Endoscopic Ganglionectomy of the Extensor Digitorum Longus Tendon: An Extraganglionic Approach

Ganglion is the most common soft tissue mass in the foot and can be painful and affect comfort wearing shoes. The usual treatment of a ganglion is conservative: careful neglect, manual rupture, or aspiration. When the lesion is recurrent or painful, surgical excision is recommended. The purpose of this Technical Note is to describe the extraganglionic approach of endoscopic ganglionectomy of the extensor digitorum longus tendon. This surgery has the advantage of being minimally invasive and having better cosmetic result, with less surgical trauma to the soft tissue. Level of Evidence Level 1: foot and ankle; Level 2: other (ganglion).
Technique Video Video 1 Endoscopic ganglionectomy of the extensor digitorum longus tendon of the right foot: an extraganglionic approach. The patient is in a supine position. The distal portal is the viewing portal, and the superficial wall of the ganglion is fenestrated with an arthroscopic shaver, and the mucinous content of the ganglion is drained. The proximal part of the ganglion is then resected with the shaver with caution to preserve the extensor digitorum longus tendon and the extensor digitorum brevis muscle. After that, the arthroscope is switched to the proximal portal, and the distal part of the ganglion is resected by the shaver via the distal portal. After the procedure, the portal incisions are closed with simple dressing, and the compression dressing is applied.