No differences in healing among different closure methods of arthroscopic portals: a systematic review

Background During arthroscopy the small skin incisions made over the joints are called arthroscopy portals. There are different methods described for arthroscopic portal closure. Very few randomised controlled trials and no systematic reviews have compared the methods of arthroscopic portal closure, and there are no clear guidelines recommending any one closure method. There is therefore a need for a systematic review that provides high-quality evidence to help surgeons choose the appropriate arthroscopic portal closure technique. Objective To undertake a systematic review to ascertain the outcome with three different closure methods for arthroscopic portals: (1) suturing; (2) application of sterile adhesive tapes; and (3) leaving wounds open covered with a dressing. Methods Randomised controlled trials comparing the closure methods of arthroscopic portals were selected using strict search criteria from electronic databases (MEDLINE, EMBASE, CINAHL, BNI and Cochrane Library) and trial registers. Two independent authors conducted the study selection, data extraction and quality assessment of each study. Quality appraisal was done using the Cochrane Collaboration risk of bias tool. Three studies were eligible for inclusion and a narrative synthesis of the findings is provided. Results One study did not show a statistically significant difference between suturing and leaving the wound open with a dressing. However, two studies found that leaving wounds open covered with a dressing had a significantly better outcome. In one of these studies, sterile adhesive tapes were used and the outcomes were better than with suturing but not so good as leaving the wounds open covered with a dressing. Conclusion Suturing of arthroscopic portal wounds confers no benefit over leaving them open covered with a simple dressing or applying sterile adhesive tapes. Meta-analysis was not performed, so a full estimate of effect size cannot be derived from this review. Managing arthroscopic portals by leaving them open covered with a dressing or by applying tissue adhesive tape can be safe alternative techniques to suturing. There is a need for randomised controlled trials with a larger sample size representing different populations in a number of centres with better methodological quality and outcome measures. Level of evidence Level 1 Systematic review of Randomised Control Trials (Level I studies).