Arthroscopic resection of dorsal wrist ganglions with or without midcarpal exploration.

Abstract

Introduction: The aim of the study was to compare a radiocarpal approach with or without a midcarpal exploration to determine outcomes and incidence of recurrences following arthroscopic excision of dorsal wrist ganglions.

Methods: This retrospective study included 39 patients who underwent arthroscopic excision of dorsal wrist ganglions with a radiocarpal approach alone and 32 patients who received radiocarpal excision with midcarpal exploration. Outcomes assessed at 1 year follow-up included Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, pain relief, patient satisfaction, complications and recurrence. Pre- and postoperative MRI images were used to classify the ganglions into four types based on their origin and location. Postoperative MRI was performed in cases of suspected recurrence.

Results: One year postoperatively, QuickDASH scores, pain relief and patient satisfaction were similar in both groups. Complications were minimal and comparable between groups. Recurrence occurred in seven patients in the radiocarpal excision group and in one patient who underwent radiocarpal excision with midcarpal exploration. Magnetic resonance imaging analysis of the eight recurrences revealed five type 2 lesions (midcarpal), one type 3 lesion (radiocarpal) and two type 4 lesions (combined radiocarpal and midcarpal), indicating that seven of eight recurrences involved the midcarpal joint.

Conclusion: Routine midcarpal joint exploration during arthroscopic excision of dorsal wrist ganglions appeared to reduce recurrence at 1 year without negatively impacting patient outcomes.

Level of evidence: III.