Comparative healing outcomes after β-tricalcium phosphate grafting in pediatric aneurysmal bone cysts, simple bone cysts and non-ossifying fibroma

Abstract

Introduction/Objective Aneurysmal bone cysts (ABC), simple bone cysts (SBC), and non-ossifying fibromas (NOF) are common in children. The standard treatment is curettage with defect filling. The graft selection and surgical approach vary according to the lesion type. While synthetic β-tricalcium phosphate (β-TCP) is a biocompatible graft, its efficacy in pediatric cases remains unclear. This study assessed radiographic healing, graft integration, complications, and recurrence rates after curettage and β-TCP grafting.

Methods We retrospectively reviewed 63 patients (23 ABC, 21 SBC, and 19 NOF) treated at a pediatric hospital from 2015 to 2023. All underwent intralesional curettage with β-TCP grafting. Healing was assessed using Wu, modified Irwin, and modified Neer criteria. The stable healing time, recurrence, complications, and morphometric predictors were also analyzed.

Results Radiographic healing rates were 73.9% for ABC, 85.7% for SBC, and 100% for NOF. Stable healing occurred at 13.5 ± 5.7 months for ABC and approximately 8.7–8.8 months for SBC and NOF (p = 0.0004). ABC healed more slowly and inconsistently; larger and relation length ratio lesions delayed healing in both ABC and SBC. Recurrence was observed in 26% of ABC cases (mean 16.7 months), 14% of SBC cases (mean 13.8 months), and none in NOF. Conclusion β-TCP grafting is safe and effective for pediatric benign bone lesions; however, healing varies by lesion type. ABC requires longer monitoring due to a higher recurrence risk; SBC mostly stabilizes within a year; and NOF reliably remodels regardless of size. Focusing on follow-up of high-risk lesions may improve outcomes and reduce unnecessary interventions.

Keywords: aneurysmal bone cyst; simple bone cyst; non-ossifying fibroma; β-tricalcium phosphate; pediatric orthopedics; bone grafting