Chondral injury from bioabsorbable screws after meniscal repair

Kumar, Arun; Malhan, Kaushal; Roberts, S.

doi:10.1053/jars.2001.25260

Cited by 18 publications

(19 citation statements)

References 5 publications

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“…However, a similar case has been presented also with a headless implant [14]. The 13 second-look arthroscopies in our series revealed seven cases in which some sort of irritation of the femoral condyle corresponding to the repair site was noted.…”

Section: Discussionsupporting

confidence: 65%

Evaluation of the second-generation Meniscus Arrow in the fixation of bucket-handle tears in the vascular area of the meniscus

Sarimo

Rantanen²,

Tarvainen³

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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The purpose of this prospective study was to evaluate whether the shorter degradation time of the second-generation Meniscus Arrow would be adequate to allow meniscal healing and whether equally good results could be achieved compared to the first generation implant. We also wanted to assess whether some of the implant related complications could be avoided with the altered absorption time. A total of 20 patients were included in this study. The mean follow-up was 26 months. The average Lysholm score at the final follow-up was 90. There were 13 second-look arthroscopies performed during the follow-up and in them two failures of the repaired menisci to heal were seen. Seven patients were found with some degree of chondral irritation of the femoral condyle corresponding to the repair site. The second generation Meniscus Arrow seems to give results comparable to the first generation Meniscus Arrow. The potential complications caused by the implant reported in the earlier literature using the first generation arrow are possible also using this implant. In seven of the 13 second-look arthroscopies some degree of chondral irritation corresponding to the repair site was seen. The clinical relevance of these lesions remains to be seen.

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Section: Discussionsupporting

confidence: 65%

Evaluation of the second-generation Meniscus Arrow in the fixation of bucket-handle tears in the vascular area of the meniscus

Sarimo

Rantanen²,

Tarvainen³

et al. 2005

Knee Surg Sports Traumatol Arthrosc

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show abstract

“…A spongeous bone transplantation and debridement of the dissecat bed, if necrosis is found, should be considered in case of Osteochondritis dissecans, regarding the development of OCD as a pseudarthrosis [1, 5, 7, 8, 10, 11, 13, 14, 16, 21, 24, 25, 27–29],.…”

Section: Discussionmentioning

confidence: 99%

“…The application of biodegradable screws, however, has potential disadvantages such as damage to the opposite cartilage from exposed screw heads and, if rapidly degrading material is used, sinus formation [8, 13, 14, 21, 27]. …”

Section: Discussionmentioning

confidence: 99%

Fixation of osteochondral fragments in the human knee using Meniscus Arrows®

Wouters

Burgerhof

Hosson

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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The aim of this study is to compare the hold in bone of Meniscus Arrows® and Smart Nails®, followed by the report of the results of the clinical application of Meniscus Arrows® as fixation devices. First, pull-out tests were performed to analyse the holdfast of both nails in bone. Statistical analysis showed no significant difference; therefore, the thinner Meniscus Arrow® was chosen as fixation device in the patient series of two patients with a symptomatic Osteochondritis dissecans fragment and three patients with an osteochondral fracture of a femur condyle. The cartilage margins were glued with Tissuecoll®. All fragments consolidated. Second look arthroscopy in three patients showed fixed fragments with stable, congruent cartilage edges. At an average follow-up period of 5 years no pain, effusion, locking, restricted range of motion or signs of osteoarthritis were reported. Based on the results of the pull-out tests and available clinical studies, Meniscus Arrows® and Smart Nails® are both likely to perform adequately as fixation devices in the treatment of Osteochondritis dissecans and osteochondral fractures in the knee. They both provide the advantage of one stage surgery. However, based on their smaller diameter, the Meniscus Arrows® should be preferred for this indication.

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“…Recently, also the second disadvantage has been demonstrated in the literature as well. Because of the relatively long degradation time of PLLA screws, the cartilage in patients, opposite to the screw, was damaged when the limb in question was loaded before total degradation of the screw 38, 39…”

Section: Discussionmentioning

confidence: 99%

“…Because of the relatively long degradation time of PLLA screws, the cartilage in patients, opposite to the screw, was damaged when the limb in question was loaded before total degradation of the screw. 38,39 Several means are applied to sterilize devices, made of PLLA or its copolymers, like plasma and ethylene oxide (EtO), gamma radiation and electron beams. Potentially, they can influence the mechanical properties by accelerate the degradation and increase the crystallinity.…”

Section: Discussionmentioning

confidence: 99%

Should in the treatment of osteochondritis dissecans biodegradable or metallic fixation devices be used? A comparative study in goat knees

Wouters¹,

Bos²,

Horn³

et al. 2007

J Biomed Mater Res

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Most of the metallic devices have to be removed, treating osteochondritis dissecans lesions. This animal study describes the biological and mechanical behavior of screws and pins, made of commercially available PGA/PLA and PLA96 and metallic screws and pins, used for fragment fixation. A sham operation served as control. A tissue reaction with cavity formation was observed around every PGA/PLA screw, beginning at 12 weeks following insertion, in contrast to once around a PLA96 screw (p < 0.001), once around one of the 16 PGA/PLA pins and never around those, made of PLA96 (no significance). Disintegration of the PGA/PLA devices started 6 weeks following implantation against 34 weeks for the PLA96 implants. The gap between the fragment and the recipient cartilage disappeared only in the sham group. Many fragments of PGA/PLA material were found in the synovia, in contrast with just a few fragments in the PLA96 group, causing a mild cellular reaction. No polymer particles were found in the draining lymph nodes at any interval. In conclusion, the tested biodegradable screws should not be used for fragment fixation in the treatment of osteochondritis dissecans. Either an undesirable tissue reaction can be expected (PGAPLA), or, because of the slow degradation (PLLA), a screw might damage the opposite cartilage during weight bearing. Two biodegradable pins provide a safe rotational stability and should be combined with one metallic screw, providing compression. This screw has to be removed before loading the limb to prevent cartilage wear of the opposite tibia plateau.

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Chondral injury from bioabsorbable screws after meniscal repair

Cited by 18 publications

References 5 publications

Evaluation of the second-generation Meniscus Arrow in the fixation of bucket-handle tears in the vascular area of the meniscus

Evaluation of the second-generation Meniscus Arrow in the fixation of bucket-handle tears in the vascular area of the meniscus

Fixation of osteochondral fragments in the human knee using Meniscus Arrows®

Should in the treatment of osteochondritis dissecans biodegradable or metallic fixation devices be used? A comparative study in goat knees

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