**9. Arthroscopic bone grafting of the intraosseus carpal ganglion cysts**

Intraosseus ganglions (IOG) can affect all carpal bones but mostly they affect the lunate, capitate and scaphoid [45]. In patients who have dorsal wrist ganglions, the prevalence of IOGs is reported to be almost 50% [46]. Most of them are asymptomatic and can be found during the routine radiographs or CT scans because of the different complains. Surgical treatment is recommended for the symptomatic IOGs and include the curettage of the damaged bone and bone grafting.

Arthroscopically assisted treatment of the intraosseus ganglions of the lunate was first described by Ashwood and Bain in 2003 with the aim of reducing the morbidity that has been seen with open techniques [47].

Surgeries can be performed via routine radiocarpal or midcarpal portals – depending of the localization of the ganglion cyst. Usually the ganglion cyst cannot be visualized by arthroscope, because they still remain covered by the articular cartilage. The location of the drill hole has to be determined by the preoperative radiographic investigations. Once the ganglion is removed with the arthroscopic cutter and the hole is debrided with curette and shaver, it can be filled with bone grafts from the distal radius or iliac crest, which can be harvested via small incision and then delivered into the bone through a trocar under the arthroscopic visualization (**Figure 22**).

**Figure 22.**

*Arthroscopic debridement of the scaphoid cyst, a – defect of the bone after debridement, b – defect closed with autologous bone graft (ABG).*

Aftetreatment includes immobilization for 10 to 14 days and patients are advised not to return to light duties until 6 weeks after the surgery, and heavy manual labor is avoided for a minimum of three months [18].
