Recurrence Mechanisms and Pr eventive Strategies for Wrist Ganglion Cysts

Abstract

Wrist ganglion cysts are one of the most prevalent benign cystic lesions of the hand, with high recurrence rates posing a significant clinical challenge. Research indicates that recurrence is frequently linked to incomplete excision of the cyst pedicle, untreated one-way valve mechanisms connecting to the joint cavity, and abnormalities in local joint fluid dynamics, such as increased intra-articular pressure. Additionally, histological changes, including abnormal fibroblast proliferation and excessive hyaluronic acid accumulation, are also critical factors contributing to recurrence. Although aspiration is minimally invasive and well-tolerated by patients, it carries a high recurrence rate. In contrast, open and arthroscopic excision allow for better identification and removal of the cyst pedicle, yet recurrence rates still range from approximately 10% to 30%.In recent years, imaging has played an increasingly important role in preoperative planning. High-resolution MRI and ultrasound can enable surgeons identify the origin of the cyst pedicle. Minimally invasive alternatives such as platelet-rich plasma (PRP) injection and needle fenestration have demonstrated high safety and low recurrence potential. Moreover, arthroscopic excision under direct visualization, combined with local thermal ablation or tissue barrier repair, has been shown to further reduce recurrence. Postoperative management, particularly the balance between immobilization duration and early functional rehabilitation, is also critical in minimizing recurrence. This review aims to systematically summarize the recurrence mechanisms and major treatment strategies for wrist ganglion cysts and to explore the clinical prospects of emerging therapeutic interventions.