Rekonstruktion des dorsalen, kapsuloligamentären, skapholunären Septums bei arthroskopischer Ganglionresektion

Kystes du poignet : actualisations de la physiopathologie et de la prise en charge

It was with great interest that we read the experience of the authors regarding open excision of dorsal wrist ganglion (1). The authors underline the key points of this technique, notably the reduction of pain by resection of the posterior interosseous nerve (PIN) and the identification of the stalk of the cyst. Although there was no significant difference in ganglion recurrence between open and arthroscopic excisions (2), the authors point out that open excision seems to be more effective on pain. Their assumption is that the resection of the PIN may potentially be the cause. However, we would like to point out that a non-negligible part of cysts is not painful, patients coming mainly for an aesthetic complaints or a decrease of range of motion. We would like to emphasize the need to distinguish between painful and non-painful cysts. It has been shown in one study that arthroscopic resection associated with dorsal capsulodesis for painful cysts had significantly (p=0,035) less risk of recurrence than isolated arthroscopic resection of a non-painful cyst (3). About 10% of the painful cysts had a definite lesion of scapholunate instability and half of them had global inflammation of the dorsal scapholunate capsuloligamentous complex. Although there are no articles proving the relationship between scapholunate instability and wrist cysts, we believe that an arthroscopic analysis of scapholunate stability is an important element to consider, especially if the cyst is painful.

Is pain a determining factor in choosing between open or arthroscopic excision? – JBJS eLetters

We compared arthroscopic cyst resection (ACR) of dorsal ganglia of the wrist, either associated to reconstruction of the dorsal capsuloligamentous scapholunate septum (ACR-DCSS) in 66 cases in which the ganglia were painful on exertion, or isolated ACR in 15 pain-free cases. A single-center retrospective study analyzed data for the period April 2013 to May 2021. The main aim was to compare pre- and post-operative functional results (pain at rest (on a numerical rating scale: NRS), pain under effort (NRS), range of motion (°), grip strength (kg)) and recurrence rate between the two techniques. The study hypothesis was that DCSS repair improves recurrence of dorsal ganglion cyst and functional outcome. The ACR-DCSS group showed significant improvement in extension, pronation, supination, radial inclination, ulnar inclination, grip strength, pain at rest and pain on exertion. The ACR group showed significant improvement in pronation, ulnar inclination and pain on exertion. There was a significant difference in recurrence rate, in favor of ACR-DCSS. Recovery was also significantly better for the ACR-DCSS group in terms of extension, supination and pain at rest. Arthroscopic treatment of wrist ganglion cyst is a reliable, minimally invasive and reproducible technique that produces good results in terms of pain and recovery of range of motion, with significantly lower recurrence rate in case of DCSS repair. Level of evidence: Therapeutic III. 

Repair of the dorsal capsuloligamentous scapholunate septum during arthroscopic resection of painful dorsal wrist ganglion cyst: Comparative analysis of two techniques.

D. Querel

Papers

Repair of the dorsal capsuloligamentous scapholunate septum during arthroscopic resection of painful dorsal wrist ganglion cyst: Comparative analysis of two techniques.