Outcome of meniscal repairs in paediatric population:A tertiary centre experience

BACKGROUND Meniscal sparing surgery is a widely utilised treatment option for unstable meniscal tears with the aim of minimising the risk of progression towards osteoarthritis.However,there is limited data in the literature on meniscal repair outcomes in skeletally immature patients.AIM To evaluate the re-operation rate and functional outcomes of meniscal repairs in children and adolescents.METHODS We performed a retrospective review of all patients who underwent arthroscopic meniscal repair surgery between January 2007 and January 2018.All patients were under the age of 18 at the time of surgery.Procedures were all performed by a single surgeon.Information was gathered from our hospital Electronic Patient Records system.The primary outcome measure was re-operation rate(need for further surgery on the same meniscus).Secondary outcome measures were surgical complications and patient reported outcome measures that were International Knee Documentation Committee(IKDC),Tegner and Lysholm scores.RESULTS We identified 59 patients who underwent 66 All-inside meniscal repairs(32 medial meniscus and 34 Lateral meniscus).Meniscal repairs were performed utilizing FasT-Fix(Smith and Nephew)implants.There were 37 males and 22 females with an average age of 14 years(range 6-16).The average follow-up time was 53 months(range 26-140).Six patients had concomitant anterior cruciate ligament reconstruction surgery along with the meniscal repair.There were no requiring further meniscal repairs and 9 patients underwent partial meniscectomies.The mean postoperative IKDC score was 88(44-100),Tegner score was 7(2-10)and Lysholm score was 94(57-100).CONCLUSION Our results showed that arthroscopic repair of meniscal tears in the paediatric population is an effective treatment option that has a low failure rate and good postoperative clinical with the advantage of preserving meniscal tissues.

Randomised controlled trial of triclosan coated vs uncoated sutures in primary hip and knee arthroplasty

BACKGROUND Triclosan-coated vicryl plus suture(Ethicon, Inc.) was developed to reduce microbial colonisation during surgical procedures. However, its effect on wound healing and surgical site infections remain unclear after hip and knee arthroplasty surgery.AIM To determine the effect of triclosan-coated sutures(TCS) vs non-coated sutures on wound healing, following primary hip and knee arthroplasties.METHODS A single-centred, double-blind randomised controlled trial(RCT) was undertaken. We randomly allocated patients to receive either the triclosan-coated sutures(TCS vicryl plus) or non-coated sutures(NCS vicryl) during the closure of unilateral primary hip and knee arthroplasties. We utilised the ASEPSIS wound scoring system to evaluate wound healing for the first 6 weeks post-operatively.RESULTS One hundred and fifty patients undergoing primary total hip or knee arthroplasty over a one-year period were included. Eighty-one were randomised to the TCS group and 69 to the NCS group. Despite no statistically significant difference in the ASEPSIS scores among the study groups(P = 0.75), sensitivity analysis using the Mann Whitney test(P = 0.036) as well as assessment of the wound complications at 6 weeks follow up, demonstrated significantly higher wound complication rates in the TCS group(8 vs 1, P = 0.03).CONCLUSION No clear advantage was demonstrated for using the TCS. However, larger multicentred RCTs are required to validate their use in hip and knee arthroplasty surgery.