosynthesis. Chances of recurrence is high and patient should be followed regularly.

Patella is a rare site for ABC presentation. Very few cases of ABC patella are reported in the literature. Small cavity of patella ABC can be filled with bone substitute or bone graft. Large lesion involving almost whole of the patella is difficult to conserve because of the risk of local recurrence and pathological fracture and total patellectomy is the preferred modality of management. [12]

We have managed the case with total patellectomy with standard midline vertical incision. Quadriceps and patellar tendon were approximated and sutured. Limb immobilized in cylindrical cast for 6 weeks followed by knee bending exercises. As total patellectomy causes joint stiffness and extension lag; physiotherapy had an immense role in getting the knee function back. Full range of knee movement was achieved after 6 weeks of cast removal.

Patient was followed for 4 years with no complaint related to ABC and patellectomy operation.

 
  References Top

1.
Reddy NS, Sathi VR. Primary aneurysmal bone cyst of patella. Indian J Orthop 2009;43:216-7.  Back to cited text no. 1
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2.
Louaste J, Amhajji L, Chkoura M, Rachid K. Patellar pathologic fracture secondary to aneurysmal bone cyst. A case report. Rev Chir Orthop Reparatrice Appar Mot 2008;94:599-603.  Back to cited text no. 2
    
3.
Oh JH, Kim HH, Gong HS, Lee SL, Kim JY, Kim WS. Primary aneurysmal bone cyst of the patella: A case report. J Orthop Surg (Hong Kong) 2007;15:234-7.  Back to cited text no. 3
    
4.
Marudanayagam A, Gnanadoss JJ. Secondary aneurysmal bone cyst of the patella: A case report. Iowa Orthop J 2006;26:144-6.  Back to cited text no. 4
    
5.
Yousri B, Aboumaarouf M, El Andaloussi M. Aneurismal bone cyst in children: 17 cases. Rev Chir Orthop Reparatrice Appar Mot 2003;89:338-45.  Back to cited text no. 5
    
6.
Kumar R, Dasan B, Malhotra A. Aneurysmal bone cyst of the patella: Three-phase bone scintigraphic findings and differential diagnoses. Clin Nucl Med 2000;25:1033-4.  Back to cited text no. 6
    
7.
Desnoyers V, Charissoux JL, Aribit F, Arnaud JP. Aneurysmal bone cyst of the patella. A case report and literature review. Rev Chir Orthop Reparatrice Appar Mot 2000;86:616-20.  Back to cited text no. 7
    
8.
Ghekiere J, Geusens E, Lateur L, Samson I, Sciot R, Baert AL. Chondroblastoma of the patella with a secondary aneurysmal bone cyst. Eur Radiol 1998;8:992-5.  Back to cited text no. 8
    
9.
Castro MD, Irwin RB. Aneurysmal bone cyst of the patella. Am J Orthop (Belle Mead NJ) 1996;25:717-9.  Back to cited text no. 9
    
10.
Pevny T, Rooney RJ. Case report 876: Aneurysmal bone cyst of the patella. Skeletal Radiol 1994;23:664-7.  Back to cited text no. 10
    
11.
Grillo G, Fazioli F, Ruosi C. Aneurysmal bone cyst of the patella: Case report. Chir Organi Mov 1988;73:171-3.  Back to cited text no. 11
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12.
Gottschalk FA, Solomon L, Isaacson C, Schmaman A. Aneurysmal bone cysts of the patella secondary to chondroblastoma. Case reports. S Afr Med J 1985;67:105-6.  Back to cited text no. 12
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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