Arthroscopy-assisted treatment of scaphoid and lunate cysts: Clinical evaluation of 7 cases

Abstract

Intraosseous cysts of the carpus are relatively common benign tumors. They are often discovered by chance and can cause wrist pain thereby requiring appropriate management. While conventional open surgical treatment leads to good results, it has certain disadvantages, the main one being postoperative stiffness. Arthroscopic treatment has been proposed as an alternative for lunate cysts. The present study consisted in evaluating the feasibility and outcomes of arthroscopic treatment for lunate and scaphoid cysts. The main objective was to evaluate the postoperative clinical outcomes at 3 and 18 months. The secondary objective was to evaluate the integration of a cancellous bone graft. We conducted a retrospective study of eight patients who underwent surgery between April 2010 and October 2016. Of these, four had a lunate cyst and four had a scaphoid cyst; all cysts had a dorsal operculum. Patients had disabling wrist pain that did not respond to conservative treatment. The diagnosis was confirmed by radiography and either a CT scan or an MRI. Curettage and cancellous grafts were performed under arthroscopic control. The technique was carried out successfully in all cases. One patient was lost to follow-up. At 18 months, postoperative pain was rated at 1.28 on a visual analog scale. The grip strength (measured with a Jamar dynanometer) was 77% when compared to the contralateral side. There was an improvement in joint range of motion, with an average wrist flexion of 67.5° compared to 48.3° preoperatively and an average wrist extension of 71.5° compared to 47.6° preoperatively. The Patient-Rated Wrist Evaluation (PRWE) score decreased from 69.7 to 12.7, which was a significant decrease. A good integration of the cancellous graft was confirmed at 6 months in all cases by CT scan or MRI. Curettage with a cancellous graft of lunate and scaphoid cysts under arthroscopic control is a technique that allows surgeons to obtain satisfactory clinical results with good integration of the graft.