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Arthroscopic Versus Open Excision of Dorsal Ganglion Cysts: A Systematic Review
Catherine Crawford, BA; Andrew J Lovy, MD, MS; Isaiah Levy, BS; Aakash Keswani, BA; Kristina Lutz, MD; Jaehon Kim, MD; Michael R. Hausman, MD
Mount Sinai School of Medicine, New York, NY
Introduction: Ganglion cysts are common, benign tumors of the hand/wrist that cause joint instability, weakness, limited range of motion, and pain. Surgical excision is a successful treatment for removing cyst and alleviating these symptoms; however, it is unclear whether open or arthroscopic excision produces better clinical and patient-reported outcomes. The purpose of this study was to conduct a systematic review comparing clinical outcomes following open versus arthroscopic excision of ganglion cysts.
Methods: We performed a systematic search of Pubmed, EMBASE, and CENTRAL databases for articles published between 2000 and 2016. Included studies reported treatment outcomes of adult dorsal wrist ganglions and met the following criteria: (1) adults (>18 years) with dorsal wrist ganglia; (2) primary cases only; (3) recurrence rate and complications reported in the article; (4) minimum of one year follow-up; (5) minimum of 10 patients per cohort; (6) English translation available. Two reviewers screened each article, evaluating the methodological quality of Randomized Control Trials, observational cohort studies with controls, and observational cohort studies without controls using the Cochrane Handbook for Systematic Reviews, Newcastle-Ottawa Scale, and the modified Newcastle-Ottawa Scale, respectively. The main clinical outcome measured was recurrence rate of the ganglion cyst after excision by either open or arthroscopic surgery.
Results: A total of 788 abstracts were identified, of which 88 full-text articles were reviewed and screened for inclusion criteria. Of these, 71 articles were removed because they did not meet criteria. Ultimately, 17 full-text articles (5 randomized control trials and 12 retrospective cohort studies) were included of which 8, 6, and 3 had a high, moderate, and low risk of bias, respectively. Across the 17 studies there were 587 arthroscopic and 323 open dorsal ganglion cyst excisions with an average participant age of 33.2 and 33.9 years, and mean follow-up time of 36 and 46 months, respectively. The pooled recurrence rate of open excision was 20.1% [range: 5.6%-40.7%] with Q value of 5.99 and I2 of 16.5%. The pooled recurrence rate of arthroscopic excision was 8.50% [range: 0%-17.3%] with Q value of 10.87 and I2 of 8.7%. For the subset of studies (4 open, 269 ganglions; 10 arthroscopic, 440 ganglions) with complete reporting of complications (neurovascular, infection), rates were similar for open and arthroscopic excision (5.6% vs. 9.1%).
Conclusion: Our review demonstrates the effectiveness of arthroscopic compared to open excision with a similar complication profile. Further studies are required to increase confidence in these findings.
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