Incidence of Ganglion Cyst Formation After Wrist Arthroscopy: A Longitudinal Analysis
Year: 2019
Type: article
Study design: Observational Study
Abstract: PURPOSE: Ganglion cysts are theorized to occur secondary to leakage of synovial fluid from a tear in the scapholunate ligament or wrist capsule. An analogous injury is created in an iatrogenic manner with portal placement during routine wrist arthroscopy. We hypothesized that wrist arthroscopy increases the risk of developing a wrist ganglion cyst. METHODS: Using the MarketScan Outpatient Services Database, individuals who had a diagnosis of wrist ganglion cyst without an arthroscopy procedure were identified using International Classification of Diseases, 10th Edition, codes to establish a baseline incidence in the general population. Patients who underwent wrist arthroscopy and developed an ipsilateral wrist ganglion cyst postoperatively were identified using Current Procedural Terminology and International Classification of Diseases, 10th Edition, codes. Exclusion criteria included patients who had a wrist ganglion diagnosis before or at the time of arthroscopy, had bilateral wrist pathology, or did not have a diagnosis indicating laterality. Predictor variables included age, gender, comorbidities, and arthroscopic procedure performed. Multivariable logistic regression was used to analyze outcomes. RESULTS: Among 24,718,751 unique outpatients, 39,832 patients had a diagnosis of a wrist ganglion cyst (0.16%) during encounters from October 2015 to December 2016. A total of 2,420 patients underwent wrist arthroscopy during this time period. Of this group, the majority of patients were women (60.0%) and average age was 40.5 years (SD, 14.9; range, 11–65 years). Rates of diabetes mellitus (0.04%), obesity (0%), nicotine dependence (0.04%), and connective tissue disorder (0%) were low. Indications for arthroscopy most commonly involved osteoarthritis (8.3%), other joint derangements or disorders (78.9%), dislocation and sprain (56.7%), and synovitis (23.2%). Arthroscopic procedures performed included diagnostic arthroscopy with or without synovial biopsy (3.4%); lavage and drainage for infection (0.1%); partial or complete synovectomy (8.1%), triangular fibrocartilage complex excision, repair, and/or joint debridement (80.0%); internal fixation (1.5%); or a combination of these procedures (15.9%). Postoperatively, 30 patients (1.24%) were diagnosed with an ipsilateral wrist ganglion with a mean time to diagnosis of 4.0 months (SD, 2.4; range, 0.2–9.0). Significant predictors of postoperative ganglion diagnosis included female gender (odds ratio, 4.0; P < 0.01) and triangular fibrocartilage complex and/or joint debridement (odds ratio, 0.1; P < 0.01) as the arthroscopic procedure performed. CONCLUSIONS: Wrist arthroscopy is associated with a postoperative incidence of ganglion cyst formation that is nearly 8 times the rate of the general population. Surgeons should consider discussing ganglion cyst formation as a possible risk when obtaining informed consent for wrist arthroscopy. Additional studies are needed to investigate techniques that minimize risk.
Institution: Stanford University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W2972999043