Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft and Bioresorbable Interference Screws

Abstract

Material and Method: Bioresorbable and biostable interference screws in operative reconstruction of anterior cruciate ligament (ACL) ruptures were compared concerning safety and efficacy. The randomized prospective clinical study consisted of 2 groups with 15 patients each, admitted at our center with acute (< 8 weeks) traumatic loss of ACL-stability. The ACLreconstruction was performed in open technique using a bone-patellar tendon-bone autograft and fixation with bioresorbable (study group) or titanium (control group) interference screws. Results: Employing a special questionnaire patients' satisfaction was recorded. Functional results were scored using clinical examination and the Lachman test under sonographic control. Foreign-body reactions against the implants were assessed by clinical examinations and on radiographs. The follow-up of all patients was at least for 2 years. Ligament stability of the knee joint, operative and postoperative complication rate did not significantly differ between the two groups. 14 patients of the study group and 13 patients of the control group were completely satisfied. One patient of the study group was dissatisfied because of developing an infection. Conclusion:The results using bioresorbable interference screws in ACL-reconstruction are identic to those employing standard titanium implants. Differences in rates of operative and postoperative complications were not statistically significant. The advantages of the bioresorbable implants include the absence of urgent implant removal in case of secondary ACL-reconstruction procedures and undisturbed MRI and CT scans postoperatively.

Comparison of Bioabsorbable and Metallic Interference Screws for Graft Fixation During ACL Reconstruction: A Meta-analysis of Randomized Controlled Trials

“…All studies reported level 1 or 2 evidence and were published between 1999 and 2020. Two studies were performed in the United States, 18,27 2 in Australia, 29,36 3 in Finland, 15,16,28 and 1 each in Austria, 9 Germany, 14 India, 13 Japan, 20 the Netherlands, 2 Norway, 7 and Sweden. 24 Seven studies involved hamstring autografts, 13,15,16,24,28,29,36 6 involved bone-patellar tendon-bone autografts, 2,7,9,14,18,20 and 1 study 27 involved autografts and allografts.…”

“…24 Seven studies involved hamstring autografts, 13,15,16,24,28,29,36 6 involved bone-patellar tendon-bone autografts, 2,7,9,14,18,20 and 1 study 27 involved autografts and allografts. Six studies involved bioabsorbable screws made of PLLA 7,14,18,20,24,27 ; 2 studies each involved screws of PLLA-HA, 29,36 PGA/ TMC, 2,9 or PLLA/TMC/PDLA 16,28 ; and 1 study 15 screws of PLLA/TMC. One study 13 did not mention the composition of its bioabsorbable screws.…”

“…Twelve studies k reported data on adverse complications, of which 5 studies 2,14,18,27,36 reported data on joint effusion, 6 studies 2,9,14,18,24,27 reported data on deep or superficial infection, and 9 studies 2,7,14-16,24,27-29 reported data on graft rupture. Across all 12 studies, data on complications did not show significant heterogeneity (I 2 ¼ 0%; P ¼ .72), and bioabsorbable screws were associated with a significantly higher risk of complications (RR, 1.70; 95% CI, 1.16-2.50) (Figure 3).…”

“…Only 3 studies 7,14,20 reported rates of a positive result on the Lachman test. There was no significant difference between patients receiving bioabsorbable or metallic screws (RR, 0.82; 95% CI, 0.48-1.39) (Figure 8).…”

Bioabsorbable Versus Titanium Screws in Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Prospective, Randomized Controlled Trial With 13-Year Follow-up

“…Previous comparative studies on this topic have reported positive results. 4,8,13 Complications, such as foreign body tissue reactions, 6 synovitis, 9 screw migration, cyst formation, 3,10 and screw breakage during implantation, 23 have been reported with bioabsorbable screws. However, these devastating complications may be the result of the type of polymer used, 1 certainly being more frequent in specific polymer types, such as PGA.…”