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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Arthroscopic surgery for recurrence after wrist ganglion excision, a series of 12 procedures

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  • presenting/speaker Pierre Croutzet - Institut Toulousain Membre Supérieur, Toulouse, France
  • Iskander Djerbi - Institut Toulousain Membre Supérieur, Toulouse, France
  • Regis Guinand - Institut Toulousain Membre Supérieur, Toulouse, France

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1292

doi: 10.3205/19ifssh0959, urn:nbn:de:0183-19ifssh09598

Published: February 6, 2020

© 2020 Croutzet et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Recurrences after a wrist ganglion excision are a common problem. It occurs either after arthroscopic or open surgery, various series have reported a recurrence rate around 10% whatever the procedure.

We wanted to evaluate the efficiency of the arthroscopic surgery after recurrence of a wrist ganglion excision. We report our outcomes concerning 12 consecutive cases

Methods: Over a period of 5 years, 12 ganglion cysts recurrences were operated on. In these 12 cases, 7 recurrences occur in the first year after excision, 4 between 2-5 years, 1 after 10 years, it was a second recurrence in one case. The first excision was performed open in 11 cases and arthroscopic in 1 case.

To cure these 12 recurrences, all procedures were performed with arthroscopy using two midcarpal portals: an optical ulnar midcarpal portal and an instrumental radial midcarpal portal, portals were switched during the surgery.

Articular diagnosis was performed first then the transverse midcarpal ligament was incised longitudinally. An extra-articular excision of the cyst was performed between the capsule and the extensor then between the extensor and the extensor retinaculum.

A single layer adhesive dressing with a splint was kept for a week.

Clinical examination and Quick-Dash were performed before and after surgery.

Results and Conclusions: The mean follow up was 30 months (12-61).

The pre-op clinical examination reported a ROM of 110°in F/E° and a mean QuickDASH score of 11 (6-24); the post-op examination reported a ROM of 130° (at 3 months) and a phone interview QuickDASH score (at follow-up) of 6 (0-9).

The time of surgery was 28 minutes (22-45), articular abnormalities were reported in 8 cases.

1 recurrence occurs after 6 months.

Although the recurrence after wrist ganglion excision is a frequent issue, this study is the first dedicated specifically to this complication.

This series suggests the recurrence rate would be equivalent after a first or a second excision.

Arthroscopic surgery is reliable to cure recurrences after wrist ganglion excisions.