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Arthroscopic view: cyst resection is completed with a small curette (arthroscope in 3-4 portal and instruments in 45 portal).
Source publication
Intraosseous ganglion cysts are rare causes of wrist pain. Surgical treatment of this pathologic condition yields good results and a low recurrence rate. The main complications are joint stiffness and vascular disturbances of the lunate bone. Wrist arthroscopy is a surgical technique that reduces the intra-articular operative area and therefore min...
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Citations
... Wrist arthroscopy is a minimally invasive surgical technique, usually performed under local or regional anesthesia, that reduces the intra-articular surgical area, thus minimizing the incidence of postoperative stiffness. Arthroscopy has been widely applied for the treatment of wrist diseases, such as in the treatment of scaphoid fracture, distal radius fracture, scapholunate ligament repair, and ganglion cystectomy of soft tissues in the wrist (10)(11)(12). There are few reports on the application of arthroscopy for carpal IGCs in the wrist. ...
... There are few reports on the application of arthroscopy for carpal IGCs in the wrist. Alexandre Cerlier, Jr. et al (12). conducted arthroscopic cystectomy and bone grafting in four patients with carpal IGCs. ...
Objective
To investigate the application and the clinical efficacy of wrist arthroscopy in the treatment of carpal intraosseous ganglion cysts (IGCs).
Methods
A retrospective case study method was adopted to analyze the clinical data of 28 patients with carpal IGCs admitted to the Sixth Hospital of Ningbo from April 2012 to January 2019. A hypodensity in the bone was shown by X-ray before the operation, with hypodensity and cystic change in the bone being confirmed by computed tomography and magnetic resonance imaging. Arthroscopic open window of the wrist, cystectomy, and autologous iliac bone graft implantation were conducted. Regular postoperative X-ray combined with CT follow-ups were conducted to observe the healing after bone implantation. Patients were followed up regularly and assessed by the Modified Mayo Wrist Score in four aspects of the postoperative pain, wrist mobility, grip, and function to provide an objective overall assessment of the therapeutic outcome.
Results
All 28 patients were followed up for 8–16 months, with an average follow-up duration of 10 months. After the operation, pain disappeared completely for 25 patients, and 3 cases showed significant improvement. All cases were pathologically confirmed as ganglion cysts and had first-stage bony healing after bone grafting with an average healing time of 10.8 weeks. The grip returned to normal for all patients, and wrist flexion and extension were the same as the healthy wrist for 25 patients, with a Modified Mayo Wrist Score of excellent in 19 cases and good in 9 cases. No recurrence was observed.
Conclusion
In patients with symptomatic carpal IGCs, the application of arthroscopic open window, cystectomy, and autologous bone graft implantation could achieve satisfactory clinical therapeutic effects.
... 5,6 The surgical treatment of this pathology has evolved over the years, from open procedures to arthroscopicassisted to all-arthroscopic techniques, mostly consisting of curettage of the cyst combined with bone grafting (usually autologous), yielding good functional results and low recurrence rates. 6,7 Open treatment has been associated with wrist stiffness, persistent pain, 8 and vascular disorders of the lunate. 7,9 Wrist arthroscopy techniques have allowed enhancement of ILBG curettage and grafting, overcoming the complications of the open approach. ...
... 6,7 Open treatment has been associated with wrist stiffness, persistent pain, 8 and vascular disorders of the lunate. 7,9 Wrist arthroscopy techniques have allowed enhancement of ILBG curettage and grafting, overcoming the complications of the open approach. 7,10,11 The goal of this study is to describe a minimally invasive technique that consists of arthroscopically passing through the proximal, nonvascularized portion of the scapholunate ligament. ...
... 7,9 Wrist arthroscopy techniques have allowed enhancement of ILBG curettage and grafting, overcoming the complications of the open approach. 7,10,11 The goal of this study is to describe a minimally invasive technique that consists of arthroscopically passing through the proximal, nonvascularized portion of the scapholunate ligament. It can allow direct access to the cyst, which frequently opens into the scapholunate joint, for curettage and bone grafting. ...
Intraosseous lunate bone ganglia (ILBG) are known to be a cause of chronic wrist pain and disability. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain. Arthroscopic techniques are more recent and seem very reliable. Several arthroscopic techniques have been reported for ILBG approach and treatment. The present study describes an approach that preserves all the lunate cartilage of both radiocarpal and midcarpal surfaces. The surgical technique allows easy and direct access to the bone ganglia, passing through the intermediate portion of the scapholunate ligament, with the scope in the 1-to-2 portal and instrumentation through the 3-to-4 portal. The rest of the procedure is straightforward: curettage and bone grafting are performed through this specific approach, similarly to other techniques. This an easy and accurate approach that avoids any damage to the major cartilage surfaces of the lunate, with easy and reliable access to the intraosseous lunate bone ganglion, allowing cyst curettage and autologous bone graft in a proper and noninvasive way.
... This minimally invasive approach irritates signi cantly less soft tissue; thus, the capsules and ligaments remain intact, reducing the risk of arthro brosis and damage to the vascular system of the carpal bones that might possibly lead to open exposure. [7,15,19] Using an arthroscope, a complete and clear view of the joint could be achieved, subsequently treating the intra-articular lesions. Furthermore, concomitant morbidities such as extraosseous cysts and intercarpal joint instability can also be treated arthroscopically with a better esthetic result. ...
Background: Intraosseous ganglion cysts (IOGs) of the carpal bone are uncommon tumors that may represent rare causes of chronic wrist pain. Arthroscopic resection has been described in isolated symptomatic cases as a feasible technique; however, there is no published study investigating this technique in an unstable wrist. We aimed to study the outcome of arthroscopic lesion resection combined with intercarpal ligament thermal shrinkage for the IGOs in the wrists with occult instability.
Methods: Fourteen patients from our hospital database between 2013 and 2015 who had IOGs combined with occult carpal instability were retrospectively reviewed. Diagnosis was exclusively established based on persistent wrist pain and functional limitation before surgery. The IOGs were removed under arthroscope, and bone grafting was performed accordingly dependent on the sizes and locations of the lesion. The lax intercarpal ligaments were tightened by radiofrequency shrinkage. Results were analyzed for demographic data and functional outcomes.
Results: At a mean follow-up of 27 months, all patients were satisfied with pain relief and the patients’ grip power improved. The pre- and postoperative range of motion of the affected wrist had no significant difference. Radiologically, cyst recurrence and joint instability development were not observed. The postoperative function of the wrists significantly improved based on the Mayo Wrist Score and Patient-rated Wrist Evaluation score.
Conclusions: For IOGs of carpal bones in the wrist with occult instability, arthroscopic treatment, including cyst resection and ligament thermal shrinkage, was an effective way to improve pain and function of the effected wrist.
... It consists of curettage of the cyst and application of a bone graft, most often an autologous graft is performed by an open surgical approach. Complications are rare and include joint stiffness and impairments of the vascular system of the lunate bone [12]. Another treatment option is an arthroscopic minimally invasive technique, which involves debridement and grafting of the lunate IOG [1]. ...
... This offers an explanation as to why the lunate and scaphoid are the most commonly involved carpal bones [15]. [12,[14][15][16]. The correct diagnosis is established through several imaging modalities [12]. ...
... [12,[14][15][16]. The correct diagnosis is established through several imaging modalities [12]. Conventional radiographs of IOG affecting the lunate bone present eccentrically located well-defined osteolytic lesion, outlined by a sclerotic rim [8]. ...
Intraosseous ganglia of the carpal bones are infrequent, benign, non-neoplastic bone lesions, which are observed predominantly in young and middle-aged adults. The most commonly affected bones are the lunate and scaphoid, followed by the capitate, triquetrum and trapezoid bones. Carpal intraosseous ganglia are uncommon causes of chronic wrist pain. They have a broad and complex differential diagnosis based on various imaging modalities and histological examination. Treatment of such lesions involves several techniques and is associated with complete cure of the symptoms and low rate of recurrence. In this study, we present two cases with an intraosseous ganglion cyst of the lunate bone. We also briefly review the clinical aspects, imaging findings and treatment options of this condition.
Intraosseous lunate bone ganglia (ILBG) are known to be a cause of chronic wrist pain and disability, most often after collapse of a ganglion wall in the scapholunate joint. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain. Arthroscopic techniques are more recent and have begun to prove themselves very reliable, with studies reporting satisfactory functional and radiological results after arthroscopic bone grafting for intraosseous lunate bone ganglia.
Background
Intraosseous ganglia of the carpal bones are uncommon with sparse publications to guide treatment. The purpose of this study was to review a single-institution experience to determine the outcomes of patients with surgically treated intraosseous carpal ganglia.
Methods
Skeletally mature patients with intraosseous carpal ganglia between 1995 and 2016 treated operatively were identified. Demographic information, clinical data, and radiographic studies were evaluated.
Results
Thirty-three ganglia in 31 patients were identified. Intraosseous ganglia were located in the lunate (23), scaphoid (9), and trapezoid (1). Patients who presented with pathologic fracture or collapse had larger intraosseus ganglia than those presenting with pain alone. Surgery significantly improved pain. Patients treated with debridement with autograft bone graft had a higher consolidation rate compared with allograft bone but no difference in pain.
Conclusions
Patients with large or symptomatic lesions can be treated successfully with curettage and debridement, which leads to relief of pain. The use of bone grafting remains controversial.
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.
Purpose:
Intraosseous ganglion cyst (IGC) is a rare disease, particularly in lunate. The objective of this study was to summarize current knowledge on the treatment of IGC of the lunate, through a literature review, to provide a therapeutic strategy for this rare disease.
Methods:
The PubMed, ISI Web of Science, Cochrane Library, EMBASE, Science Direct database were searched with a set of predefined inclusion and exclusion criteria. Manual searches for references were performed to find potential relevant studies. The authors extracted data from the articles selected.
Results:
Different treatment modalities of IGC of the lunate were described, all of which were divided into 3 categories: conservative treatment, classical surgical procedures, and novel surgical procedures. An overview on the main treatment modalities for IGC of the lunate was provided.
Conclusions:
Conservative treatments can be the doctors' first choice for patients with IGC. Surgical procedure is advised when conservative treatment fails. Traditional surgical curettage with autologous bone grafting is the mainstay of treatment with satisfactory outcomes; however, novel surgical techniques like arthroscopically assisted minimally invasive technique or filling with bone cement are considered as more promising attempts with less trauma and shorter recovery period. Nonetheless, studies with high levels of evidence are guaranteed for developing widely accepted clinical treatment guidelines.
