Abstract：Objective：To observe the clinical effect of small needle knife combined with cross suture ligation for tendon sheath cyst. Methods：A total of 96 cases of patients with tendon sheath cyst were randomly divided into three groups，with 32 cases in each group. Group A was treated with small needle knife combined with cross suture ligation； Group B was treated with cyst aspiration and hormone blockade；Group C was treated with operation. Pain scores in Visual Analogue Scale (VAS)， clinical effects， recurrence rates， infection rates and hospitalization expenses among the three groups were compared. Results：One day after treatment，the VAS pain scores in Group A and Group B were lower than that in Group C (P＜0.01)；there was no significant difference being found in the comparison of VAS pain scores between Group A and Group B(P＞0.05). One week after treatment， VAS pain scores in Group A and Group B were lower than that in Group C， differences being significant (P＜0.01)；there was no significant difference being found in the comparison of VAS pain scores between Group A and Group B (P＞0.05). One month after treatment，there was no significant difference being found in the comparison of VAS pain scores among the three groups(P＞0.05). One year after treatment，the clinical effect in Group A was better than that in Group B (P＜0.05). The clinical effect in Group A and Group B were similar to that in Group C (P＞0.05). During the follow- up within one year， the recurrence rate in Group A was lower than that in Group B (P＜0.05). The recurrence rate in Goup A and Group B were similar to that in Group C，there being no significance in the difference (P＞0.05). No infection was found in the three groups. During the whole treatment，the hospitalization expense in Group A was lower than those in Group B and Group C (P＜0.01)；the hospitalization expense in Group B was lower than that in Group C (P＜ 0.01). Conclusion：The cure rate of small needle knife combined with cross suture ligation for tendon sheath cyst is similar to that of surgical resection， but there is no locally residual surgical scar， the level of short- term pain is lower， and the treatment cost is much lower than surgical resection. When compared with cyst aspiration combined with hormone blockade， the therapy of small needle knife combined with cross suture ligation can reduce the recurrence rate.