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In August 1996, a 16-year-old boy presented with a history of limp for 6 weeks with increasing pain since 3 days. The pain was localised at the heel. No history of trauma was noted. An X rays of the hind foot shoved a calcaneus cyst. The lesion was then injected with methylprednisolone in July 1992 but it did not respond. This procedure was repeated in January 1993 and June 1993, but the lesion continued to enlarge. On examination of the right foot, tenderness was noted on the lateral surface with a full range of motion of the ankle joint. Radiographs of the calcaneus revealed a central lytic lesion thinning and inflating the cortex without periosteal reaction in the middle part of the calcaneus . Bone scan (TDM) showed a nonspecific light peripheral uptake with a cold central area swelling liquid-filled lesion. Discontinuity of the lateral part of the calcaneus was noticed, with possibility of microfracture. MRI showed a low signal on T1 weighted scan and bright signal on T2. Routine hematology and biochemistry results were normal. In November 1996 we decided to operate under endoscopy with curettage and bone grafting with autogenous bone harvested from the iliac crest. The treatment of simple bone cyst of the calcaneus by endoscopically assisted with cancellous bone grafting has not yet been published. However the endoscope is currently used for the diagnosis and treatment of many intraarticular disorders. Endoscopic surgery has been widely applied to the treatment of some bone tumours . The mechanical weakness of the cyst has often been pointed out as a disadvantage of curettage without bone grafting. From this point of view, the use of the endoscopic technique maintaining the integrity of the cortex and avoiding a large cortical defect is important in maintaining the strength of the affected bone. Endoscopic curettage offers benefits : complete curettage is assured even through small portals. Because of minimal surgical aggression, postoperative physiotherapy is not necessary and early functional recovery is obtained. The cavity of the lesion is large enough for endoscopic visualization, two or more adequate portals can be used. |