Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison

Königsberg, Matthew; Tedesco, Liana J.; Mueller, John D.; Ball, Jacob; Wu, Chia H.; Kadiyala, R. Kumar; Strauch, Robert J.; Rosenwasser, Melvin P.

doi:10.1177/15589447211003184

Cited by 6 publications

(4 citation statements)

References 41 publications

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“…Splinting to allow soft-tissue rest is frequently used for 1 to 2 weeks after surgery, although there is no clear evidence that splinting improves outcomes after cyst excision. 24 Recurrence rates after open excision range between 7% and 39% 21,25,26 in recent series.…”

Section: Dorsal Wrist Ganglion Cystsmentioning

confidence: 99%

Ganglions in the Hand and Wrist: Advances in 2 Decades

Zoller

Benner

Iannuzzi

2023

J Am Acad Orthop Surg

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Ganglion cysts represent the most common soft-tissue mass in the hand and wrist. Ganglion cysts are most commonly encountered at the dorsal or volar aspects of the wrist, although cysts may arise from the flexor tendon sheath, interphalangeal joint, and extensor tendons. Intraosseous and intraneural ganglion cysts have also been described. Diagnosis of ganglion cysts relies primarily on history and physical examination. Transillumination and aspiration of masses may be useful adjuncts to diagnosis. Imaging such as radiography and ultrasonography may be indicated to evaluate for associated conditions, such as degenerative joint disease, or to rule out a solid or heterogeneous mass. Advanced imaging such as MRI is generally reserved for patients in whom occult ganglions, intraosseous ganglions, or solid tumors, including sarcoma, remain a concern. Treatment of ganglion cysts includes observation, aspiration or puncture with possible corticosteroid injection, and surgical excision. Nonsurgical management may result in cyst resolution in over 50% of patients. Surgical excision is associated with recurrence rates of 7% to 39%. Advances in surgical techniques have allowed surgeons to conduct arthroscopic ganglion excision, with recurrence rates similar to those of open management. This study highlights the advances in diagnosis, treatment, and outcomes that have taken place over the past 2 decades for this common condition affecting the hand and wrist in the adult population.

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Section: Dorsal Wrist Ganglion Cystsmentioning

confidence: 99%

Ganglions in the Hand and Wrist: Advances in 2 Decades

Zoller

Benner

Iannuzzi

2023

J Am Acad Orthop Surg

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“…Dua dari 9 (22%) kekambuhan setelah eksisi ganglion artroskopi dan didapatkan 2 dari 8 (25%) kekambuhan setelah eksisi ganglion terbuka yang menjalani intervensi bedah berulang. Sehingga dalam studi ini menunjukan, eksisi terbuka menyebabkan tingkat kekambuhan yang relatif lebih rendah dibandingkan dengan eksisi artroskopi 12 .…”

Section: Prognosisunclassified

Perbandingan Operasi Artroskopi dengan Eksisi Terbuka pada Kista Ganglion Pergelangan Tangan

Febrian¹

2023

LMJ

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Kista ganglion merupakan tumor jinak pada jaringan lunak yang paling sering terjadi pada sisi dorsal pergelangan tangan yang bermanifestasi sebagai rasa nyeri dan penurunan range of motion. Penyakit ini dapat diterapi menggunakan metode konservatif maupun operatif, beberapa diantaranya yaitu operasi artroskopi dan operasi eksisi terbuka. Artroskopi merupakan operasi invasif minimum yang dibantu dengan penggunaan lensa kamera dalam rongga sendi, sedangkan operasi eksisi terbuka dilakukan dengan pembedahan klasik di pergelangan tangan. Kedua metode terbukti mampu meredakan nyeri, namun pada artroskopi lebih sering ditemukan nyeri residu pasca operasi. Tingkat komplikasi eksisi terbuka lebih tinggi dikarenakan bekas luka yang lebih besar serta kemungkinan kekakuan sendi lebih tinggi. Kedua metode dinilai setara unggulnya karena hasil tingkat rekurensi yang bervariasi dari penelitian yang ada. Ganglion cysts are benign tumors of soft tissues that most commonly occur on the dorsal side of the wrist that manifest as pain and decreased range of motion. This disease can be treated using conservative and operative methods, some of which are arthroscopic surgery and open excision surgery. Arthroscopy is a minimally invasive operation assisted by the use of a camera lens in the joint cavity, while open excision surgery is performed with classical surgery on the wrist. Both methods can relieve pain, but arthroscopy more often found postoperative residual pain. The rate of complications of open excision is higher due to larger scars and a higher likelihood of joint stiffness. Both methods are considered equally superior because of the results of varying levels of recurrence from existing studies.

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“…3 Recurrence is the most frequently reported complication of any form of treatment and may result from inadequate excision of the stalk of the ganglion. [4][5][6][7] Although traditional ganglion excision in an open approach is considered the gold standard and has yielded satisfactory outcomes with pain relief and functional improvement according to previous studies, 8,9 a high postoperative recurrence rate of approximately 40% was still reported. 10 Therefore, recurrent DWG cysts may frequently be encountered in clinical practice, and the treatment decision and benefit of re-excision should be evaluated with caution.…”

Section: Introductionmentioning

confidence: 99%

Two‐Year Clinical Outcomes after Arthroscopic Re‐Excision of Recurrent Dorsal Wrist Ganglion Cyst

Zheng

Huang

Yang

et al. 2022

Orthopaedic Surgery

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Objectives Arthroscopic excision of dorsal wrist ganglion (DWG) cysts has recently become an alternative to open surgery, with the advantage of lower recurrence. However, in recurrent cases, whether re‐excision using an arthroscopic approach would achieve favorable outcomes has not been determined. This study aimed to evaluate the clinical outcomes of function evaluation and recurrence rate after arthroscopic excision of recurrent DWG cysts. Methods A total of 11 consecutive patients with clinically diagnosed recurrent DWG cysts were retrospectively reviewed between November 2017 and March 2020. Extensive re‐excision of the ganglion cyst and its surrounding pathological capsule was performed using an arthroscopic approach. Magnetic resonance imaging (MRI) was routinely performed before surgery to identify the location and limits of the cyst. All patients were followed up for a minimum of 2 years. A second recurrence was recorded if a mass reappeared at the same site with a positive transillumination test. Pain during activity was evaluated using the visual analog scale (VAS). The active range of motion (ROM) of the wrist was measured using a goniometer, and the hand grip strength was measured using a digital dynamometer. Comparative analysis between the pre‐ and postoperative indexes was performed using Student's t‐test. Results After a mean follow‐up period of 29.3 months (range, 24–34 months), no second recurrence of the cyst was recorded. The VAS score improved from 1.4 to 0.3 (t = 3.833, p = 0.003), and residual pain was reported by three patients (VAS score = 1 for each). Active wrist flexion increased from 73.6° to 78.2° (t = 2.887, p = 0.016). No significant changes were found in active wrist extension or hand grip strength (p > 0.05). No major complications occurred during the study. Conclusion Arthroscopic excision of a recurrent DWG cyst yielded satisfactory results with no second recurrence, significant pain relief, and good wrist function at a minimum of 2‐year follow‐up. Clear identification of the location and limits of the ganglion based on preoperative MRI could be helpful to achieve complete excision and therefore prevent a second recurrence.

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Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison

Cited by 6 publications

References 41 publications

Ganglions in the Hand and Wrist: Advances in 2 Decades

Ganglions in the Hand and Wrist: Advances in 2 Decades

Perbandingan Operasi Artroskopi dengan Eksisi Terbuka pada Kista Ganglion Pergelangan Tangan

Two‐Year Clinical Outcomes after Arthroscopic Re‐Excision of Recurrent Dorsal Wrist Ganglion Cyst

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