Active Treatment of Pediatric Ganglia of the Wrist: What is the Risk of Recurrence?

Abstract

Background: Ganglion cysts are the most common soft tissue mass in the hand and wrist in both adults and children. More is known about wrist ganglia and their treatment outcomes in adults than in children. Current literature to guide the management of pediatric wrist ganglia is limited. The purpose of this study is to report on the rates of recurrence of pediatric wrist ganglia after active intervention—aspiration or surgical excision—at a single center, as well as to explore factors associated with recurrence in one of the largest samples to date of pediatric wrist ganglia. Methods: In all, 205 pediatric patients with wrist ganglia from our institution with at least 2-year follow up were included. The primary outcome was the recurrence rate after treatment type (aspiration vs. surgery). Secondary outcomes were demographic factors (age, sex, etc.), cyst location (volar vs. dorsal), duration of cyst before intervention, and surgeon specialty training (hand vs. non-hand). Results: Recurrence was seen in 58.4% (n=94) of patients undergoing their first aspiration. Recurrence was seen in 34% (n=97) of patients after the first surgery, but there was a significant difference in recurrence rate based on the surgeon’s fellowship training. Conclusion: In conclusion, surgery does appear to offer a higher chance of definitive resolution of pediatric wrist ganglia. Differences in technique among surgeons should be explored as a possible factor to explain the range of recurrence rates described in the limited literature on this topic. Level of Evidence: Level III—Retrospective Review.