Arthroscopic Transosseous Repair of Foveal Tears of the Triangular Fibrocartilage Complex: A Systematic Review of Clinical Outcomes.

PURPOSE: To determine whether arthroscopic transosseous foveal repair of the triangular fibrocartilage complex (TFCC) results in significant and clinically relevant improvement in clinical outcomes including pain and function with low complication and reoperation rates. METHODS: We reviewed studies investigating the clinical outcomes of arthroscopic transosseous foveal repair of the TFCC through MEDLINE, Embase, and the Cochrane Library. Studies on TFCC repair performed with an open or capsular technique and combined with other procedures, such as ulnar shortening osteotomy and a wafer procedure, were excluded. Methodologic quality was assessed using the Methodological Index for Non-randomized Studies score. Clinical outcomes were assessed using range of motion, grip strength, and patient-reported outcomes. Clinically relevant improvement was determined using the minimal clinically important difference (MCID). RESULTS: A total of 443 unique studies were identified, of which 7 (131 patients) met the inclusion criteria. The mean age ranged from 27 to 37 years, and the mean follow-up period ranged from 23.5 to 31.1 months. The grip strength (as a percentage) increased after foveal repair of the TFCC in all studies (mean difference range, 11.8% to 22.3%). All studies also reported an improvement in the visual analog scale score (mean difference range, -9.8 to -1.88); Modified Mayo Wrist Score (mean difference range, 10.5 to 27); and Disabilities of the Arm, Shoulder and Hand score (mean difference range, -51.8 to -24.48). Considering clinically relevant improvements based on the MCID, 4 of 5 studies reporting the visual analog scale score showed improvements in this score (MCID, 2) and all studies reporting the Disabilities of the Arm, Shoulder and Hand score showed improvements in this score (MCID, 10). Most complications recovered without any treatment, and 3 patients (2.29%) needed a reoperation. CONCLUSIONS: Arthroscopic transosseous foveal repair of the TFCC resulted in improvements in grip strength and functional outcomes with low complication and reoperation rates. However, the evidence for which technique produces better clinical outcomes remains limited. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

Tendon Subluxation After Surgical Release of the First Dorsal Compartment in De Quervain Disease.

We aimed to determine whether dorsoulnar incision elevating radial flap and immobilization for the treatment of de Quervain disease have an advantage over simple midline incision and early mobilization, respectively, in terms of tendon subluxation and clinical outcomes. Forty-six patients with de Quervain disease were randomly divided into 2 groups (midline incision vs dorsoulnar incision) and 2 subgroups (immobilization vs early mobilization). Subluxation of intracompartmental tendons was measured in dynamic wrist positions at 12 and 24 weeks using ultrasonography. The DASH (Disabilities of the Arm, Shoulder, and Hand) and visual analog scale scores and grip and pinch strengths were evaluated. At 24 weeks, the tendons were displaced voloradially in wrist volar flexion (1.25 mm in midline incision vs 0.36 mm in dorsoulnar incision, P = 0.001), whereas the tendons were displaced dorsoulnarly in wrist extension (0.95 mm in midline incision vs 1.78 mm in dorsoulnar incision, P = 0.041). There were no significant differences in tendon displacement between early mobilization and immobilization groups. Clinical outcome measures showed no variation between the groups, and no significant correlation occurred with tendon subluxation. Dorsoulnar incision and postoperative immobilization do not have advantage over midline incision and early mobilization, respectively. However, tendon subluxation after release of the first dorsal compartment for de Quervain disease does not affect clinical outcomes.

Editorial Commentary: The Practical Goal of Arthroscopic Osteosynthesis for the Treatment of Unstable Scaphoid Nonunion.

Arthroscopic reduction with osteosynthesis using bone grafting has become a successful alternative to open techniques for the treatment of chronically unstable scaphoid nonunions. Several studies have demonstrated that arthroscopic techniques are safe and reproducible in addition to causing less soft tissue damage and providing promising short- and mid-term results. However, these techniques have limitations in restoring normal carpal alignment, especially in patients with unstable scaphoid nonunion and carpal collapse deformities, although this does not affect the recovery of clinical function. Therefore, the practical goal of arthroscopic technique should be kept in mind when treating unstable scaphoid nonunions.

Does Bowstringing Affect Hand Function in Patients Treated With A1 Pulley Release for Trigger Fingers?: Comparison Between Percutaneous Versus Open Technique.

We aimed to inspect bowstringing after percutaneous and open release of the A1 pulley for trigger digits and its influence on hand function. Sixty-two patients with a resistant trigger digit were randomized to undergo either open release or percutaneous release of the A1 pulley. We quantified bowstringing of the digit using ultrasonography preoperatively and at 12 and 24 weeks after surgery. Pain on a visual analog scale; Disabilities of the Arm, Shoulder, and Hand questionnaire; pinch power; and grip strength were assessed. Bowstringing was significantly increased at 12 weeks after surgery in both groups, and the mean value of the open release group was significantly greater than that of the percutaneous group (2.30 ± 0.58 mm vs 1.46 ± 0.51 mm, respectively; P = 0.035). However, the bowstringing was decreased at 24 weeks without showing significant difference between the 2 groups. The clinical outcomes of each cohort improved significantly, with no difference between the groups at final follow-up. No association was found between bowstringing and any clinical outcome measure. Bowstringing occurred by A1 pulley release with either the percutaneous or open technique does not affect clinical hand function in patients with trigger fingers.

Prominent synovial plicae in radiocapitellar joints as a potential cause of lateral elbow pain: clinico-radiologic correlation.

BACKGROUND: Thickened synovial plicae in the radiocapitellar joint have been reported as a cause of lateral elbow pain. However, few reports regarding diagnosis based on detailed physical examination and magnetic resonance imaging (MRI) findings are available. The aims of this study were to characterize the clinical manifestations of this syndrome and to investigate the clinical outcomes of arthroscopic surgery. METHODS: We analyzed 20 patients who received a diagnosis of plica syndrome and underwent arthroscopic débridement between 2006 and 2011. The diagnosis was based on physical examination and MRI findings. Elbow symptoms were assessed using a visual analog scale for pain; the Mayo Elbow Performance Index; and the Disabilities of the Arm, Shoulder and Hand score at a minimum of 2 years after surgery. The thickness of plicae on MRI was compared with the normal data in the literature. RESULTS: Plicae were located on the anterior side in 1 patient, on the posterior side in 15, and on both sides in 4. Radiocapitellar joint tenderness and pain with terminal extension were observed in 65% of patients. MRI showed enlarged plicae consistent with intraoperative findings. The mean plica thickness on MRI was 3.7 ± 1.0 mm, which was significantly thicker than the normal value. The mean lengths (mediolateral length, 9.4 ± 1.6 mm; anteroposterior length, 8.2 ± 1.7 mm) were also greater than the normal values. The visual analog scale score for pain decreased from 6.3 to 1.0 after surgery. The Mayo Elbow Performance Index and Disabilities of the Arm, Shoulder and Hand scores improved from 66 to 89 and from 26 to 14, respectively. CONCLUSIONS: Specific findings of the physical examination and MRI provide clues for the diagnosis of plica syndrome. Painful symptoms were successfully relieved after arthroscopic débridement.

The effect of full dose composite tissue allotransplantation immunosuppression on allograft motor nerve regeneration in a rat sciatic nerve model.

BACKGROUND: The purpose of this study was to identify which triple immunosuppressive protocols, currently used for vascularized composite allotransplantation in the clinic, will have the best effect on motor function recovery following nerve allograft reconstruction. METHODS: Eighty-eight Lewis rats underwent a 1-cm sciatic nerve allograft transplantation and skin graft from 44 Brown-Norway rats. Group I received 0.9% isotonic saline (control); Group II, 2 mg/kg FK506; Group III, 1 mg/kg FK506 with 15 mg/kg mycophenolate mofetil (MMF); and Group IV, 2 mg/kg FK506 with 30 mg/kg MMF and prednisone. Each group consisted of 11 rats. After 12 weeks, motor function recovery was evaluated with isometric tetanic force, muscle mass, ankle contracture angle, electrophysiology, and nerve histomorphometry. Adequacy of immunosuppression was monitored with the transplanted skin graft. All data are expressed as a percentage of the contralateral side. RESULTS: Isometric tetanic force showed significantly better functional recovery in all groups treated with immunosuppression compared to control. Within the immunosuppression groups no significant difference was found: 42.1 ± 6.4% (Group I), 56.1 ± 12.4% (Group II), 58.4 ± 10.7% (Group III), and 61.3 ± 11.2% (Group IV). Group IV was superior to all other groups regarding ankle contracture (P < .05) and electrophysiology (P < .001). Skin graft rejection occurred in 41 and 0% (Groups III and IV, respectively). CONCLUSIONS: FK506 significantly enhanced motor recovery after allograft reconstruction. This effect was comparable between combination treatment (low-dose FK506 and MMF) and triple therapy (high-dose FK506 and MMF plus prednisolone). However, triple therapy was more effective in suppressing skin rejection.

Modified anterolateral approach for internal fixation of Holstein-Lewis humeral shaft fractures.

BACKGROUND: The authors modified the anterolateral approach for Holstein-Lewis humeral shaft fractures using a plating technique to achieve sufficient distal fixation by minimal splitting of the brachioradialis muscle to fix the most distal screws. The purpose of this retrospective study was to evaluate the efficacy of our modified anterolateral approach for Holstein-Lewis humeral fractures and document clinical and functional results. MATERIALS AND METHODS: Between 2008 and 2014, 18 patients (mean age 35.4 years) with a Holstein-Lewis humeral shaft fracture who underwent open reduction and internal fixation with a plate and screws using the modified anterolateral approach and followed for a minimum of 12 months were included. Radiologic fracture configurations, number of distal cortical fixations, union rate, and time to union were analyzed. Clinical outcomes were evaluated using the Mayo elbow performance index system, range of elbow motion, and postoperative complications. RESULTS: Mean fracture length was 60.2 ± 10.2 mm (range 49.2-77.2) and mean distal cortical length was 41.4 ± 7.04 mm (range 22.8-59.6). Distal fragments were fixed at a minimum of six cortical points (range 6-8) in all cases using the modified anterolateral approach. Average time to union was 10.5 weeks (range 8-12 weeks). All cases of radial nerve palsy completely recovered within 3 months. Mean elbow range of motion at final follow-up was 3.2 degrees of flexion contracture (range 0-10) and 135.4 degrees of further flexion (range 120-140), and the average Mayo elbow performance score was 96.3 points (range 90-100). There were no non-union or metal failures. CONCLUSIONS: The results obtained indicate that the modified anterolateral approach is a safe and easy accessible method that provides sufficient distal osseous fixation for Holstein-Lewis humeral shaft fractures without serious complications. The modified anterolateral approach for plate osteosynthesis appears to be one of the most available options for the treatment of Holstein-Lewis humeral fractures. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Posterior dislocation following revision total knee replacement arthroplasty: a case report and literature analysis.

Knee dislocation following total knee replacement arthroplasty is a rare but serious complication. The incidence of dislocation following primary total knee arthroplasty with posterior stabilized implants ranges from 0.15 to 0.5%, and posterior dislocation after revision total knee arthroplasty is even rarer. Here, we report the case of a 76-year-old male who presented with posterior dislocation after posterior stabilized revision total knee arthroplasty.

Topographical Anatomy of the Distal Ulna Attachment of the Radioulnar Ligament.

PURPOSE: The deep component of the distal radioulnar ligament provides translational stability and rotational guidance to the forearm. However, controversy exists regarding the importance of this structure as well as the nature of its attachment to the distal ulna. We aimed to evaluate the topographic anatomy of the distal ulna attachment of both the superficial and the deep components of the radioulnar ligament and to assess the relationship between its internal and its external morphometry. METHODS: Thirteen human distal ulnae attached by ulnar part of the distal radioulnar ligament were scanned using micro-computed tomography and reconstructed in 3 dimensions. In addition, the distal radioulnar ligaments were examined under polarized light microscopy to determine the histological characteristics of collagen contained within the ligaments. RESULTS: The deep limbs have broad marginal insertions at the fovea, whereas the superficial limbs have a circular and condensed insertion to the ulnar styloid. The center of the deep limb was separated from the base of the ulnar styloid by a mean of 2.0 ± 0.76 mm, and this distance was positively correlated with the width of the ulnar styloid. The mean distance between the center of the ulnar head and the center of the fovea was 2.4 ± 0.58 mm. The proportion of collagen type I was lower in the deep limb than in the superficial limb. CONCLUSIONS: This new observation of the footprint of the radioulnar ligament in the distal ulna indicates that the deep limb may serve as an internal capsular ligament of the distal radioulnar joint, whereas the superficial limb as the external ligament. CLINICAL RELEVANCE: Knowledge of the topographic anatomy of the radioulnar ligament's attachment to the distal ulna may provide a better understanding of distal radioulnar ligament-related pathologies.

Compliment Graphene Oxide Coating on Silk Fiber Surface via Electrostatic Force for Capacitive Humidity Sensor Applications.

Cylindrical silk fiber (SF) was coated with Graphene oxide (GO) for capacitive humidity sensor applications. Negatively charged GO in the solution was attracted to the positively charged SF surface via electrostatic force without any help from adhesive intermediates. The magnitude of the positively charged SF surface was controlled through the static electricity charges created on the SF surface. The GO coating ability on the SF improved as the SF's positive charge increased. The GO-coated SFs at various conditions were characterized using an optical microscope, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), Raman spectroscopy, and LCR meter. Unlike the intact SF, the GO-coated SF showed clear response-recovery behavior and well-behaved repeatability when it was exposed to 20% relative humidity (RH) and 90% RH alternatively in a capacitive mode. This approach allows humidity sensors to take advantage of GO's excellent sensing properties and SF's flexibility, expediting the production of flexible, low power consumption devices at relatively low costs.

The Outcomes of Arthroscopic Repair Versus Debridement for Chronic Unstable Triangular Fibrocartilage Complex Tears in Patients Undergoing Ulnar-Shortening Osteotomy.

PURPOSE: The aim of this study was to compare the results of arthroscopic peripheral repair (AR) and arthroscopic debridement (AD) for the treatment of chronic unstable triangular fibrocartilage complex (TFCC) tears in ulnar-positive patients undergoing ulnar-shortening osteotomy (USO). METHODS: A total of 31 patients who underwent arthroscopic treatments combined with USO for unstable TFCC tears and were followed-up at a minimum of 24 months were included in this retrospective cohort study. Fifteen patients were treated with AR, and 16 patients were treated with AD while at the same time undergoing a USO. Outcome measures included wrist range of motion, grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores, and overall outcomes according to the modified Mayo wrist scoring system. In addition, a stress test to assess distal radioulnar joint (DRUJ) stability was performed before and after surgery to compare the 2 cohorts. RESULTS: Both respective cohorts showed significant improvements in grip strength and subjective scores at the final follow-up. Grip strength, DASH, and PRWE scores were better in the AR group than in the AD group. The recovery rate from DRUJ instability observed during the preoperative examination was superior in the AR group. CONCLUSIONS: Both AD and AR of the TFCC combined with USO are reliable procedures with satisfactory clinical outcomes for unstable TFCC tears in ulnar-positive patients. However, AR of the TFCC is suggested if DRUJ stability is concomitantly compromised. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Fatigue Stress Fracture of the Talar Body: An Uncommon Cause of Ankle Pain.

Fatigue stress fractures of the talus are rare and usually involve the head of the talus in military recruits. We report an uncommon cause of ankle pain due to a fatigue stress fracture of the body of the talus in a 32-year-old male social soccer player. Healing was achieved after weightbearing suppression for 6 weeks. Although rare, a stress fracture of the body of the talus should be considered in an athlete with a gradual onset of chronic ankle pain. Magnetic resonance imaging and bone scan are useful tools for early diagnosis.

Sonographic Quantification of Pronator Quadratus Activity During Gripping Effort.

OBJECTIVES: The aim of this study was to obtain quantitative data related to the activity of each head of the pronator quadratus based on dynamic sonographic parameters during gripping effort and to assess their relationships with grip and pronation strengths. METHODS: The forearms of 33 healthy volunteers were evaluated at 5 positions of axial rotation (full supination, 45° supination, neutral, 45° pronation, and full pronation). Echogenic intensity ratios and muscle thicknesses of each head of the pronator quadratus were measured from transverse cross-sectional sonograms obtained during maximal grip and release. Grip strengths and maximal isokinetic pronation torques at 90°/s and 360°/s were evaluated as strength parameters and correlated with sonographic measures. RESULTS: Echogenic intensity ratios of both heads significantly decreased during power grip (P ≤ .002). Changes in echogenic intensity ratios of the superficial head were greater when the forearm was pronated compared to supination (P < .001), whereas changes in echogenic intensity ratios of the deep head were constant at all forearm positions. Muscle thicknesses of the superficial head maximally increased at the neutral position during power grip (P < .001), whereas muscle thicknesses of the deep head did not change. There were significant negative correlations between grip strength and echogenic intensity ratios of both heads at all respective forearm positions (P ≤ .048). Pronation torque was significantly correlated with echogenic intensity ratios of the superficial head at all forearm positions and the deep head at 45° and full pronation positions (P ≤ .034). CONCLUSIONS: The data revealed that the superficial head of the pronator quadratus more actively contracts when the forearm is in pronation, whereas the deep head constantly contracts at all positions. This study suggests that both heads of the pronator quadratus also play a role in grip strength, but the superficial head contributes more to pronation strength.

Arthroscopic management of chronic unstable scaphoid nonunions: effects on restoration of carpal alignment and recovery of wrist function.

PURPOSE: The purpose of this study was to assess the effects of arthroscopically assisted reduction and osteosynthesis on restoration of carpal alignment and recovery of clinical wrist function in patients with unstable scaphoid nonunion. METHODS: Thirty-six patients who underwent arthroscopically assisted osteosynthesis with or without bone grafting for unstable scaphoid nonunion between July 2006 and January 2012 were enrolled. The average time from injury to surgery was 51 ± 78.3 months. Radiographic and clinical evaluations were assessed on preoperative and postoperative days, and follow-up evaluation took place at a minimum of 24 months. RESULTS: Union was achieved in 86% (31 of 36) of patients at a mean of 11 ± 2.7 weeks. Scaphoid axial length (SAL), lateral intrascaphoid angle (ISA), scapholunate angle (SLA), and reversed carpal height ratio (CHR) was significantly improved after surgery, and those correction ratios averaged 66% ± 46.8%, 74% ± 58.2%, 81% ± 59.8%%, and 94% ± 46%, respectively. The range of wrist motion was unchanged after surgery, but the grip strength improved from 74% ± 22.1% preoperatively to 89% ± 13.7% postoperatively compared with the contralateral side (P = .042). Mean Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Related Wrist Evaluation (PRWE) scores improved significantly (P < .001) from 44 and 51 preoperatively to 13 and 23 postoperatively, respectively. The radiological parameters of the scaphoid and carpal alignment in patients who achieved bony union did not correlate with clinical wrist function. CONCLUSIONS: Arthroscopic reduction and osteosynthesis of chronic unstable scaphoid nonunion is limited for restoration of normal carpal alignment but has positive effects on the recovery of clinical wrist function. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

A rare case of bilateral proximal femoral insufficiency fractures after interlocking IM nailing for bilateral atypical femoral shaft fractures.

Atypical femoral fractures have unique radiologic and clinical feature. Most commonly used fixation method for atypical femoral fracture is interlocking intramedullary (IM) nailing. The aim of this paper is to document a rare case of a 76-year-old female who sustained bilateral proximal femoral insufficiency fractures after conventional interlocking IM nailing for bilateral atypical femoral shaft fractures without taking history of bisphosphonates. We recommend the routine use of full-length reconstruction or cephalomedullary-type interlocking IM nail for atypical femoral fractures.

Restoration of the central slip in congenital form of boutonniere deformity: case report.

We present a case of a congenital form of a boutonniere deformity involving both little fingers with a poorly differentiated extensor mechanism and the absence of the tendinous attachment on the dorsal aspect of the middle phalanx. This complex deformity was evaluated histologically followed by successful reconstruction of the central slip.

Porous Carbon Interlayer Derived from Traditional Korean Paper for Li-S Batteries.

A carbonized interlayer effectively helps to improve the electrochemical performance of lithium-sulfur (Li-S) batteries. In this study, a simple and inexpensive carbon intermediate layer was fabricated using a traditional Korean paper called "hanji". This carbon interlayer has a fibrous porous structure, with a specific surface area of 91.82 m2 g-1 and a BJH adsorption average pore diameter of 26.63 nm. The prepared carbon interlayer was utilized as an intermediary layer in Li-S batteries to decrease the charge-transfer resistance and capture dissolved lithium polysulfides. The porous fiber-shaped carbon interlayer suppressed the migration of polysulfides produced during the electrochemical process. The carbon interlayer facilitates the adsorption of soluble lithium polysulfides, allowing for their re-utilization in subsequent cycles. Additionally, the carbon interlayer significantly reduces the polarization of the cell. This simple strategy results in a significant improvement in cycle performance. Consequently, the discharge capacity at 0.5 C after 150 cycles was confirmed to have improved by more than twofold, reaching 230 mAh g-1 for cells without the interlayer and 583 mAh g-1 for cells with the interlayer. This study demonstrates a simple method for improving the capacity of Li-S batteries by integrating a functional carbon interlayer.

Impact of COVID-19 Pandemic Restrictions on Respiratory Virus Patterns: Insights from RSV Surveillance in Gwangju, South Korea.

The social restriction measures implemented due to the COVID-19 pandemic have impacted the pattern of occurrences of respiratory viruses. According to surveillance results in the Gwangju region of South Korea, respiratory syncytial virus (RSV) did not occur during the 2020/2021 season. However, there was a delayed resurgence in the 2021/2022 season, peaking until January 2022. To analyze this, a total of 474 RSV positive samples were investigated before and after the COVID-19 pandemic. Among them, 73 samples were selected for whole-genome sequencing. The incidence rate of RSV in the 2021/2022 season after COVID-19 was found to be approximately three-fold higher compared to before the pandemic, with a significant increase observed in the age group from under 2 years old to under 5 years old. Phylogenetic analysis revealed that, for RSV-A, whereas four lineages were observed before COVID-19, only the A.D.3.1 lineage was observed during the 2021/2022 season post-pandemic. Additionally, during the 2022/2023 season, the A.D.1, A.D.3, and A.D.3.1 lineages co-circulated. For RSV-B, while the B.D.4.1.1 lineage existed before COVID-19, both the B.D.4.1.1 and B.D.E.1 lineages circulated after the pandemic. Although atypical RSV occurrences were not due to new lineages, there was an increase in the frequency of mutations in the F protein of RSV after COVID-19. These findings highlight the need to continue monitoring changes in RSV occurrence patterns in the aftermath of the COVID-19 pandemic to develop and manage strategies in response.

Highly visible-light-active sulfur and carbon co-doped TiO2 (SC-TiO2) heterogeneous photocatalysts prepared by underwater discharge plasma.

To promptly and simply create highly crystalline S/C co-doped TiO2 (SC-TiO2) photocatalysts at room temperature and atmospheric pressure, we suggest a novel plasma-assisted sol-gel synthesis method. This method is a simultaneous synthetic process, in which an underwater plasma undergoes continuous reactions to generate high-energy atomic and molecular species that enable TiO2 to achieve crystallinity, a large surface area, and a heterogeneous structure within a few minutes. In particular, it was demonstrated that the heterogeneously structured TiO2 was formed by doping that sulfur and carbon replace O or Ti atoms in the TiO2 lattice depending on the composition of the synthesis solution during underwater plasma treatment. The resultant SC-TiO2 photocatalysts had narrowed bandgap energies and extended optical absorption scope into the visible range by inducing the intermediate states within bandgap due to generation of oxygen vacancies on the surface of TiO2 through synthesis, crystallization, and doping. Correspondingly, SC-TiO2 showed a significant degradation efficiency ([k] = 6.91 h-1) of tetracycline (TC, antibiotics) under solar light irradiation, up to approximately 4 times higher compared to commercial TiO2 ([k] = 1.68 h-1), resulting in great water purification. Therefore, we anticipate that this underwater discharge plasma system will prove to be an advantageous technique for producing heterostructural TiO2 photocatalysts with superior photocatalytic efficiency for environmental applications.

Arthroscopic excision of dorsal wrist ganglion: factors related to recurrence and postoperative residual pain.

PURPOSE: The purpose of this study was to assess the recurrence rate and postoperative residual pain rate after arthroscopic excision of dorsal wrist ganglia and the risk factors for recurrence and residual pain. METHODS: A total of 115 wrists (111 patients: 57 men, 54 women; average age 34 years; range, 9 to 72 years) treated with arthroscopic excision for wrist dorsal ganglia between April 2005 and December 2009 were enrolled. The follow-up averaged 32 months (range, 12 to 67 months). Demographic data and operative details, including the presence of a ganglion stalk, were retrospectively reviewed and tested against recurrence and residual pain at final follow-up. RESULTS: The recurrence rate of dorsal wrist ganglia after arthroscopic excision was 11% (13 of 115 wrists). Recurrence was on the dominant side in 12 of 13 (91%) patients, which was the most important risk factor for recurrence (odds ratio [OR], 8.0; 95% confidence interval [CI], 0.94 to 68.49), followed by female sex (OR, 4.9; 95% CI, 0.84 to 28.39) and age 24 years or younger (OR, 3.1; 95% CI, 0.75 to 12.74). Twenty-seven wrists (23%) had postoperative residual pain at final follow-up. The results of logistic regression showed that pain before surgery was the most important risk factor for residual pain after surgery (OR, 4.9; 95% CI, 1.36 to 18.3), followed by female sex (OR, 3.2; 95% CI, 1.22 to 8.53). CONCLUSIONS: Dominant side, female sex, and age of 24 years or younger are considered to be the most influential risk factors for recurrence after arthroscopic excision of dorsal wrist ganglia. However, the presence or absence of the cyst stalk was not a significant factor for recurrence. Female patients who have preoperative pain around the dorsal wrist ganglia were most likely to experience residual pain after surgery. LEVEL OF EVIDENCE: Level IV, therapeutic case series.