Predictors of recurrence after open excision of wrist ganglion cysts: an MRI-based and clinical analysis

TL;DR

This study identifies factors like dominant-hand involvement and cyst-to-joint distance that predict recurrence after wrist ganglion cyst surgery.

Contribution

The study introduces MRI-based and clinical predictors for recurrence after wrist ganglion cyst excision.

Findings

Dominant-hand involvement increases recurrence risk (OR = 6.51).

Shorter cyst-to-joint distance is associated with higher recurrence rates (OR = 0.59 per mm increase).

Overall recurrence rate was 8.6% after 24 months of follow-up.

Abstract

Wrist ganglion cysts (GCs) are the most common soft-tissue masses of the hand and wrist. Although surgical excision is considered the most effective treatment, recurrence remains a clinical concern. Anatomical and demographic predictors of postoperative recurrence are not well established.

We included 347 patients who underwent surgical excision of wrist GCs between 2015 and 2023, with a minimum follow-up of 24 months. Clinical data (age, sex, side, hand dominance) and magnetic resonance imaging (MRI)–based topographic features (volume, surface area, wall thickness, location, longest and shortest diameters, aspect ratio, and distance to the adjacent joint) were recorded retrospectively. The primary outcome was cyst recurrence at a minimum follow-up of 24 months, defined as clinically or radiologically confirmed return of the cyst. Statistical analyses included chi-square tests, t-tests or Mann–Whitney U tests, and univariable and multivariable logistic regression analyses. All analyses were performed in the Python (Google Colab) environment using the pandas, NumPy, SciPy, and statsmodels libraries.

The overall recurrence rate at a minimum follow-up of 24 months was 8.6% (30 of 347). Dominant-hand involvement was significantly associated with recurrence (χ² p = 0.006). In age-adjusted logistic regression, dominant-hand involvement increased the risk (OR = 6.51; 95% CI, 1.87–22.63; p = 0.003). Cyst distance to the adjacent joint was significantly shorter in recurrent cases (mean 7.6 mm vs. 8.1 mm; t-test p = 0.001, Mann–Whitney U p = 0.021). Based on age-adjusted logistic regression, each additional millimeter of cyst-to-joint distance conferred a 41% relative reduction in recurrence risk (OR = 0.59; 95% CI, 0.39–0.90; p = 0.013).

MRI-based evaluation of cyst-to-joint distance and consideration of dominant-hand involvement may help identify patients at increased risk of recurrence after surgical excision of wrist GCs. Incorporating these factors into preoperative planning may optimize surgical strategy, guide follow-up, and improve patient counseling.

The online version contains supplementary material available at 10.1186/s12893-026-03562-3.

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