Aspiration of Pediatric Wrist Ganglion Cysts has higher rates of recurrence: JHS study

Dallas, TEXAS: Ganglion cysts arise in all age groups and populations, but are most commonly seen in the young adult female population; with an estimated 70% of cysts occurring in people aged 20-40. In children, the spontaneous resolution rate with observation alone ranges from 48% to 83%.

The treatment of ganglion cysts of the wrist remains understudied in the pediatric population, with the literature showing variable recurrence rates following different interventions.

Carolyn Shanks et al did a study to determine whether surgical and nonsurgical management of pediatric ganglion cysts was associated with improved resolution rates when compared to observation alone.

• The authors identified 654 cases of pediatric ganglion cysts treated across 5 institutions.

• The mean age at presentation was 11.6+/- 5.2 years.

• Of the patients, 315 had >2 years (mean, 50.0 months) of follow-up, either via chart review or telephone callbacks.

• There were 4 different treatment groups: (1) observation, (2) cyst aspiration, (3) removable orthosis, and (4) surgical excision.

• For patients followed >2 years, the cyst resolved in 44% (72/163) of those observed.

• Only 18% (9/49) of those treated with aspiration resolved.

• 55% (12/22) of those treated with an orthosis resolved.

• Surgical excision was associated with resolution of the cyst in 73% (59/81) of patients.

• Observation had higher rates of cyst resolution compared to aspiration.

• Orthosis fabrication and observation had similar rates of cyst resolution.

• Surgery had the highest rates of resolution when compared to observation and aspiration.

• Patients older than 10 years were less likely to have the cyst resolve with observation (35%; 28/80) than those younger than 10 years (53%; 44/83) at >2 years of follow-up.

This study did not find evidence that nonsurgical treatments were associated with improved rates of cyst resolution compared to observation alone in a large pediatric sample.

Surgical excision had the overall highest rate of resolution. Despite the costs and increased clinic time of orthosis fabrication and aspiration, these treatments were not associated with improved rates of cyst resolution in pediatric ganglion cysts compared to observation, with aspiration having higher rates of recurrence compared to observation.

The authors no longer offer aspiration or orthosis fabrication as methods of definitive treatment of pediatric ganglion cysts, although aspiration may be offered as a temporizing method for children who are experiencing limitations in sports and activities and wish to defer possible surgery to a more convenient time if the cyst recurs after aspiration.

Key Words: Ganglion cyst, aspiration, observation, pediatric, the Journal of Hand Surgery.

Type of study/level of evidence: Therapeutic IV

The Efficacy of Nonsurgical and Surgical Interventions in the Treatment of Pediatric Wrist Ganglion Cysts

Carolyn Shanks, Tyler Schaeffer, David P. Falk et al

J Hand Surg Am. 2022;47(4):341- 347

https://doi.org/10.1016/j.jhsa.2021.12.005