Title : A systematic review of management of trochanteric neck of femur fractures and the impact of emerging research and guidelines on considerations for surgery
Background: Previous studies have demonstrated that debridement of meniscal tears in the paediatric population leads to poorer long-term outcomes than primary arthroscopic repair, which has led to a shift in the management of these injuries. This study aims to evaluate the current practice in management of paediatric meniscal tears in a UK major trauma centre.
Methods: We performed a retrospective review of consecutive paediatric patients (aged <18 years) with traumatic meniscal tears between 2018 and 2020. Patients’ clinical notes (digital and paper) were reviewed and the following were extracted: Operation performed (arthroscopic debridement vs repair), performing surgeon Orthopaedic subspecialty (adult or paediatric), intra-operative images (where available), healthcare resource group code allocated to procedure, non-traumatic or saucerisation of discoid meniscus were excluded.
Results: 26 cases were included, 65% male, 35% female, median age of 15 years (13-16). 8 cases were performed by a paediatric specialist: 18 by an adult knee surgeon. 62% of cases were meniscal debridement compared to 38% repaired. Comparing orthopaedic specialty, paediatric surgeons performed meniscal repair in 25% (n=2) of their cases, compared to 44% (n=8) of cases performed by adult surgeons. One case had incorrect HRG coding, resulting in a loss of £973 to the department.
Conclusion: Surgical management for paediatric meniscal tears was predominantly performed by debridement (62%) compared to repair (38%). Heterogeneity of cases and poor arthroscopic images limited assessment of whether debridement was performed due to lack of skill set or due to meniscal tears that were not amenable to repair. Standardisation of arthroscopic images is recommended to allow classification of tears.