Treatment of Primary Dorsal Wrist Ganglion—A Systematic Review

Abstract

Purpose The aim of this study was to compare the rates of recurrence and wound infection in patients with primary dorsal wrist ganglion treated with aspiration (with or without an injection of an additive), open excision, or arthroscopic resection.

Methods This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered on PROSPERO. Systematic electronic searches in PubMed (MEDLINE), EMBASE, Web of Science, and the Cochrane Library of Controlled Trials were performed on May 5, 2020, and June 1, 2021, respectively. All clinical studies written in English determining the recurrence and wound infection rates after treatment of primary dorsal wrist ganglion with aspiration, open excision, or arthroscopic resection in patients over the age of 16 years were eligible for inclusion. Quality assessment was guided by the Cochrane Collaboration's tool for randomized controlled trials (RCTs) and the methodological index for nonrandomized studies (MINORS) tool for observational studies.

Results The literature searches resulted in 1,691 studies. After screening, five RCTs, enrolling 233 patients, and six observational studies, enrolling 316 patients with primary dorsal wrist ganglions were included. Quality assessment of the included RCTs and observational studies determined the existing level of evidence pertaining to primary dorsal wrist ganglion treatment to be low. About 11 studies reported on recurrence rate, which ranged between 7 and 72% for patients initially treated with aspiration (with or without an injection of an additive). In comparison, the recurrence rate for the open excision and arthroscopic resection groups ranged between 6 to 41% and 0 to 16%, respectively. Four studies investigated wound-related complications, for which zero infections were reported, irrespective of treatment.

Conclusion The evidence summarized in this systematic review demonstrates a considerable variability in recurrence rate following aspiration and open or arthroscopic resection of a primary dorsal wrist ganglion. The greatest variability in recurrence was displayed among studies on aspiration. The overall infection rate after treatment of dorsal wrist ganglions seems to be low regardless of the treatment type. However, the divergent results of individual studies highlight a pressing need for prospective controlled trials assessing outcomes following dorsal wrist ganglion treatment.

Level of Evidence Systematic review on level 1 to 4 clinical therapeutic studies.

Keywords

arthroscopic resection - aspiration - dorsal ganglion cyst - dorsal wrist ganglion - open excision

Ethical Approval

Ethical approval was not sought for this study as it is not required from the regional Ethical Committee at the University of Gothenburg. Given the nature of the current study, informed consent was not deemed necessary as no human subjects were enrolled.

Authors' Contributions

Authors A.H., B.Z., S.K., and N.Z. contributed substantially to the acquisition of the data, analysis of the data, and are responsible for drafting the manuscript and revising it critically for important intellectual content. K.S., E.H.S., and E.S. made large contributions to the revision and design of the work. All authors have given their final approval of the manuscript to be published. Moreover, all authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Publikationsverlauf

Eingereicht: 08. April 2022

Angenommen: 30. Mai 2022

Artikel online veröffentlicht:
11. Juli 2022

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