Healing of arthroscopic portals: a randomised trial comparing three methods of portal closure

We carried out a single blind, randomised trial in which we examined the healing of portal wounds treated by three techniques: suturing, approximating the edges of the wound with sterile adhesive tapes (steristrips) or covering them with a simple sterile dressing. The study included patients who underwent arthroscopy of the knee joint, either for diagnostic purposes or for small therapeutic procedures. All patients were admitted as day cases. Outcome measures adopted were level of pain at the portal site, redness, swelling and cosmesis. The power of the study was designed to detect 10% difference with 95% confidence and p < 0.05. A total of 160 patients with an average age of 40 years were studied : 45 patients had their wounds covered with simple sterile dressing, 52 had steristrips, and 63 had sutures on the portals. The total numbers of portals were 380. No patient was lost to follow-up. There was significant difference between the three groups with regards to post operative swelling and redness : 29% patients in the suture group had swelling as compared to around 11% in the two other groups (p = 0.02); 37% patients in the suture group and 23% patients in the steristrips group developed redness while only 9% patients in the simple dressing group had redness at 4 weeks (p = 0.004). Patients in the suture group experienced more pain as measured by visual analogue scale; however there was no statistically significant difference (p = 0.37) in the number of patients who had pain. All patients in the steristrips and simple dressing group were satisfied cosmetically; 8% in the suture group were not. There were no major complications. The present study shows that suturing the portals has no additional advantage. There is little to choose between the other two methods and treating these wounds with either simple dressing or steristrips is easy and causes less discomfort to the patient.