Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically

Abstract

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 degrees . 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 degrees 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.