Most lesions can be treated with currettage and application of a high-speed burr. Local recurrence rates vary widely, with one recent report having 4 recurrences in 40 patients (Gibbs JBJS Am 1999 Dec;81(12):1671-8). Recurrence was statistically related to young age and open growth plates, and may be less likely following wide excision than following intralesional treatment by currettage. If a recurrence is detected, a thorough examination of the original radiographs and pathology specimens should be performed to insure that the primary lesion, if any, is discovered, since this may radically alter the treatment plan. Once the precise diagnosis is known, local recurrences may be retreated by appropriate methods. Wide resection and limb-sparing reconstructions are necessary to prevent progressively destructive recurrence. Curettage and bone graft can be complicated by profuse bleeding from the lesion. If bleeding is a concern, preoperative selective embolization can be used. Radiation has been used in some cases where operative treatment is not possible, but this adds the additional risk of malignancy.
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