Aneurysmal bone cyst (ABC) in top of tibia bone near knee area
My son is 12 years old and Aneurysmal bone cyst growing in his Tibia, near adjacent to the proximal tibial growth plate (physis) near Knee since Feb 2026. Pathology after surgery confirmed a benign ABC, with blood-filled cystic spaces, giant cells, hemosiderin, reactive woven bone, and no malignant features (no atypia, necrosis, or significant mitotic activity) - Underwent surgery with orthopedic/oncology surgeon - extensive curettage, multiple adjuvant treatments, and bone grafting of the proximal tibial lesion. Surgeon told us that he could not clean aggressively near growth plate.This ABC is frustrating us as it reoccurs/residual cells are active and growing back.
Current Issue (approximately 18 weeks post-op):
• Developed recurrent activity-related pain around the proximal tibia/growth plate region, particularly with hiking and swimming, now walking also.
Recent MRI Findings:
• Original ABC cavity is predominantly replaced by bone graft material.
• Persistent scattered peripheral residual cysts remain along the graft margin.
• Largest residual cyst measures 1.4 x 2.5 x 2.5 cm, located anteromedially, subcortically, just inferior to the physis.
• MRI notes that the overlying cortex is thin.
• Mild bone marrow edema surrounds the graft and extends across the physis into the epiphysis.
• No report of aggressive recurrence, cortical breakthrough, or soft tissue mass.
Orthopedic Pediatric Oncology/Surgeon Assessment:
• Believes the residual cyst likely represents persistent biologically active ABC rather than simple postoperative change.
• Concern is ongoing bone weakening near the growth plate and persistence of symptoms.
Current Treatment Options Discussed:
1. Repeat surgical curettage/resection of the residual cyst
2.CT-guided doxycycline sclerotherapy performed by Interventional Radiology ( preferably).
What do you recommend ? are there any other option(s)?