Risk Factors Influencing Recurrence Rates Following Open Excision of Wrist Ganglion Cysts: A Retrospective Cohort Study

Objectives: Ganglion cysts are the most common benign masses of the hand and wrist, frequently requiring surgical intervention due to symptoms such as pain, weakness, or aesthetic concerns. Open excision is a widely used method with varying recurrence rates reported in the literature. However, risk factors contributing to recurrence remain incompletely understood. Our study aims to evaluate the recurrence rates following open excision of wrist ganglion cysts and identify patient-related and surgical factors influencing recurrence.
Methods: Patients who underwent wrist ganglion excision between 2012 and 2024 were identified using the National Healthcare Implementation Communique code 611650. Exclusion criteria included cases without ganglion pathology confirmation, follow-up of less than one year, volar cysts, multiple cysts, first-time surgery for recurrence at the institution, incomplete medical records, and arthroscopic excision. Recurrence rates were calculated, and patient demographics, cyst characteristics, and surgical variables were recorded. Surgical experience was defined as years worked as an orthopedic surgeon. Cyst volume was measured using Magnetic Resonance Imaging data.
Results: A total of 109 patients with dorsal wrist ganglion cysts who underwent surgical excision were retrospectively reviewed. The overall recurrence rate is 11.9%. Ganglion cysts are more commonly observed in women and laborers. Surgical experience and the use of a tourniquet were found to be associated with recurrence (p<0.001 and p=0.019, respectively). Correlation analysis revealed no significant correlation between recurrence and age, follow-up duration, or cyst volume. According to the multivariate regression analysis, the most significant risk factors for recurrence are tourniquet use and surgical experience.
Conclusion: The use of a tourniquet and high surgical experience reduce the recurrence rate after open excision of ganglion cysts.

Keywords: Ganglion, recurrence, risk factor, tourniquet