Arthroscopic excision of gnglion cyst and a review of literature

1. ARTHROSCOPIC EXCISION OF
GANGLION CYST
BY DR ANKIT JOSE
FELLOW IN ARTHROSCOPY AND
SPORTS MEDICINE

2. INTRODUCTION
• Incidence of 25/100,000 in males and
43/100,000 in females.
• Causes-
Trauma to the scapholunate joint.
Degeneration of tissue lining a tendon or sheath near the joint.
Synovial herniation.
Location
-70 % dorsal SL articulation
-20 % volar – radiocarpal
- Retinaculum or tendon sheath

3. Daily massage with spit
Suture transfixation
The infamous traumatic rupture either with the spine
of a Bible, a ganglion mallet, or the physician's
thumb.
HISTORY
The initial idea, however, came with
Osterman AL, Raphael JS. Arthroscopic resection of dorsal
ganglion of the wrist. Hand Clin 1995;11:7-12.

4. Treatment options
• Observation
• Closed rupture
• Aspiration
• Open surgery
• Arthroscopic excision – Wet or Dry
Resection of the stalk and dorsal capsule
RECURRENCE RATE OF 78 %

5. Surgical Technique - DORSAL GANGLION
Operating room setup

6. Ganglion stalk
Carpal bone
Distal Radius

9. VOLAR GANGLION

10. Endoscopic Ganglionectomy of the Volar
Radial Wrist Ganglion
Volar ganglion cysts commonly occur near the radial artery in the wrist.
A total of 8/40(20%) of patients had recurrence after one treatment
with needle aspiration.
Finsen V, Håberg Ø, Borchgrevink GE. Surgery for wrist
ganglia: one-hundred and twenty-two patients reviewed 8
years after operation. Orthopedic Reviews. 2014 Jan 20;6(1).

11. Preoperative Planning
Magnetic resonance imaging of
the wrist of the illustrated case
shows the multiloculated radial
volar ganglion.
The distal portal (DP) is at the level of
the volar joint line of the radiocarpal
joint. The proximal portal (PP) is 2 to
3 cm proximal to the distal portal.
Both portals are ulnar
to the flexor carpi radialis tendon.

12. Endoscopic resection of the ganglion (G) by the arthroscopic shaver (AS).
(FCR, flexor carpis radialis tendon; FPL, flexor pollicis longus tendon; RA,
radial artery; S, distal scaphoid tubercle.)

14. ADVANTAGES OF ARTHROSCOPY
• Smaller incisions,
• Earlier return to function,
• Minimized postoperative pain,
• Lower recurrence rates
• Opportunity to assess for concomitant intra-
articular pathology

15. Complications
• Incomplete cyst excision
• Ligamentous injury- scapholunate ligament
injury
• Stiffness
• Extensor tendon injury
• Infection

16. 114 patients underwent arthroscopic resection of
DWG with a minimum follow-up of 24 months.
The recurrence rate was 12.3%, and patient satisfaction was high.
Arthroscopic technique allows patients to use their hand immediately
Unsightly appearance in 63 (55.2%)
Pain in 33 (28.9%)
Both unsightly appearance and pain in 18 (15.8%).

17. Our review suggests that arthroscopic and open
approaches have comparable outcome profiles

18. recurrence rate of arthroscopic
excision was 9%
Recurrence rate of arthroscopic excision was 9%
Recurrence rate of open excision was 20%

19. Take home message
• Arthroscopic and open excision has comparable
outcome rates.
• Principle of surgery remains the same.
• Better visualization of the stalk of the ganglion.
• Learning curve is high.