Purpose
To prospectively evaluate objective and subjective outcomes of arthroscopic dorsal
wrist ganglion cyst resection, and to identify and examine intra-articular pathologies
associated with ganglion cysts.
Methods
We prospectively evaluated 55 patients with dorsal wrist ganglion cysts who underwent
arthroscopic resection with a minimum follow-up of 24 months. Ten had recurrent ganglion
cysts previously treated with open resection. Grip strength, wrist motion, and Disabilities
of the Arm, Shoulder, and Hand questionnaire scores were evaluated preoperatively
and at 6 weeks, 6 months, and 2 years postoperatively. Intraoperative findings were
reviewed.
Results
In primary ganglion cysts a discrete stalk was present in 4 of 45 cases and diffuse
cystic material and redundant capsular thickening were present in 38 of 45 cases.
Cystic material appeared to arise from the radiocarpal joint exclusively in 11 of
42 cases, extended into the midcarpal joint in 29 of 42 cases, and arose exclusively
from the midcarpal joint in 2 of 42 cases. The scapholunate joint demonstrated instability
types I (2 of 45 cases), II (22 of 45 cases), III (20 of 45 cases), and IV (1 of 45
cases). The lunatotriquetral joint demonstrated instability types II (6 of 45 cases)
and III (39 of 45 cases). At 6 weeks, average grip strengths increased by 5.9 kg and
wrist flexion decreased 13°. Preoperative Disabilities of the Arm, Shoulder, and Hand
scores improved from 14.2 to 1.7 at 6 weeks and remained stable at 2 years. At 2 years,
all patients demonstrated motion to within 5° of preoperative measurements, and there
were no recurrences.
Conclusions
Patients experienced significant increases in function and decreases in pain within
6 weeks after arthroscopic ganglion cyst resection, and the recurrence and complication
rates appear to be comparable to open resections. Ganglion cysts also have a high
association with certain interosseous laxities, and recurrent ganglion cysts originating
from the midcarpal joint are not contraindications for arthroscopic resection. Assessment
of the midcarpal joint is necessary for complete resection of most ganglion cysts,
and identification of a discrete stalk is an uncommon finding and not necessary for
successful resection.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Accepted:
November 24,
2008
Received:
October 14,
2007
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
