Arthroscopic Treatment of Intraosseous Ganglion Cyst of the Lunate Bone

Abstract

Intraosseous ganglion cysts are rare causes of wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The main complications are joint stiffness and vascular disturbances of the lunate bone. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore minimizes postoperative stiffness. This article describes an arthroscopic technique used for lunate intraosseous cyst resection associated with an autologous bone graft in a series of cases to prevent joint stiffness while respecting the scapholunate ligament. This study was based on a series of 4 patients, all of whom had wrist pain because of intraosseous ganglion cysts. Arthrosynovial cyst resection, ganglion curettage, and bone grafting were performed arthroscopically. Pain had totally disappeared within 2 months after the operation in 100% of patients. The average hand grip strength was estimated at 100% compared with the opposite side, and articular ranges of motion were the same on both sides in 100% of cases. No complications were reported after surgery. On the basis of these results, arthroscopic treatment of intraosseous synovial ganglion cysts seems to be more efficient and helpful in overcoming the limitations of classic open surgery in terms of complications.

Fig 1

(A) Frontal radiographic view of the wrist of a 48-year-old woman with an intraosseous ganglion cyst of the lunate bone. (B) Close-up view of cyst.

Fig 2

Computed tomography scans of the wrist of a 63-year-old man with an intraosseous ganglion cyst of the lunate bone. (A) Frontal view showing that the cyst is on the scaphoid side of the lunate and is communicating with the articulation. (B) Frontal view showing the cyst on the triquetral side. (C) On the sagittal view, the cyst is shown to represent more than 50% of the height of the lunate. (D) On the transverse view, the cyst is shown to represent one-third of the lunate length.

Fig 3

Magnetic resonance images, frontal view. (A) T2 image showing no sclerosis of the lunate bone, permitting exclusion of Kienböck disease. (B) T1 image showing a cyst with hypersignal in the lunate bone.

Fig 4

Arthroscopic view from radiocarpal showing scapho lunate space and capitate on the top (arthroscope in 3-4 portal and instruments in 4-5 portal).

Fig 5

Arthrosynovial cyst resection with shaver from radiocarpal position (arthroscope in 3-4 portal and instruments in 4-5 portal).

Fig 6

Arthroscopic views (A) with awl in radiocarpal joint and (B) after corticotomy (arthroscope in 3-4 portal and instruments in 4-5 portal).

Fig 7

Arthroscopic view: cyst resection is completed with a small curette (arthroscope in 3-4 portal and instruments in 4-5 portal).

Fig 8

Placement of bone graft in lunate with a 2.7-mm soft-tissue protector (arthroscope in 3-4 portal and instruments in 4-5 portal).

Fig 9

Bone graft impaction.

Fig 10

CT scan showing cyst resorption.