Arthroscopic Ganglionectomy Research Articles

Outcome Evaluation of Arthroscopic Resection of Dorsal Wrist Ganglia.

Goals: Arthroscopic ganglionectomy has become an increasingly popular surgical option for dorsal wrist ganglia. The aim of this study was to describe our technique for the arthroscopic treatment of dorsal wrist ganglia and to evaluate the clinical results as well as the recurrence rate in our patients. Methods: In a prospective study, 48 patients who underwent arthroscopic treatment of dorsal ganglion of the wrist were included. Patients were evaluated preoperatively and 3 and 24 months post arthroscopy. A presence of recurrence at 24 months was recorded. The subjective outcome was evaluated with The Patient-Rated Wrist Evaluation (PRWE) and the Visual analog scale (VAS). Objective outcomes included grip strength and range of movement measurements. Results: The mean age was 36 years; the majority were women (36/48). Mean grip strength and the average flexion and extension in the wrist showed improvement after 3 months. The total PRWE score improved from 26.7 preoperatively to 10.2 at three months and 2.4 two years after surgery. After 24 months follow-up, there were only two patients with recurrence (4.2%). Conclusion: The arthroscopic resection of the dorsal wrist ganglia is a procedure with a low recurrence rate and lowest scaring and stiffness; it should be considered as a golden standard for operative treatment of the dorsal wrist ganglia.

Clinical Results of Arthroscopic Resection of Dorsal Wrist Ganglion with a Minimum of 3 Years Follow-up.

Introduction Ganglion cysts are the most common benign tumors of the wrist. Their arthroscopic resection is becoming common. However, there are a limited number of studies comparing arthroscopic and open surgeries. This study evaluated the subjective and objective results of arthroscopy with a minimum of 3 years follow-up. Patients and Methods Patients with dorsal wrist ganglion who underwent arthroscopic ganglionectomy were evaluated regarding pain (using visual analog scale) and satisfaction as subjective results. We also evaluated their scar (with the Vancouver scar scale), range of motion, and recurrence as objective results. Results There were 20 patients in the study. Mean of follow-up time was 52.5 months. Recurrence rate was 5%, and visual analog scale of pain decreased from 3.7 to 0.5 at the final follow-up. Sixteen patients were completely satisfied, three patients were partially satisfied, and one patient was unsatisfied. The mean of Vancouver scar scale was 1.4 (range of 0-3). Improvement in range of flexion and extension of the wrist was significant without a significant complication. Conclusion Arthroscopic excision of dorsal wrist ganglion in the way described in this study is a safe and effective method that improves pain and range of motion of the wrist without major complications. The rate of recurrence was less than those reported for open surgery in long-term follow-up. The surgery scar has a promising score in Vancouver scar scale.

Arthroscopic treatment of massive acromioclavicular joint ganglion cysts with color-aided visualization: a case series of 4 patients

Acromioclavicular joint ganglion cysts are rare lesions that mainly arise from the degeneration of the acromioclavicular joint in elderly patients. Although surgical management may be required because of their high recurrence rate after aspiration, few reports have described arthroscopic surgical procedures to treat acromioclavicular ganglion cysts. We report the surgical results of arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts. This retrospective case series examined patients identified with massive ganglion cysts that were localized above the acromioclavicular joint. All patients underwent an arthroscopic removal of subacromial synovium and subsequent injection of indigo carmine into the ganglion. The distal end of the clavicle was excised arthroscopically from the inferior surface, and the ganglion stalk was confirmed using indigo carmine for enhanced visualization and magnification. A ganglion portal was created, and the ganglion cyst was resected with the aid of the dye. Four female patients, aged 78-90 years, were identified with a massive acromioclavicular joint ganglion cyst. Plain radiography showed joint degeneration in the acromioclavicular joint, and magnetic resonance imaging scans showed fluid-filled mass formation. Although all patients initially underwent multiple aspirations of the ganglion cyst, we opted for surgical intervention because of its persistent recurrence. Three patients exhibited concurrent rotator cuff tears, and one patient had a prior history of cuff repair with no retear. After arthroscopic ganglionectomy with color-aided visualization for massive acromioclavicular ganglion joint cysts, none of the patients have shown recurrences at 2 years postoperatively. Novel aspects of this case series include the use of indigo carmine to provide a better visualization and identification of the ganglion stalk under arthroscopy. Furthermore, a ganglion portal is useful for achieving complete resection of the indigo carmine-stained ganglion cyst. Color-aided visualization using indigo carmine and the construction of a ganglion portal were useful techniques for performing arthroscopic ganglionectomy in patients with a massive acromioclavicular joint ganglion cyst.

A cost and efficacy analysis of performing arthroscopic excision of wrist ganglions under wide-awake anaesthesia versus general anaesthesia

BackgroundArthroscopic excision has currently become popular for the treatment of wrist ganglions. The objective of this study was to evaluate the clinical outcomes and cost effectiveness of arthroscopic wrist ganglion excisions under Wide-Awake Local Anaesthesia No Tourniquet versus general anaesthesia.MethodsWe retrospectively reviewed patients who underwent arthroscopic ganglionectomy from April 2009 to October 2016 at our institute. They were separated into two groups according to anaesthesia techniques: general anaesthesia and Wide-Awake Local Anaesthesia No Tourniquet. We compared the clinical outcomes and cost-effectiveness of the two groups.ResultsSeventy-four patients were included. Both groups were matched with regard to the demographics and preoperative clinical assessments. We found no significant differences between groups in postoperative visual analog scale, modified Mayo wrist score, Disabilities of Arm, Shoulder and Hand score, recurrence, residual pain, or complications. Recurrence was found in five of 74 patients, one (4.3%) in the Wide-Awake Local Anaesthesia No Tourniquet group and four (7.8%) in the general anaesthesia group. One extensor tendon injury and four extensor tenosynovitis cases occurred in the general anaesthesia group. Regarding cost effectiveness, the mean operating time in the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were 88.7 ± 24.51 and 121.5 ± 25.75 min, respectively (p < 0.001). The average total costs of the Wide-Awake Local Anaesthesia No Tourniquet and general anaesthesia groups were €487.4 ± 89.15 and €878.7 ± 182.13, respectively (p < 0.001).ConclusionsFor arthroscopic wrist ganglion resections, both anaesthesia techniques were effective and safe regarding recurrence rates, complications, and residual pain. The most important finding of this study was that arthroscopic ganglionectomy under Wide-Awake Local Anaesthesia No Tourniquet was superior to that under general anaesthesia for cost-effectiveness.Level of evidenceLevel III, Retrospective comparative study.

Endoscopic Ganglionectomy of the Volar Radial Wrist Ganglion

Volar ganglion cyst of the wrist is a common hand problem faced by orthopaedic surgeons. Excision is indicated if it is painful. Arthroscopic ganglionectomy of the wrist ganglion has been reported with the advantage of minimally invasive surgery. Most of them involve elimination of the valvular mechanism and internal drainage of the ganglion fluid to the wrist joint. The access of the ganglion sac is limited especially for a multiloculated cyst. The purpose of this Technical Note is to report the technique of endoscopic resection of the volar radial wrist ganglion. This can ensure complete resection of the ganglion sac especially for the multiloculated one.

Arthroscopic ganglionectomy of a toe with color-aided visualization of the ganglion stalk

Arthroscopic ganglionectomy of a toe with color-aided visualization of the ganglion stalk

Audit of Clinical and Functional Outcomes of Arthroscopic Resection of Wrist Ganglions.

The purpose of this study is to audit the clinical and functional outcomes of arthroscopic ganglionectomy (AG) in our centre. A retrospective study was conducted on all 29 patients who underwent AG from 2007 to 2012 with a mean clinic and telephone follow-up duration of 6 months and 32 months respectively. A total of 29 patients (17 women and 12 men) with a mean age of 38 years underwent AG. 15 patients (52%) had associated pain with the lump, 24 out of 29 patients (83%) had preoperative ultrasound to confirm the diagnosis. All patients had preoperative wrist radiographs that showed no chronic carpal instability and bony pathology. 26 out of 29 patients (90%) had dorsal wrist ganglions and 3 patients (10%) had volar wrist ganglions. 15 out of 24 ganglions (62.5%) were multiloculated. Mean ganglion size clinically and through wrist ultrasound was 2.5 cm and 1.8 cm respectively. During arthroscopy, ganglion stalk was identified in 14 patients (48%). Average operating time was 69.5 minutes. Intraoperatively, 24 out of 29 patients (83%) had wrist synovitis and 26 patients (90%) had associated carpal ligament laxity. 97% of cases were successfully resected arthroscopically. Recurrence rate was 10% (3 cases). There was no significant difference between preoperative and postoperative range of motion of wrists - the mean wrist flexion ranged from 63 to 59 degrees pre and postoperatively, and the mean wrist extension ranged from 66 to 64 degrees pre and postoperatively. Overall grip strength improved from 27 kg to 32 kg ([Formula: see text]), and there was also a significant improvement in pain scores pre and post-operatively from visual analogue scale (VAS) score of 0.8 to 0.3 ([Formula: see text]). No major intra or post-operative complications occurred. All patients were satisfied in terms of cosmesis. AG is a safe and reliable alternative to open resection of wrist ganglions. In addition, it can be used as a diagnostic and therapeutic tool for other wrist conditions.

Interphalangeal arthroscopy of the toes

Interphalangeal (IP) joint pathology of the toes has gained little attention of the orthopedic surgeon. However, similar intra-articular pathologies e.g. osteoarthritis, synovitis, chondral lesion, arthrofibrosis and instability can occur as in other joints. Moreover, many corrective procedures of toe deformity involved excisional arthroplasty or arthrodesis of the IP joint although it is not the site of primary pathology. Classically, the operations of the IP joint were performed in an open manner. We described the technique of interphalangeal arthroscopy and its application to treat various pathologies of the interphalangeal joint was discussed. Among the various indications for interphalangeal arthroscopy, arthroscopic ganglionectomy of recurrent IP ganglion is the single most important one.

Symptomatic ganglion cysts of cruciate ligaments of the knee: A series of nine cases

BackgroundGanglion cysts of cruciate ligaments of the knee are uncommon, especially because a proportion of them are asymptomatic. Moreover, symptomatic lesions have diverse presentation and are not easily detected in physical examinations. The purpose of this report was to define the relationship between clinical symptoms and the sites of ganglia of cruciate ligaments of the knee. Materials and methodsWe conducted a retrospective review of a series of nine patients treated at our institute for intra-articular ganglion cysts of cruciate ligaments of the knee. One patient presented with pain and an inability to fully extend the knee. The remaining eight patients presented with nonspecific pain or pain during knee flexion and/or extension. The diagnosis and definite location of ganglia of cruciate ligaments were confirmed by arthroscopy. All patients were treated by ganglionectomy using arthroscopic techniques. ResultsSubstantial cyst impingements were observed during knee motion using arthroscopy. At the last follow-up, all but one patient had achieved considerable symptomatic improvement after arthroscopic ganglionectomy. ConclusionWe suggest that depending on cyst location, a more applicable hypothesis for knee joint pain during motion is cyst impingement on the other cruciate ligament or the intercondylar notch.

Arthroscopic ganglionectomy of the foot and ankle

To study the efficacy of arthroscopic ganglionectomy in the management of ganglia of the foot and ankle. From 2006 to 2010, arthroscopic ganglionectomy was performed for 89 ganglia in the foot and ankle of 88 patients. Clinical and intra-operative details were reviewed retrospectively. Ganglion stalk was identified in 6 % of the cases. The overall rate of presence of pathology was 26 %. The overall rate of recurrence or residual lesion was 12 % with high recurrent rate for extensor tendon ganglia and toe pulp ganglia. Arthroscopic ganglionectomy of the foot and ankle ganglion by either internal drainage or complete resection is a feasible approach. Good results can be achieved in case of adequate internal drainage of the ganglion to the joints or fibrous tendon sheath.

Color-Aided Visualization of Dorsal Wrist Ganglion Stalks Aids in Complete Arthroscopic Excision

Dorsal wrist ganglia are the most common mass of the upper extremity. Treatment modalities include benign neglect, aspiration, and surgical excision. Arthroscopic excision is a less invasive surgical alternative to open resection with the benefit of visualizing and treating other intra-articular pathology, fewer potential complications, earlier return to activities, and possibly, a more complete resection. This may lead to a lower rate of recurrence, although this has not been proven in the literature. Recurrence depends in part on adequate ganglion stalk visualization and resection. This is often difficult in open and arthroscopic ganglionectomy. This work describes a new technique with improved arthroscopic stalk visualization and ganglion resection using intralesional injection of an inert dye.

Arthroscopic Ganglionectomy Through an Intrafocal Cystic Portal for Wrist Ganglia

A retrospective study was conducted on arthroscopic ganglionectomy in wrists using a novel intrafocal cystic portal. The safety and efficacy of this technique were assessed by treatment of 15 wrists in 15 patients. Arthroscopic ganglionectomy was performed by the same surgeon with the patient under general anesthesia or regional block. Preoperative complaints, intraoperative findings, and postoperative results of all the patients were reported. The mean follow-up was 15.3 months. Functional assessment by use of modified Mayo wrist scores, patient satisfaction, and recurrence were included in the follow-up evaluation. Two thirds of the patients acquired good to excellent results, whereas the results for the remaining third were fair. Complications included 1 recurrence and 1 case of transient paresthesia sensation. The most common arthroscopic findings were capsular and ligament lesions, rather than ganglionic stalks. Arthroscopic ganglionectomy through an intrafocal cystic portal is a safe and efficacious option for the treatment of painful wrist ganglia. Level IV, therapeutic case series.

Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period

Purpose The purpose of this report is to review the results of arthroscopic resection of dorsal wrist ganglions. Methods Forty-one patients with dorsal wrist ganglions had arthroscopic resection: 24 women and 17 men. The average patient age was 29.8 years. All of the patients had some or all of the following: pain, localized swelling, and limited range of motion. Along with clinical examination, 19 wrists had ultrasound or magnetic resonance imaging to confirm diagnosis. Twelve patients had previous injections with recurrence. The average follow-up time to date is 47.8 months (range, 28–97 months). Results Overall postoperative motion improved compared with preoperative values. No cases of scapholunate instability were noted. The average postoperative grip strength improved significantly. Only 2 ganglions recurred and required 2 attempts at open resection for successful eradication the ganglion. No major intraoperative or postoperative complications occurred. Conclusion Arthroscopic ganglionectomy is a safe and reliable alternative to open resection.

The carpus: Therapist's commentary

This paper presents an overview of therapy for the wrist after soft tissue reconstruction, arthroscopic debridement, arthroscopic ganglionectomy, total wrist arthrodesis, and vascularized bone grafts. Postoperative problems common to each of these procedures include stiffness, edema, scarring, decreased strength, and decreased use of the involved extremity. An understanding of the surgical procedure and its specific purpose is necessary for the hand therapist to formulate a plan of treatment and appropriate goals for rehabilitation. Treatment techniques and modalities for these procedures are reviewed, as well as the importance of patient education and activity modification.