DOI: https://doi.org/10.36347/sasjs.2026.v12i07.001

Pages: 586-591

Introduction: Aneurysmal bone cyst (ABC) is a benign but locally aggressive osteolytic bone neoplasm characterised by blood-filled, multi-septated cavities. It predominantly affects the metaphyseal regions of long bones in children and young adults. Distal tibial involvement is uncommon and presents specific surgical challenges due to the proximity of the ankle joint and physis. We report a case of a large ABC of the distal tibia treated successfully with intralesional curettage and polymethylmethacrylate (PMMA) cementation. Case Presentation: A 30-year-old patient presented with progressive pain and swelling of the right ankle. Plain radiographs and computed tomography (CT) revealed a large, expansile, multi-lobulated metaphyso-epiphyseal osteolytic lesion of the distal tibia measuring 40 × 26 mm in cross-section with a 38 mm craniocaudal extent, cortical thinning, and no soft tissue invasion. Magnetic resonance imaging (MRI) demonstrated pathognomonic fluid-fluid levels on T2-weighted sequences with moderate peripheral gadolinium enhancement, consistent with ABC. Intralesional curettage and PMMA cementation were performed. Histopathological examination confirmed the diagnosis. At final follow-up, the patient achieved complete resolution of pain and full, pain-free ankle range of motion with no recurrence. Conclusion: ABC of the distal tibia is a rare but treatable periarticular lesion. MRI with fluid-fluid levels is the cornerstone of preoperative characterisation. Intralesional curettage combined with PMMA cementation offers immediate mechanical stability, facilitates recurrence surveillance, and yields excellent functional outcomes.