Which technique — arthroscopic surgery (AS) or open surgery (OS) — causes less recurrence, pain and complications in dorsal synovial cyst treatment?

The PubMed, Embase and Cochrane databases were used to search for prospective, retrospective and case series comparing both techniques comparatively or alone. The meta-analysis was calculated using the RevMan software (Review Manager, versão 5.4, The Cochrane Collaboration, 2020).

We included 17 studies involving 3427 patients. 3 studies compared both techniques including 289 patients (110 AS, 179 OS), 3 studies used only OS including 195 patients and 11 studies used only AS including 2943 patients.

When we have used all the studies as our database, exclusive OS studies revealed increased postoperative pain in visual analogue scale (0.99 in OS vs 0.62 in AS) and complications (34.4% in OS vs 14.3% in AS) while greater recurrence was found with AS (10% in AS vs 7% in OS). Also, it is important to reinforce that OS studies treated cysts with greater diameter (1.75cm in OS and 1.37cm in AS).

Regarding comparative studies, it was found that OS was associated with lower recurrence rates and residual pain (P=0.02 and P=0.10, respectively).

OS studies had increased postoperative pain and complications, whereas AS studies had increased recurrence when all the studies served as our database; interestingly, in comparative studies OS had a lower recurrence and pain rates.

The results are controverse in literature when comparing all data available and when comparing just randomizes OS and AS trials; we need more studies/trials comparing AS and OS.