Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort

Kenneth R. Gundle1, 2, Etasha M. Bhatt3, Stephanie E. Punt3, Viviana Bompadre4, Ernest U. Conrad3, 4, *
1 Oregon Health & Science University, Department of Orthopaedics & Rehabilitation, Portland, USA
2 Portland VA Medical Center, Operative Care Division, Portland, USA
3 Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, Seattle, Washington, USA
4 Department of Orthopaedics & Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA

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Creative Commons License
© 2017 Gundle et al..

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Orthopaedics & Sports Medicine, University of Washington Medical Center, Seattle Children’s Hospital, Seattle, Washington, USA; Tel: 206-981-1944; Fax: 206-987-3852; E-mail:



Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC.


Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center.


The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute.


A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments.

Level of Evidence:

Level IV retrospective cohort study.

Keywords: (Unicameral bone cyst, Bone marrow aspirate, Demineralized bone matrix, Less invasive surgery.