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Sonobe T, Nikaido T, Yoshida K, Suzuki T, Kikuchi T, Matsumoto Y. Effectiveness of capsulodesis in ganglion cysts caused by a medial meniscotibial ligament tear and medial meniscus extrusion. Int J Surg Case Rep 2024; 122:110063. [PMID: 39067100 PMCID: PMC11332203 DOI: 10.1016/j.ijscr.2024.110063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/13/2024] [Accepted: 07/19/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Meniscotibial ligament (MTL) has received attention as a major meniscus stabilizer. An MTL injury results in instability and extrusion of the meniscus. Cases of knee ganglion cyst formation due to an MTL tear and medial meniscus extrusion (ME) are extremely rare. CASE PRESENTATION A 42-year-old female Japanese childcare worker presented painful ganglion cysts on the proximal medial side of her left tibia. An MTL tear and medial ME were thought to be involved in the ganglion formation. Joint fluid flowed through the meniscotibial side of the extruded meniscus into the space between the medial collateral ligament and tibia, where the MTL tear acted as a check valve, forming ganglion cysts. Ultrasonography-guided aspiration of the ganglion was attempted, but ganglion cysts recurred within 1 month. We used an open excision for the ganglion cysts, and arthroscopic capsulodesis was performed to repair the MTL and internalize the medial meniscus to block the inflow route from the intra-articular space. CLINICAL DISCUSSION We performed capsulodesis, which repaired the MTL and internalized the medial meniscus to prevent the recurrence of the ganglion cyst. Three months have passed since the surgery, with no recurrence of knee pain or ganglion cysts, indicating good short-term results. CONCLUSIONS We encountered a rare case of ganglion cyst formation in the knee joint due to MTL tear and medial ME. Arthroscopic MTL repair and internalization of the meniscus by capsulodesis were effective in treating the ganglion cysts.
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Affiliation(s)
- Tatsuru Sonobe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan; Department of Orthopaedic Surgery, Bange-Kosei General Hospital, Fukushima 969-6593, Japan.
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Katsuhiro Yoshida
- Department of Orthopaedic Surgery, Fujita General Hospital, Fukushima 969-1793, Japan.
| | - Takeo Suzuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Tadashi Kikuchi
- Department of Orthopaedic Surgery, Bange-Kosei General Hospital, Fukushima 969-6593, Japan.
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
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Firdaus M, Aslam F, Muhammad Nawawi RF. A Case of Traumatic Distal End Radius Fracture With a Hemorrhagic Volar Wrist Ganglion Cyst. Cureus 2024; 16:e61923. [PMID: 38978947 PMCID: PMC11228419 DOI: 10.7759/cureus.61923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
Wrist ganglion cysts are the most common benign soft tissue swelling in the hand and wrist. They may arise from flexor and extensor tendon sheaths, interphalangeal joints, wrist joints, and even the neural tissues around the hand and wrist. Some volar wrist ganglion cysts arise from the radiocarpal joint and scaphotrapezial joint. It is uncommonly encountered as an incidental finding during the fixation of a distal radius fracture. In our case, a volar wrist hemorrhagic ganglion cyst was incidentally found during the fixation of the fracture. Prior to the injury, the patient had no complaints of swelling over her right wrist. The cyst was removed using microscopic magnification.
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Affiliation(s)
| | - Firdaus Aslam
- Orthopaedics and Traumatology, Hospital Selayang, Selangor, MYS
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3
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Wozniak S, Paulsen F. Introducing the Foveola lunata, an anatomical landmark of the wrist. Ann Anat 2023; 250:152163. [PMID: 37778712 DOI: 10.1016/j.aanat.2023.152163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
The lunate foveola is often the starting point of a cystic swelling called a "ganglion". To make the anatomy of this region more relevant to the needs of clinicians and more accessible to students, we propose to introduce the term lunate foveola (Foveola lunata) on the dorsal side of the wrist just distal to the os lunatum. The easily located foveola will help in the examination of the wrist to more easily understand the anatomy of the wrist and facilitate the examination of patients with wrist injuries when an injury to the lunate (Os lunatum) is suspected.
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Affiliation(s)
- Slawomir Wozniak
- Department of Human Morphology and Embryology, Division of Anatomy, Wroclaw Medical University, Chalubinskiego 6a, 50-368 Wroclaw, Poland.
| | - Friedrich Paulsen
- Friedrich Alexander University Erlangen-Nürnberg (FAU), Institute of Functional and Clinical Anatomy, Universitätsstr. 19, 91054 Erlangen, Germany
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Bak GG, Lee HS, Choi YR, Kim TH, Kim SH. Excision with Temporary Interphalangeal Joint Pin Fixation for Toe Ganglion Cysts. Clin Orthop Surg 2023; 15:653-658. [PMID: 37529185 PMCID: PMC10375817 DOI: 10.4055/cios22321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background Toe ganglion cysts are often symptomatic and recurrent. Communicating lesions between ganglion cysts and the interphalangeal joint (IPJ) or tendon sheath make it difficult to prevent a recurrence. Temporary restriction of the joint and tendon motion can facilitate surgical site healing. This study analyzed the clinical results of temporary pin fixation of the IPJ after toe ganglion cyst excision. Methods Sixteen patients with symptomatic toe ganglion cysts underwent surgical treatment. Excision alone was initially performed on 10 patients. Six patients underwent temporary pin fixation of the IPJ after ganglion cyst excision. Repeat excision with pin fixation was performed for recurrence in two patients after excision only. Clinical evaluations and postoperative complications were analyzed. Results Fourteen of 16 toe ganglion cysts were located near the IPJ. Two cysts not adjacent to the joint completely healed after excision alone. Seven of 14 cysts near the joint recurred after initial excision alone and required repeated reoperation. Eight cysts did not recur after excision with pin fixation, including 2 that recurred after excision alone. Conclusions Temporary IPJ pin fixation after excision for ganglion cysts can be effective for preventing the recurrence of ganglion cysts adjacent to toe IPJ.
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Affiliation(s)
- Gyeong-Gu Bak
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ho-Seong Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Rak Choi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Sung-Hoo Kim
- Department of Orthopedic Surgery, Chungbuk National University Hospital, University of Chungbuk, Cheongju, Korea
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5
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d'Ailly PN, Deugd C, Schep NWL, Kuijper TM, Kok MR, Willemze A, Coert JH, de Jong PHP, Lam-Tse WK, van der Helm-van Mil AHM, Tchetverikov I, Weel-Koenders AEAM, Bisoendial RJ. Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial). Trials 2023; 24:229. [PMID: 36966310 PMCID: PMC10039772 DOI: 10.1186/s13063-023-07129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/31/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. METHODS This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0-100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. DISCUSSION Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. TRIAL REGISTRATION Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. CLINICALTRIALS gov NCT04755127. Registered after the start of inclusion on 15 February 2021.
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Affiliation(s)
- P N d'Ailly
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - C Deugd
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - T M Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - M R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - A Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - J H Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W K Lam-Tse
- Department of Rheumatology, Franciscus Gasthuis en Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - I Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - A E A M Weel-Koenders
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R J Bisoendial
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Clark DM, Nelson SY, O'Hara M, Putko RM, Bedrin MD, Daniels CM. Surgical and Patient-Centered Outcomes of Open versus Arthroscopic Ganglion Cyst Excision: A Systematic Review. J Wrist Surg 2023; 12:32-39. [PMID: 36644727 PMCID: PMC9836780 DOI: 10.1055/s-0042-1749678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/20/2022] [Indexed: 01/18/2023]
Abstract
Introduction As the popularity of wrist arthroscopy grows, it continues to prove useful in the treatment of ganglion cysts. Previous studies comparing an arthroscopic technique to traditional open excision have demonstrated generally equivalent results regarding complications and cyst recurrence. However, this systematic review compares the two treatment methods not only regarding cyst recurrence but also regarding patient-centered outcomes. Additionally, new studies in the available literature may allow for further analysis. Methods This systematic review identified 23 articles published between 2000 and 2021 that met inclusion criteria. Articles were assessed for quality, and reported cyst recurrence rates, patient satisfaction, patients' preoperative and postoperative pain, and complications associated with either open or arthroscopic excisions were pooled into open excision and arthroscopic excision groups for analysis. Results In total, 23 studies accounted for 1,670 cases. Pooled data for patient-centered outcomes indicated a significantly higher patient satisfaction rate (89.2 vs 85.6%, p < 0.001) and higher reported pain relief (69.5 vs. 66.7%, p = 0.011) associated with arthroscopic excision versus open excision. Recurrence rates were also significantly lower for the arthroscopic excision group (9.4 vs. 11.2%, p < 0.001). Overall, the complication rate was significantly lower for arthroscopic excision (7.5 vs. 10.7%, p < 0.001), but the complication profile distinctly differed between the two methods. Conclusions Both arthroscopic and open excision of dorsal wrist ganglions are viable treatment options. However, the results of this meta-analysis suggest benefits associated with the arthroscopic technique in both patient-centered outcomes and in traditional, surgical outcomes. This may prove advantageous as wrist arthroscopy becomes more common.
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Affiliation(s)
- DesRaj M. Clark
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Sarah Y. Nelson
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Matthew O'Hara
- University of California Riverside, School of Medicine, Riverside, California
| | - Robert M. Putko
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Michael D. Bedrin
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
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7
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Konigsberg MW, Tedesco LJ, Mueller JD, Ball JR, Wu CH, Kadiyala RK, Strauch RJ, Rosenwasser MP. Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison. Hand (N Y) 2023; 18:133-138. [PMID: 33789496 PMCID: PMC9806526 DOI: 10.1177/15589447211003184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options. METHODS We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up. RESULTS The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence (P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups. CONCLUSIONS Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.
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Affiliation(s)
| | - Liana J. Tedesco
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - John D. Mueller
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Jacob R. Ball
- Columbia University Irving Medical
Center, New York City, NY, USA
| | - Chia H. Wu
- Baylor College of Medicine, Houston,
TX, USA
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8
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Grégoire C, Guigal V. Efficacy of corticosteroid injections in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist. Orthop Traumatol Surg Res 2022; 108:103198. [PMID: 35031514 DOI: 10.1016/j.otsr.2022.103198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/24/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Ganglion cysts of the dorsal aspect of the wrist are a benign pathology frequently encountered in consultations for hand surgery. Their treatment, irrespective of the type, presents a risk of recurrence and there is no consensus on the management to adopt. Medical treatments such as corticosteroid injections have recurrence rates between 8 and 74%. Surgical treatments seem to have better results, with less disparate failure rates, at around 15%. HYPOTHESIS The objective of this retrospective study was to determine the effectiveness of the aspiration and injection of corticosteroids under ultrasound guidance in the treatment of 85 ganglion cysts of the dorsal aspect of the wrist. PATIENTS AND METHODS We retrospectively included 99 patients suffering from a non-occult ganglion cyst of the dorsal aspect of the wrist, who had received a referral for aspiration, and subsequent injection of corticosteroids between January 2015 and December 2020. Data collection was carried out by the analysis of files on the institution's software, and by a phone call. Data such as age, sex, pre- and post-treatment QuickDASH score, as well as recurrence and second-line treatments were collected. RESULTS The average age of our cohort was 31, with a 65% female predominance. The recurrence rate after a first injection was 73.2% with a mean follow-up of 34 months. The QuickDASH score improved significantly by 26.2 points out of 100 in non-injected patients, and by 18.6 points out of 100 after injection, whether the cyst recurred or not. CONCLUSION With 73.2% recurrence, corticosteroid injections do not appear to be effective in treating dorsal ganglion cysts of the wrist. They lead to an improvement in the functional score of the wrist, but not significantly compared to treatment abstinence. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Coline Grégoire
- Clinique du Parc, 155, bis boulevard Stalingrad, 69006 Lyon, France.
| | - Vincent Guigal
- Clinique du Parc, 155, bis boulevard Stalingrad, 69006 Lyon, France
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Rafaqat W, Ahmad T, Ibrahim MT, Kumar S, Bluman EM, Khan KS. Is minimally invasive orthopedic surgery safer than open? A systematic review of systematic reviews. Int J Surg 2022; 101:106616. [PMID: 35427798 DOI: 10.1016/j.ijsu.2022.106616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess the safety of minimally invasive surgery (MIS) for orthopedic spinal, upper limb and lower limb procedures, this systematic review of systematic reviews compared their complications with open procedures. MATERIALS AND METHODS A literature search was conducted electronically (PubMed, Cochrane library and Web of Science; May 8, 2021) without language restriction in the past five years. Reviews that consulted at least two databases, compared MIS with open orthopedic surgery, and reported the following: intraoperative, post-operative or total complications, function, ambulation, pain, hospital stay, reoperation rate and operation time were included. Article selection, quality assessment using AMSTAR-2, and data extraction were conducted in duplicate on predesigned forms. In each review, a subset analysis focusing on prospective cohort and randomized studies was additionally performed. PROSPERO CRD42020178171. RESULTS The search yielded 531 articles from which 76 reviews consisting of 1104 primary studies were included. All reviews were assessed as being low quality. Compared to open surgery, MIS had fewer total, postoperative and intraoperative complications in 2/10, 2/11 and 2/5 reviews of spinal procedures respectively, 1/3, 1/4 and 1/2 reviews of upper limb procedures respectively, and 4/6, 2/7 and 0/2 reviews of lower limb procedures respectively. CONCLUSIONS MIS had greater overall safety compared to open surgery in spinal procedures. In upper limb and lower limb procedures, MIS was not outright superior to open procedures in terms of safety hence a general preference of MIS is not justified on the premise of a better safety profile compared to open procedures.
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Abstract
Background: The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. Methods: This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired t tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. Results: The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.
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Affiliation(s)
| | - John R. Fowler
- University of Pittsburgh Medical Center,
PA, USA,John R. Fowler, Department of Orthopaedics,
University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA
15213, USA.
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11
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Shakya A, Garje V, Rathore A. The triple technique: A simple and effective outpatient procedure for the dorsal wrist ganglion. J Clin Orthop Trauma 2021; 23:101619. [PMID: 34650906 PMCID: PMC8498456 DOI: 10.1016/j.jcot.2021.101619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Dorsal ganglia are the most common types of wrist ganglia. Though largely asymptomatic, they can cause pain, stiffness and require treatment. The different methods described for the management have high recurrence rates even up to 70%. We describe a new method which combines 3 of these methods thus aiming to achieve the best from each of the techniques. METHODS A prospective observational study was undertaken to include patients requiring surgery for dorsal ganglion. The method involved a combination of aspiration, steroid instillation and tranfixation with silk suture for 3 weeks. Various demographic parameters, operative variables and functional criteria like QuickDASH Score and Numerical Pain Rating scale (NPRS) were used. The patients were followed up for atleast 24 months. Overall satisfaction rate was also recorded. RESULTS 83 patients were included with a mean age of 31.7 ± 12.4 years. The mean duration of surgery was 12.0 ± 4.9 min and follow up was 29.8 ± 7.1 months. 15 patients had complex multilobulated ganglia. The most common indication for surgery was cosmesis. 4 complications were encountered of which 2 were superficial infections, 1 whitish discoloration locally and 1 case of persistent pain. We achieved a success rate of 95.2% with only 4 recurrences with a mean reduction in size to be 82.2 ± 5.8%. NPRS and QuickDASH scores improved significantly. Mean satisfaction rate was 89% and 84.3% wished to have the surgery again for a similar complaint. The loss of work was 2.5 ± 1.4 days. CONCLUSIONS Triple Technique is an effective and safe technique with <5% recurrence at 2 years.
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Affiliation(s)
- Akash Shakya
- Department of Orthopaedics, ESIC Hospital, Mumbai, India,Corresponding author. Department of Orthopaedics, ESIC Hospital, Mumbai, India
| | - Vinayak Garje
- Department of Orthopaedics, ESIC Hospital, Mumbai, India
| | - Amisha Rathore
- Department of Obstetrics and Gynaecology, ESIC Hospital, Mumbai, India
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d'Ailly PN, Koopman JE, Selles CA, Rahimtoola ZO, Schep NW. Patient-Related Outcomes of Arthroscopic Resection of Ganglion Cysts of the Wrist. J Wrist Surg 2021; 10:31-35. [PMID: 33552692 PMCID: PMC7850802 DOI: 10.1055/s-0040-1716509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
Background Ganglion cysts of the wrist can cause pain and loss of functionality. No consensus exist on optimal treatment. Arthroscopic resection shows promising results but is poorly studied. Furthermore, only few studies have used patient-related outcomes to evaluate arthroscopic treatment. Purpose The purpose of this study was to assess patient-related outcomes following arthroscopic resection of wrist ganglion cysts. Patients and Methods This was a retrospective study of all consecutive patients that underwent arthroscopic resection of a dorsal or volar wrist ganglion. Minimum follow-up was 6 months. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were recurrence rate and complications. Results A total of 53 patients were included with a mean follow-up of 13 months (interquartile range: 6-23 months). Twenty-six patients (49%) presented with a recurrence following prior treatment. Mean PRWE was 13 (standard deviation [SD] = 1.8), with no difference between patients with dorsal or volar ganglion cysts. There were five recurrences (9%), of which three occurred in the first five patients who were operated. There were three patients with complications (6%), consisting of neuropraxia, extensor carpi ulnaris tendinitis, and painful scar tissue. Conclusion Arthroscopic resection results in good patient-related outcome and low complication and recurrence rates when performed by an experienced surgeon. Recurrence and complication rates are similar to arthroscopic resections described in literature and superior to open resection and needle aspiration. Well-designed randomized clinical trials will be necessary to confirm these findings. Level of Evidence This is a level IV, retrospective study.
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Affiliation(s)
- Philip N. d'Ailly
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jaimy E. Koopman
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Caroline A. Selles
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Zulfiquar O. Rahimtoola
- Department of Orthopaedic and Trauma Surgery, Royal Berkshire Hospital, Reading, United Kingdom
| | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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