Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone

Abstract

Intraosseous ganglion cysts are rare causes of wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The main complications are joint stiffness and vascular disturbances of the lunate bone. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while respecting the scapholunate ligament. This study was based on a series of 4 patients, all of whom had wrist pain because of intraosseous ganglion cysts. Arthrosynovial cyst resection, ganglion curettage, and bone grafting were performed arthroscopically. Pain had totally disappeared within 2 months after the operation in 100% of patients. The average hand grip strength was estimated at 100% compared with the opposite side, and articular ranges of motion were the same on both sides in 100% of cases. No complications were reported after surgery. On the basis of these results, arthroscopic treatment of intraosseous synovial ganglion cysts seems to be more efficient and helpful in overcoming the limitations of classic open surgery in terms of complications.W rist intraosseous ganglion cysts are rare tumors in adults, and they are asymptomatic and idiopathic most of the time; however, but they represent one of the few causes of wrist pain.1 Classic cases include lytic bone tumors found through radiologic diagnosis, with a scapholunate ligament origin. Diagnoses of symptomatic cystic lesions of the lunate bone (Kienböck disease, trauma, scaphoid pseudarthrosis) must be eliminated before stating that the wrist pain is due to an intraosseous bone ganglion cyst.Surgical treatment of this pathologic condition yields good results and a low recurrence rate. Wrist arthroscopy is a recent, up-and-coming surgical technique, usually performed with the patient under local or regional anesthesia and performed either with saline irrigation or as a dry procedure. The wrist arthroscopy setup includes a small fiberoptic camera with a diameter of 2.4 or 2.7 mm, a shaver without a suction pump and with or without an electrocautery, and basic arthroscopy instruments (palpation rod, basket forceps). There are more and more wrist arthroscopy indications, including scapholunate ligament repair, treatment of fractures of the distal radius, intercarpal arthrodesis, and intra-articular cyst resection, but the use of wrist arthroscopy in such cases needs to be qualified. The main advantage of this technique is that it reduces the intra-articular operative area and therefore minimizes postoperative joint stiffness. However, it is a difficult technique with a significant learning process.This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while res...

Arthroscopic Bone Graft for Intraosseous Lunate Bone Ganglion

“…Intraosseous ganglia cysts of the lunate are relatively rare but nonetheless represent a cause of chronic wrist pain, stiffness, or loss of strength. 6 This etiology must be well known not to miss the diagnosis, which is rendered quite easily through simple radiological examination such as plain radiography, MRI, or CT. 12,13 Although most ganglia are often asymptomatic, 7 complications such as lunate wall perforation or fracture, and even secondary flexor tendon injury, 14 can occur and be responsible for a mild to severe handicap of the wrist. 2 Intraosseous ganglia can occur or coexist in other carpal bones, usually scaphoid, capitate, and triquetrum; multiple locations are not rare.…”

“…6,7,11,[17][18][19] Several arthroscopic techniques have been reported for ILBG approach and treatment. Ashwood and Bain 11 and Bain et al 6 proposed direct drilling of the lunate, either dorsal or volar, under fluoroscopic control (respectively 8 and 10 cases); Bhatia 18 suggested a similar direct "cystoscopy" through cartilage drilling (1 case), along with Cerlier et al, 7 who also performed direct transosseous approach on the articular side of the lunate, the location of the cyst beforehand specified on CT (4 cases). Rimokh et al 17 recently reported a comparable method (7 cases).…”

“…5,6 The surgical treatment of this pathology has evolved over the years, from open procedures to arthroscopicassisted to all-arthroscopic techniques, mostly consisting of curettage of the cyst combined with bone grafting (usually autologous), yielding good functional results and low recurrence rates. 6,7 Open treatment has been associated with wrist stiffness, persistent pain, 8 and vascular disorders of the lunate. 7,9 Wrist arthroscopy techniques have allowed enhancement of ILBG curettage and grafting, overcoming the complications of the open approach.…”

“…6,7 Open treatment has been associated with wrist stiffness, persistent pain, 8 and vascular disorders of the lunate. 7,9 Wrist arthroscopy techniques have allowed enhancement of ILBG curettage and grafting, overcoming the complications of the open approach. 7,10,11 The goal of this study is to describe a minimally invasive technique that consists of arthroscopically passing through the proximal, nonvascularized portion of the scapholunate ligament.…”

Arthroscopic Treatment for Intraosseous Ganglion Cyst of Carpal Bone Combined With Occult Wrist Instability

“…This minimally invasive approach irritates signi cantly less soft tissue; thus, the capsules and ligaments remain intact, reducing the risk of arthro brosis and damage to the vascular system of the carpal bones that might possibly lead to open exposure. [7,15,19] Using an arthroscope, a complete and clear view of the joint could be achieved, subsequently treating the intra-articular lesions. Furthermore, concomitant morbidities such as extraosseous cysts and intercarpal joint instability can also be treated arthroscopically with a better esthetic result.…”