A Prospective Randomized Controlled Trial of Aspiration and Fibrin Sealant Use Versus Aspiration Alone in the Treatment of Dorsal Wrist Ganglia

Abstract

Multiple treatments for dorsal wrist ganglia (DWG) exist but have high recurrence rates. We investigated whether aspiration followed by injection of Tisseel is more effective at reducing the DWG recurrence rate than aspiration alone. Methods: Adults with untreated DWG were randomly assigned to aspiration alone (A) or aspiration followed by Tisseel injection (AT). Patients were measured at baseline, 1, 6, and 12 months. Primary outcome was the rate of recurrence. Secondary outcomes included recurrent ganglion size and maximum pain experienced from the ganglion. Continuous data were compared with Student t tests and Mann-Whitney U tests. Categorical data were compared with w 2 tests and Fisher exact tests. Treatment effect was reported as relative risk or mean differences (MD) with 95% confidence intervals. Results: Seventy-nine patients were randomized to the A (n ¼ 39) or AT (n ¼ 40) group. Twenty-five patients were lost to follow-up. There were no differences in recurrence risk between groups at 1, 6, or 12 months (P > .05). Ganglia were significantly smaller for both groups at 1 month versus baseline (P < .001). The A group demonstrated a significantly larger decrease in size at 1 month versus the AT group (MD ¼ 0.75 cm 2 , 95% confidence interval: 0.07-1.43, P ¼ .03). Both groups experienced significantly less pain at 1, 6, and 12 months (P < .03), but this was not significantly different between groups. Conclusion: Aspiration and Tisseel injection does not decrease DWG recurrence versus aspiration alone. Both interventions produced a significant decrease in pain. Although aspiration alone carries a high recurrence risk, it may provide sufficient symptomatic relief for patients with DWG. Résumé Objectif : Malgré les nombreux traitements des ganglions de la face dorsale du poignet (GFDP), les taux de récurrence sont elevés. Les auteurs ontévalué si la ponction suivie d'une injection de Tisseel réduisait le taux de récurrence de GFDP avec plus d'efficacité que la ponction seule. Méthodologie : Les adultes présentant un GFDP non traité ontété répartis au hasard entre la ponction seule (P) et la ponction suivie par une injection de Tisseel (PT). Les chercheurs les ont mesurés au départ, puis au bout de un, six et 12 mois. Le taux de récurrence représentait le résultat clinique primaire, et la taille des ganglions récurrents et la douleur maximale provoquée par le ganglion, les résultats cliniques secondaires. Les chercheurs ont comparé les données continues avec les tests de Student et les tests Mann-Whitney et les données catégorielles avec les tests du chi carré et les tests

Treatment of Primary Dorsal Wrist Ganglion—A Systematic Review

“…The full-text articles for the remaining 109 studies were read and assessed for eligibility, resulting in 11 studies that met the inclusion criteria. 4 5 9 15 16 17 18 19 20 21 22…”

“…2 and 3 represent the risk assessment of bias for the included five RCTs. 5 9 17 18 20 Two of the included RCTs 5 20 reported random sequence generation and allocation concealment, while the risk of bias was unclear or high in three RCTs. 9 17 18 Detection and performance bias were considered high in all five RCTs.…”

“…9 17 18 Detection and performance bias were considered high in all five RCTs. 5 9 17 18 20 Attrition bias was considered high in two RCTs 17 20 due to high rates of dropout during the follow-up. Reporting bias was unclear in two RCTs, 5 17 although three RCTs 9 18 20 provided predefined outcomes of interest.…”

“…5 9 17 18 20 Attrition bias was considered high in two RCTs 17 20 due to high rates of dropout during the follow-up. Reporting bias was unclear in two RCTs, 5 17 although three RCTs 9 18 20 provided predefined outcomes of interest. As a result, the overall risk of bias in the included RCTs was deemed moderate to high.…”

“…Included studies consisted of the following study designs; RCT ( n = 5; 311 patients), 5 9 17 18 20 prospective cohort study ( n = 2; 253 patients), 4 15 retrospective chart review ( n = 2; 58 patients), 16 22 case-control ( n = 1; 52 patients), 19 and case-series ( n = 1; 32 patients). 21 The study characteristics are described in Table 3 .…”