Coexisting Intraarticular Disorders Are Unrelated To Outcomes After Arthroscopic Resection of Dorsal Wrist Ganglions

Abstract

Background Dorsal wrist ganglions are one of the most frequently encountered problems of the wrist and often are associated with intraarticular disorders. However, it is unclear whether coexisting intraarticular disorders influence persistent pain or recurrence after arthroscopic resection of dorsal wrist ganglions. Questions/purposes We investigated (1) which intraarticular disorders coexist with dorsal wrist ganglions and (2) whether they influenced pain, function, and recurrence after arthroscopic ganglion resection. Methods We retrospectively reviewed 41 patients with primary dorsal wrist ganglions who underwent arthroscopic resection. We also obtained VAS pain scores and the Mayo Wrist Scores (MWS) preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and annually thereafter postoperatively. Minimum followup was 24 months (mean, 38.9 months; range, 24-60 months).Results Twenty-one patients had other coexisting intraarticular disorders: 18 triangular fibrocartilage complex tears and nine intrinsic ligament tears. All coexisting disorders were treated simultaneously. Two years after surgery, the mean VAS pain score decreased from 2.4 to 0.6, and mean grip strength increased from 28 to 36 kg of force. The mean active flexion-extension showed no change. The mean MWS improved from 74 to 91. Three ganglions recurred. There was no difference in mean VAS pain score and MWS preoperatively and at 2 years after surgery or recurrence of ganglions between patients with or without coexisting lesions. Conclusions Intraarticular disorders commonly coexist with ganglions but we found they were unrelated to pain, function, and recurrence after arthroscopic resection of the ganglion when the intraarticular disorders were treated simultaneously.

Arthroscopic Resection of Dorsal Wrist Ganglion: Results and Rate of Recurrence Over a Minimum Follow-up of 4 Years

“…Failure to identify this pedicle and excise its attachment to the scapholunate ligament increases the likelihood of recurrence. 3 In the study by Kang et al, 20 discrete stalks were identified in only 9 of 41 patients (22%), and none of these patients reported recurrence. In the study by Kim et al, 22 the presence or absence of the cyst stalk was not a significant factor for recurrence.…”

Arthroscopic versus open excision of dorsal ganglion cysts: a systematic review

“…Of the remaining two cohort studies, one (Balazs et al., 2015) was of moderate quality and the other (Craik and Walsh, 2012) was low (per modified-NOS). Among the 11 arthroscopic excision studies, one RCT had a high risk of bias (Kang et al., 2008), and among the remaining 10 retrospective cohort studies, seven (Aslani et al., 2012; Edwards and Johansen, 2009; Gallego and Mathoulin, 2010; Mathoulin et al., 2004; Rizzo et al., 2004; Shih et al., 2002; Yamamoto et al., 2012) were low quality and three (Chen et al., 2010; Kang et al., 2013; Kim et al., 2013) were moderate quality (Table 1). The average modified NOS score was 5.5 for the two open excision cohort studies, and 5.2 for the 10 arthroscopic excision studies.…”

“…Across the 16 studies, there were 587 arthroscopic and 323 open dorsal ganglion cyst excisions with an average patient age of 33 and 34, and mean follow-up time of 36 and 46 months, respectively (Table 1). Complication rates were reported in 13 of the studies, four of which (Kang et al, 2008;Gavaghan et al, 2000;Gude et al, 2008;Head et al, 2015) described outcomes after open excision (269 ganglions) and nine of which (Dias et al, 2007;Duggal et al, 2013;Edwards et al, 2009;Jacobs and Govaers, 1990;Jagers et al, 2002;Kang et al, 2013;Kang et al, 2008;Mathoulin et al, 2004) described outcomes after arthroscopic excision (440 ganglions).…”

Prospective Outcomes of Arthroscopic Versus Open Resection of Dorsal Wrist Ganglions

“…Likewise, Edwards and Johansen (23) claimed that all of the patients with dorsal wrist ganglions also had ligament instabilities. Kang et al (24) reported intraarticular pathologies with dorsal wrist ganglions in 21 of 41 patients, such as TFCC and intrinsic ligament tears (23). We diagnosed scapholunate interosseous ligament tear in seven patients and grade 1 TFCC tear in one patient who underwent arthroscopic ganglion excision.…”

“…We have not performed any arthroscopic repair to any identified coexisting intraarticular pathology; however, this may be because of our lack of experience in wrist arthroscopy and we may have underestimated the potential ligament laxity or other pathologies. On the other hand, a recent study showed that additional intraarticular pathologies did not affect functional outcomes after arthroscopic excision of dorsal ganglions (24).…”