A Scoping Review Regarding the Treatment of Foot and Ankle Ganglia

CATEGORY: Other INTRODUCTION/PURPOSE: Ganglion cysts are a well documented phenomena occurring in a variety of joints. They are described as a tumour like lesion filled with mucopolysaccharides. The majority occur in the hand and wrist (88%) with a small yet significant minority occurring in the foot and ankle (11%). Currently, there is a lack of high-quality literature regarding the management of ganglia in the foot and ankle region. Therefore this scoping review aims to systematically map and summarise current evidence regarding the management of ganglia of the foot and ankle, whilst identifying areas for further research. METHODS: This scoping review follows the methodology outlined by Arksey and O'Malley, Levac, the Joanna Briggs Institute and PRISMA framework.. A detailed search strategy was used to identify relevant articles using free text terms such as 'foot' 'ankle' 'ganglion' 'ganglia' 'ganglionic cyst'. This was carried out in four electronic databases; PubMed, EMBASE, CINAHL and Ovid MEDLINE. A stage two-stage independent screening process based and title and/or abstract then full-text was carried our by two reviewers. The a-priori selection criteria included all primary research (observational studies and randomised control trials) whilst excluding (case reports, letters to editors, editorials, commentaries and review articles). Studies that did not separate the treatment of foot and ankle tumours from ganglia were excluded. The MINORS criteria were used to assess methodological quality of included studies. RESULTS: In total, 2286 unique articles were initially identified, from which 11 met the criteria for inclusion. A variety of conservative and surgical treatment strategies were reported. The use of surgical excision was reported in all 11 studies, ten of which via an open surgical approach, with only one study using an endoscopic approach. The use of conservative treatments, involving aspiration and/or steroid injection, were reported in only 5 studies. As for the recurrence rate, 7 studies reported a rate of 5.7% - 65.7%, with an overall pooled recurrence rate of 30.6%. Pooled recurrence rates showed that surgical excisions were associated with a lower recurrence rate than conservative treatments. Complications other than occurrence were described in 6 studies. Only 3 studies performed an analysis of outcomes based on the location or site of origin of ganglia. CONCLUSION: The current literature regarding the treatment of foot and ankle ganglia is of a low-quality, as the articles included in this scoping review are level III or IV cohort or case series design. The literature alludes to the idea that a surgical approach provides greater efficacy than a conservative approach. There is also limited evidence to suggest that factors such as the origin or location of ganglia may affect treatment outcomes. Alternative approaches utilised in the treatment of wrist ganglia are yet to be investigated. Further research is required before more definitive conclusions into any such associations may be drawn.