Résection arthroscopique des kystes synoviaux dorsaux du poignet : à propos de 54 cas

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

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.

Factors Impacting Recurrence Rate After Open Ganglion Cyst Excision

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.

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

BACKGROUND

Dorsal wrist ganglia are the most common soft tissue tumor type of the upper limb. Surgical resection, open or arthroscopic, is one of the most frequent procedures performed by hand surgeons. This study sought to perform an objective evaluation of the outcomes of arthroscopic resection of dorsal wrist ganglia and their recurrence rates over 4 years. Patients treated with arthroscopic resection were expected to have favorable outcomes and low complication rates after 4 years of follow-up.

METHODS

We evaluated 34 cases of dorsal wrist ganglia in patients who underwent arthroscopic resection. The patients were evaluated using the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measure, visual analog scale (VAS) for pain, range of motion of the wrist, palmar grip strength, rates of recurrence, and complications.

RESULTS

During the postoperative period, the QuickDASH score averaged 2.3 points, the mean residual pain by VAS was 0.54, full range of wrist movement was recovered by all patients, and the mean palmar grip strength was 29.4 kgf; there was 1 case with recurrence. There were no severe postoperative complications throughout the follow-up period.

CONCLUSIONS

The outcomes, recurrence, and complications rates after 4 years of follow-up presented in this study support the use of arthroscopy as a treatment for dorsal wrist ganglion.

Arthroscopic excision of wrist ganglions: does trans-cystic or cystic-sparing portal technique affect clinical outcomes?

INTRODUCTION

The preliminary results of arthroscopic wrist ganglionectomy were contradictory. The approach used for the arthroscopic excision of wrist ganglions may play an important role. We analyzed two surgical approaches for arthroscopic excision of wrist ganglions.

MATERIALS AND METHODS

Between April 2009 and October 2014, 49 patients with wrist ganglions who underwent arthroscopic excision in our institute were retrospectively classified into two treatment groups, namely the trans-cystic portal technique (TCP) and cyst-sparing portal technique (CSP). The visual analog scale (VAS), Mayo wrist scores, and disabilities of the arm, shoulder, and hand (DASH) scores were measured for clinical assessment. Recurrence, residual pain, and complications were evaluated at follow-up.

RESULTS

No significant differences were found between the groups in terms of demographic data, and preoperative clinical assessment, as well as with regard to postoperative VAS score (p = 0.898), Mayo wrist score (p = 0.526), DASH score (p = 0.870), recurrence (p = 0.491), residual pain (p = 0.690), and complications (p = 0.352). Recurrence was found in 2 of the 47 patients and they were both in the CSP group. At the final follow-up, residual pain was found in four patients in the TCP group and three in the CSP group.

CONCLUSIONS

For performing arthroscopic resection of wrist ganglions, both techniques are safe regarding the complication rates. In recurrence rate, no significant difference was found between the two groups, but no recurrence was observed when the TCP technique was used.

Arthroscopic Ganglionectomy in the Pediatric Population

BACKGROUND

Arthroscopic dorsal wrist ganglionectomy is an established alternative to open excision in the adult population. The purpose of this study was to retrospectively compare outcomes of arthroscopic and open dorsal wrist ganglionectomy in the pediatric population.

METHODS

All patients who underwent arthroscopic or open dorsal wrist ganglionectomy at a single pediatric institution between 2011 and 2014 were retrospectively evaluated by chart review and telephone interview. The primary outcome variable was whether or not the cyst had recurred. Other outcome measures included the incidence of complications, and patient-rated outcome measures such as satisfaction, pain, function, and aesthetics.

RESULTS

There were eight cases of arthroscopic and 19 cases of open ganglionectomy, with a mean age of 14 years. At an average follow-up of 2 years, the recurrence rate was one of eight for the arthroscopic group and two of 19 for the open group. No patients in the arthroscopic group reported functional limitations, compared with three patients in the open group. On a 10-point scar appearance scale, with 1 being not satisfied at all and 10 being highly satisfied, the median score in the arthroscopic group was 9.5, compared with 8 in the open group. No patients in the arthroscopic group had residual pain at the surgical site, compared with nine patients in the open group, a finding that was statistically significant. All patients in the arthroscopic group reported that they would undergo surgery again, whereas two patients in the open group would not undergo surgery again.

CONCLUSION

Arthroscopic dorsal wrist ganglionectomy compares favorably with open ganglionectomy in the pediatric population.

Arthroscopic excision of dorsal wrist ganglion: factors related to recurrence and postoperative residual pain

PURPOSE

The purpose of this study was to assess the recurrence rate and postoperative residual pain rate after arthroscopic excision of dorsal wrist ganglia and the risk factors for recurrence and residual pain.

METHODS

A total of 115 wrists (111 patients: 57 men, 54 women; average age 34 years; range, 9 to 72 years) treated with arthroscopic excision for wrist dorsal ganglia between April 2005 and December 2009 were enrolled. The follow-up averaged 32 months (range, 12 to 67 months). Demographic data and operative details, including the presence of a ganglion stalk, were retrospectively reviewed and tested against recurrence and residual pain at final follow-up.

RESULTS

The recurrence rate of dorsal wrist ganglia after arthroscopic excision was 11% (13 of 115 wrists). Recurrence was on the dominant side in 12 of 13 (91%) patients, which was the most important risk factor for recurrence (odds ratio [OR], 8.0; 95% confidence interval [CI], 0.94 to 68.49), followed by female sex (OR, 4.9; 95% CI, 0.84 to 28.39) and age 24 years or younger (OR, 3.1; 95% CI, 0.75 to 12.74). Twenty-seven wrists (23%) had postoperative residual pain at final follow-up. The results of logistic regression showed that pain before surgery was the most important risk factor for residual pain after surgery (OR, 4.9; 95% CI, 1.36 to 18.3), followed by female sex (OR, 3.2; 95% CI, 1.22 to 8.53).

CONCLUSIONS

Dominant side, female sex, and age of 24 years or younger are considered to be the most influential risk factors for recurrence after arthroscopic excision of dorsal wrist ganglia. However, the presence or absence of the cyst stalk was not a significant factor for recurrence. Female patients who have preoperative pain around the dorsal wrist ganglia were most likely to experience residual pain after surgery.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Prospective outcomes of arthroscopic treatment of dorsal wrist ganglia

The purpose of this study was to assess the results of arthroscopic resection of dorsal wrist ganglia. Between November 2002 and September 2007, all patients with dorsal wrist ganglia underwent arthroscopic resection in our institution. Average follow-up was 39.2 months (range, 24-71 months). Fifty-two patients (40 women and 12 men; mean age, 29.8 years) were treated with our operative technique. Symptoms at presentation were unpleasant appearance in 15 patients (28.8 %), pain in 30 (57.6%), and unpleasant appearance and pain in 7 (13.5%). The ganglion cyst site was in front of the midcarpal joint in 41 patients (78.8%), in front of the radiocarpal joint in 6 patients (11.5%), and in front of the radiocarpal and midcarpal joints in 5 patients (9.6%). Our surgical technique resulted in a significant improvement in flexion, extension, and grip strength (P≤.005). In patients with painful ganglia, treatment also had a significant effect. Nine (17.3%) recurrences were observed. Mean time off work was 14 days, but 19 patients returned to work immediately. According to the results of this study, we recommend the use of arthroscopy as the primary treatment method for dorsal wrist ganglion excision.

Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain

PURPOSE

The purpose of this study was to compare the postoperative rates of ganglion recurrence between arthroscopic and open techniques of dorsal ganglion (DG) excision.

METHODS

A total of 72 patients had either arthroscopic or open excision of a primary, simple DG by 1 of 2 senior hand surgeons. Three prospective postoperative assessments were performed. The first examination was performed at 5 to 7 days, the second at 4 to 8 weeks, and the third assessment was performed at a minimum of 1 year after surgery. Percentages of ganglion recurrence at the second and third assessments were recorded.

RESULTS

Forty-one patients had arthroscopic excision, and 31 patients had open excision. Baseline patient age, gender, and surgical side were similar between the 2 groups. Recurrence of the DG at the second postoperative assessment was 1 of 41 patients in the arthroscopic group and none in the open excision group, and, after a minimum of 12 months after excision, recurrence was 3 of 28 in the arthroscopic group and 2 of 23 in the open group.

CONCLUSIONS

This study compares the rates of ganglion recurrence between arthroscopic and open DG excision. Our results demonstrate that at 12 months follow-up, the rates of recurrence with arthroscopic DG excision are comparable with and not superior to those of open excision. Our results suggest that additional long-term comparative studies are needed to accurately differentiate the efficacy of open and arthroscopic techniques.

Current concepts in wrist arthroscopy

The purpose of this article is to review the recent literature on arthroscopic treatment of distal radius fractures (DRFs), triangular fibrocartilage complex injuries, intercarpal ligament injuries, and ganglion cysts, including the use of electrothermal devices. A major advantage of arthroscopy in the treatment of DRFs is the accurate assessment of the status of the articular surfaces and the detection of concomitant injuries. Nonrandomized studies of arthroscopically assisted reduction of DRFs show satisfactory results, but there is only 1 prospective randomized study showing the benefits of arthroscopy compared with open reduction-internal fixation. Wrist arthroscopy plays an important role as part of the treatment for DRFs; however, the treatment for each practitioner and each patient needs to be individualized. Wrist arthroscopy is the gold standard in the diagnosis and treatment of triangular fibrocartilage complex injuries. Type 1A injuries may be successfully treated with debridement, whereas the repair of type 1B, 1C, and 1D injuries gives satisfactory results. For type 2 injuries, the arthroscopic wafer procedure is equally effective as ulnar shortening osteotomy but is associated with fewer complications in the ulnar positive wrist. With interosseous ligament injuries, arthroscopic visualization provides critical diagnostic value. Debridement and pinning in the acute setting of complete ligament tears are promising and proven. In the chronic patient, arthroscopy can guide reconstructive options based on cartilage integrity. The preliminary results of wrist arthroscopy using electrothermal devices are encouraging; however, complications have been reported, and therefore, their use is controversial. In dorsal wrist ganglia, arthroscopy has shown excellent results, a lower rate of recurrence, and no incidence of scapholunate interosseous ligament instability compared with open ganglionectomy. Arthroscopy in the treatment of volar wrist ganglia has yielded encouraging preliminary results; however, further studies are warranted to evaluate the safety and efficacy of arthroscopy.