Prevalence of Ganglion Cyst Formation After Wrist Arthroscopy: A Retrospective Longitudinal Analysis of 2420 Patients.

BACKGROUND: Dorsal wrist ganglion cysts arise from the leakage of synovial fluid through tears in the scapholunate ligament and/or dorsal wrist capsule. An analogous disruption of the dorsal capsule is created with routine portal placement during wrist arthroscopy. We hypothesized that wrist arthroscopy would predispose to wrist ganglions. METHODS: Using the Truven MarketScan Outpatient Services Database from 2015 to 2016, patients who underwent wrist arthroscopy and developed an ipsilateral wrist ganglion were identified. Exclusion criteria included ganglion diagnosis preceding arthroscopy and bilateral pathology. Postoperative ganglion diagnosis was modeled with logistic regression. Predictor variables included age, gender, comorbidities, and arthroscopic procedure. RESULTS: In all, 2420 patients underwent wrist arthroscopy. Thirty (1.24%) were diagnosed with an ipsilateral wrist ganglion at a mean time of 4.0 months (standard deviation: 2.4, range: 0.2-9.0). Significant predictors of ganglion diagnosis included female gender (odds ratio [OR]: 4.0, P < .01) and triangular fibrocartilage complex and/or joint debridement (OR: 0.13, P < .01). By comparison, among all 24,718,751 outpatients who had not undergone wrist arthroscopy, 39,832 patients had a diagnosis of a wrist ganglion cyst (0.16%). CONCLUSIONS: Wrist arthroscopy is associated with a postoperative rate of ganglion cyst formation that is nearly 8 times the rate in the general population. Additional studies are needed to investigate techniques that minimize the risk of this complication.

Clinical Presentation and Characteristics of Hand and Wrist Ganglion Cysts in Children.

PURPOSE: Ganglion cysts are the most common mass of the hand or wrist. In adults, ganglions have a female predilection and are commonly located in the dorsal wrist. However, their presentation in children has not been well reported. This investigation sought to describe the presentation of pediatric ganglion cysts in a prospective cohort. METHODS: A multicenter prospective investigation of children (aged ≤18 years) who presented with ganglion cysts of the hand or wrist was conducted between 2017 and 2019. The data collected included age, sex, cyst location, hand dominance, pain, and patient-reported outcomes measurement information system (PROMIS) scores for upper-extremity (UE) function. The patients were divided into cohorts based on age, cyst location, and cyst size. Multivariable analyses were performed to identify factors predictive of worse UE function and higher pain scores. RESULTS: A total of 173 patients with a mean age of 10.1 ± 5.3 years and female-to-male ratio of 1.4:1 were enrolled. The dorsal wrist was the most commonly affected (49.7%), followed by the volar wrist (26.6%) and flexor tendon sheath (18.5%). In older patients, dorsal wrist ganglions were more common than tendon sheath cysts (11.9 ± 4.1 years vs 6.2 ± 5.8 years) and were larger (86.7% were >1 cm) than cysts in other locations (34.5% were >1 cm). Patients aged >10 years reported higher pain scores, with 21.5% of older patients reporting moderate/severe pain scores versus 5.0% of younger children. This cohort of patients had an average PROMIS UE function score of 47.4 ± 9.5, and lower PROMIS scores were associated with higher pain scores. CONCLUSIONS: Ganglions in pediatric populations, which most commonly affect the dorsal wrist, demonstrate a female predilection. In younger children, cysts are smaller and more often involve the volar wrist or flexor tendon sheath. Older children report higher pain scores. Pediatric ganglion cysts do not appear to result in a clinically meaningful decrease in UE function. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.

An epidemiological review of 623 foot and ankle soft tissue tumours and pseudo-tumours.

BACKGROUND: In evaluating foot and ankle soft tissue masses, comprehensive epidemiological data, especially clinical predictors of malignancy, is essential knowledge. Our aim was to assess these data in a cohort of patients that have undergone surgical excision of foot and ankle soft tissue tumours and pseudo-tumours over a 10-year period. METHODS: A retrospective review of foot and ankle soft tissue tumours and pseudo-tumours excised in a tertiary hospital from 1 Jan 2006 to 31 Dec 2016 was performed. Uni- and multivariable analyses via logistic regression were conducted for all independent variables to identify their relationship with malignancy. Applying receiver operating characteristic (ROC) curves and Youden's Index to significant variables, we attempted to identify optimal threshold values to predict malignancy of the soft tissue mass. RESULTS: A total of 623 tumours and pseudo-tumours were analysed, and majority were benign (n = 605, 97.1%). The most common pseudo-tumour, benign, and malignant tumours were ganglion cysts (n = 289, 90.3%), plantar fibromas (n = 54, 18.9%) and pleomorphic undifferentiated sarcomas (n = 4, 22.2%), respectively. Increasing age (P = 0.036), larger size of mass (P < 0.001) and male gender (P = 0.017) were significant predictors of malignancy. ROC and Youden's Index analyses identified optimal threshold values of 4.0 cm (area under curve [AUC] = 87.6%) for size of mass and 66 years (AUC = 60.7%) for age. CONCLUSION: Majority of foot and ankle soft tissue masses are benign. Increasing age, larger size of mass and male gender are significant predictors of malignancy. The threshold value in predicting malignancy is 4.0 cm for size of mass and 66 years for age.

Pediatric Ganglion Cysts: A Retrospective Review.

Background: Ganglion cysts are the most common type of soft tissue tumors of the hand. In the pediatric population, monitoring may be appropriate unless cysts are painful, interfering with range of motion or parental concerns exist. Reported recurrence rates after surgical removal of pediatric ganglion cysts vary widely in the literature. Notably, recurrence rates are higher for children than adults, ranging from as low as 6% to as high as 35%. Methods: A retrospective review was performed of a single pediatric hand surgeon's patients undergoing excision of primary and recurrent ganglion cysts from 2010 to 2015. Variables measured included patient age at diagnosis of ganglion cyst, time to presentation, location of cyst, hand dominance, previous therapy, previous surgery, length of surgery, tourniquet time, length of follow-up, any associated complications, and recurrence of cyst. Results: Ninety-six patients were identified with an average age of diagnosis 10.2 years. Indications for surgery: 95.8% for pain or decreased range of motion, 4.2% for cosmetic or parental concern. About 75% of the cysts were dorsally located, with the remaining 24.2% being volar. A total of 5 (5.3%) recurrences were recorded. Tourniquet time was on average 9.8 minutes longer for cases that resulted in recurrence. Multivariate analysis of the data demonstrated a 25% increased risk of recurrence with patients who had a previous aspiration. Conclusions: This is a retrospective review of a single pediatric hand surgeon's outcomes of pediatric wrist ganglion cysts. Our recurrence rate of 5.3% is low for a pediatric population indicating potential merit in this surgeon's operative and postoperative techniques. We demonstrate significantly increased rates of recurrence when a cyst had been previously aspirated, possibly indicating scarring and disruption of planes resulting in difficult dissection, increased tourniquet times, and incomplete excision.

The lymph node status as a prognostic factor in colon cancer: comparative population study of classifications using the logarithm of the ratio between metastatic and nonmetastatic nodes (LODDS) versus the pN-TNM classification and ganglion ratio systems.

BACKGROUND: pN stage in the TNM classification has been the "gold standard" for lymph node staging of colorectal carcinomas, but this system recommends collecting at least 12 lymph nodes for the staging to be reliable. However, new prognostic staging systems have been devised, such as the ganglion quotients or lymph node ratios and natural logarithms of the lymph node odds methods. The aim of this study was to establish and validate the predictive and prognostic ability of the lymph node ratios and natural logarithms of the lymph node odds staging systems and to compare them to the pN nodal classification of the TNM system in a population sample of patients with colon cancer. METHODS: A multicentric population study between January 2004 and December 2007. The inclusion criteria were that the patients were: diagnosed with colon cancer, undergoing surgery with curative intent, and had a complete anatomopathological report. We excluded patients with cancer of the rectum or caecal appendix with metastases at diagnosis. Survival analysis was performed using the Kaplan-Meier actuarial method and the Log-Rank test was implemented to estimate the differences between groups in terms of overall survival and disease-free survival. Multivariate survival analysis was performed using Cox regression. RESULTS: We analysed 548 patients. For the overall survival, the lymph node ratios and natural logarithms of the lymph node odds curves were easier to discriminate because their separation was clearer and more balanced. For disease-free survival, the discrimination between the pN0 and pN1 groups was poor, but this phenomenon was adequately corrected for the lymph node ratios and natural logarithms of the lymph node odds curves which could be sufficiently discriminated to be able to estimate the survival prognosis. CONCLUSIONS: Lymph node ratios and natural logarithms of the lymph node odds techniques can more precisely differentiate risk subgroups from within the pN groups. Of the three methods tested in this study, the natural logarithms of the lymph node odds was the most accurate for staging non-metastatic colon cancer. Thus helping to more precisely adjust and individualise the indication for adjuvant treatments in these patients.

Ganglions of the hand and wrist: Retrospective statistical analysis of 520 cases.

BACKGROUND: Ganglions constitute the most common tumor type of the hand and wrist region. They have a non-neoplastic character and affect patients of all ages. OBJECTIVES: The purpose of this work was to analyze the epidemiological data of a representative group of patients diagnosed with ganglions of the hand and wrist. MATERIAL AND METHODS: Five-hundred-and-twenty patients operated on for ganglions of the hand and wrist between the years 2000 and 2014 were included in the study. For the statistical analysis, STATISTICA v. 10 was used. Categorical data was analyzed using the χ2. The distribution of two and more independent samples was compared through the Mann-Whitney U test and Kruskal-Wallis test followed by pairwise comparisons for significant test statistics, respectively. RESULTS: In the studied group of patients, ganglions affected females more often than males, with a 2.8 : 1 ratio. No statistically significant differences in age distribution between women and men (median age 38 vs. 40 years) were found. Ganglions affected both sides of the body with comparable equality. Wrist ganglions predominated (76%). The patients diagnosed with hand ganglions were statistically significantly older (p < 0.001), and the right hand was affected more often (p = 0.003). A statistically significant difference in age distribution between the patients with DWG (dorsal wrist ganglions) and VRG (volar retinacular ganglions) was observed (p < 0.001). DWG affected the left side (p = 0.003) and VRG the right side (p = 0.005) of the body more often. CONCLUSIONS: Statistical analysis of our patients confirmed much of the previously published data. Although the diagnosis and treatment of ganglions of the hand and wrist are relatively uncomplicated, the pathophysiology of their formation is still waiting to be thoroughly explained.

Incidence and anatomical distribution of hand tumours: a Singapore study.

INTRODUCTION: Hand tumours are frequently encountered in clinical practice. A list of differential diagnoses of the most common hand tumours based on anatomical location would be helpful for clinicians. We aimed to determine the anatomical distribution of hand tumours seen at a hand surgery practice in Singapore. METHODS: The medical records of 50 men and 65 women (mean age 41.7 [range 17-74] years) who underwent excision of hand tumours between 1 June 2010 and 31 December 2012 were reviewed. The histological diagnoses and anatomical locations of the tumours were analysed. The locations were divided into three main groups: (a) distal to the metacarpophalangeal joints (MCPJs); (b) between the MCPJs and carpometacarpal joints (CMCJs); and (c) between the CMCJs and the radiocarpal joint (RCJ). RESULTS: Overall, the most common tumours excised from the hand were ganglions (n = 66/116, 56.9%) and giant cell tumours of the tendon sheath (GCTTSs; n = 11/116, 9.5%). However, distal to the MCPJs, GCTTSs (n = 11/39, 28.2%) were more common than ganglions (n = 7/39, 17.9%). Most of the ganglions (n = 59/66, 89.4%) arose from between the CMCJs and RCJ. CONCLUSION: Most hand tumours were benign. Ganglions were the most common tumours between the CMCJs and RCJ, while GCTTSs were the most common tumours distal to the MCPJs.

Ganglion cysts in the paediatric wrist: magnetic resonance imaging findings.

BACKGROUND: The majority of published literature on ganglion cysts in children has been from a surgical perspective, with no dedicated radiologic study yet performed. OBJECTIVE: Our aim was to assess the magnetic resonance (MR) imaging appearance of ganglion cysts in a series of paediatric MR wrist examinations. MATERIALS AND METHODS: Ninety-seven consecutive paediatric MR wrist examinations were retrospectively reviewed for the presence of ganglion cysts. Only those studies with wrist ganglia were included. Cysts were assessed for location, size, internal characteristics and secondary effect(s). RESULTS: Forty-one ganglion cysts (2-32 mm in size) were seen in 35/97 (36%) patients (24 female, 11 male), mean age: 13 years 11 months (range: 6 years 3 months-18 years). The majority were palmar (63.4%) with the remainder dorsal. Of the cysts, 43.9% were related to a wrist ligament(s), 36.6% to a joint and 17.1% to the triangular fibrocartilage complex. Of the patients, 91.4% had wrist symptoms: pain (n=29, 82.9%), swelling (n=7, 20%) and/or palpable mass (n=4, 11.4%); 71.4% patients had significant additional wrist abnormalities. CONCLUSION: Ganglion cysts were frequently found in children referred for wrist MRI.

Digital mucous cysts.

BACKGROUND: Digital mucous cyst (DMC) is a common benign condition, but consensus has not been reached regarding its pathogenesis and treatment. OBJECTIVE: This review provides a concise overview of DMCs. METHODS: The review presents the literature pertaining to the etiology, pathogenesis, classification, clinical features, epidemiology, differential diagnoses, diagnosis, and management of DMCs. RESULTS: DMCs have a predilection for middle-aged patients, a good prognosis, and a high recurrence rate. DMCs may occur in one of three locations on the distal digit. They arise owing to a metaplastic or degenerative process. Preexisting osteoarthritis is common and may be an etiologic factor in patients with DMCs. A number of conservative and surgical treatments are available depending on the structures and locations involved. CONCLUSION: Studies with greater sample size and longer follow-up would enrich current knowledge of the benefits, recurrences, and complications for each treatment modality.

[Epidemiology of bone and soft-part tumors of the foot and knee]. / Epidemiología de tumores óseos y partes blandas del pie y tobillo.

DESIGN: Report of cases. OBJECTIVE: Review of the cases in a period of 10 years with bone and soft tumors in foot and ankle, to knowing epidemilogical, clinic and patologic anatomy parameters to describe the behavior. MATERIALS AND METHODS: Review of 166 cases from 1991 to 2000 and been analyze with descriptive statistic, association measurment for inside stratum, with odds ratio, hipótesis test with chi square for qualitative date and t to Student for quantitative date. RESULTS: 166 patients within 2 years to 78 years old, 81 with bone tumors and 79 with soft tumors, mostly benign, the most frequent was in the soft tissue ganglion and oseal benign exostosis in bone, 6 different malignant tumors, the principal affected zone were the toes, as a difference to literature, the most affected age group was 10 to 20 years followed to the 30 to 40 years old, we report 42 different patological diagnostics results to soft tissue and osseous tissue. CONCLUSION: clinical features is not a useful parameter to differentiate between malign or benign tumors and does not allow to establish the biological behavior, we propose the diagnostic algorithm that includes the intentional clinical probe, comparative X-ray in three projections with soft technique, in suspicion to malignant lesion may require CT scan, MRI, osseous scan and finally biopsy which will improve the final outcome.

A case of unilateral lower limb swelling secondary to a ganglion cyst.

INTRODUCTION: We present a case of leg swelling of unusual aetiology which serves as a reminder to the surgeon to consider causes of leg swelling other than lymphoedema and venous insufficiency. CASE REPORT: A 40 year old man developed progressive left leg swelling despite treatment of his varicose veins. Subsequent investigation revealed a lesion compressing the femoral vein. At exploration this was found to be a ganglion cyst. Removal of this resulted in resolution of the swelling. DISCUSSION: Venous compression due to external cystic lesions, although rare, is recognised. This case serves as a reminder that the rarer causes of limb swelling should not be forgotten, especially where potentially treatable.

[Ganglion cysts of the knee originating from tendons and ligaments]. / Diz tendon ve baglarindan köken alan gangliyon kistleri: klinik ve MRG bulgulari.

PURPOSE: To investigate the clinical features and MR imaging findings of the ganglion cysts arising from the tendons and ligaments of the knee. MATERIALS AND METHODS: One thousand six hundred and twenty knee MR examinations that had been performed in a three-year period were evaluated retrospectively for the presence of ganglion cysts originating from tendons or ligaments. Clinical findings and MRI features of the lesions were noted. RESULTS: Twenty-three patients had a ganglion cyst originating from a tendon or a ganglion, with an incidence of 1.4%. Six lesions were associated with the anterior cruciate ligament, six with the posterior cruciate ligament, six with the medial collateral ligament, two with the lateral collateral ligament, two with the transverse ligament, and one with the patellar tendon. The most common clinical finding was knee pain. There were swelling at the medial side of the knee in two patients, swelling at the lateral side of the knee in one patient and swelling in the popliteal region in one patient. CONCLUSION: MR appearance of ganglion cysts arising from the tendons and ligaments of the knee is characteristic. Meniscal cysts, pigmented villonodular synovitis, and synovial hemangioma should be considered in the differential diagnosis.

Anterior cruciate ligament ganglia and mucoid degeneration: coexistence and clinical correlation.

OBJECTIVE: The purpose of our study was to describe the MR appearance and coexistence of anterior cruciate ligament ganglia with mucoid degeneration and to address the clinical significance of these entities. MATERIALS AND METHODS: A database search of 4221 knee MRI examinations over 2 years revealed 90 examinations with reported anterior cruciate ligament ganglion or mucoid degeneration. Imaging criteria for ligament ganglion included fluid signal in the ligament disproportionate to joint fluid showing mass effect on intact ligament bundles. The size, location, complexity, and degree of lobulation of ganglia were recorded. Criteria for mucoid degeneration included ligament bundles poorly seen on T1-weighted and proton density-weighted images but with both bundles seen as intact on T2-weighted images. Intraosseous cysts at the ligament attachments and presence of joint effusion were noted. Clinical assessment of ligament instability was recorded when available. RESULTS: Of 74 examinations that met imaging criteria, 56 (76%) had discrete intraligamentous ganglia, 18 (24%) had mucoid degeneration, and 26 (35%) had features of both. Ganglia were located in the proximal ligament in 16 examinations (22%) and the distal ligament in 10 (14%) and involved the entire ligament in 30 (40%). Ganglia ranged in maximum diameter from 20 to 73 mm (mean, 31 mm). Complexity of ganglia was mild (41%), moderate (39.2%), or marked (19.8%). Intraosseous cysts were noted proximally in 48 examinations (65%) and distally in 20 (27%). Of 52 patients with accessible records, 48 had no clinical evidence of instability. Twelve patients who underwent arthroscopy had an intact anterior cruciate ligament at that time. CONCLUSION: Anterior cruciate ligament ganglia and mucoid degeneration commonly coexist on MRI and are typically not associated with ligament instability.