Intraarticular migration of a broken biodegradable interference screw after anterior cruciate ligament reconstruction

Abstract

Poly-L: -lactic acid biodegradable screws have been used effectively for graft fixation in anterior cruciate ligament (ACL) reconstruction. The overall complication rate associated with the use of this implant is low, although some authors reported complications, such as osteolysis and aseptic effusion of the knee joint. We report a case of a 29-year-old female patient with a failure of a biodegradable interference screw at 22 months after ACL reconstruction using bone-patellar tendon-bone graft. In this illustrated case, the screw broke and migrated into the knee joint. In addition, we performed a detailed review of the medical literature from 1990-2005 to identify possible causes of biodegradable screw failures. We identified six published cases of bioabsorbable interference screw failure with migration into the knee joint. Several authors have reported small diameter of the screw, poor bone quality, bone resorption, and screw divergence as potential causes for intraarticular migration of metallic interference screws. With regard to bioscrews, no specific risk factors for screw breakage and intraarticular migration have been reported. ACL reconstruction with the use of bioabsorbable interference screws for fixation is considered to be reliable. However, we need to be aware of potential problems associated with the use of this implant. Early recognition of bioscrew failure may prevent associated morbidities, such as subsequent cartilage damage.

Biodegradation of a magnesium alloy implant in the intercondylar femoral notch showed an appropriate response to the synovial membrane in a rabbit model in vivo

“…Degradable screws manufactured of polymers such as poly-L-lactide or poly-DL-lactide-co-glycolide have been used clinically, but have displayed insufficient mechanical stability and the degradation products can produce adverse effects. 2 Intraoperative and postoperative implant breakages of a resorbable polylactid acid screw have been reported, 3,4 as well as implant displacement into the joint, 5,6 joint swelling, 7 and tunnel widening around the implant. 8 In recent years, magnesium alloys have been investigated intensively as an alternative biodegradable material for orthopedic implants.…”

Case Report: Fibroxanthoma

“…The reported complications of biodegradable screws are osteolysis around the screw [17], allergic reaction [15], and extraarticular pretibial sterile abscess [4]. Other reported complications are transcutaneous [18] and intraarticular migration [2], recurrent pretibial ganglion cyst formation [19], and intraarticular granuloma formation [7]. There is disagreement among pathologists regarding whether a fibroxanthoma represents a true neoplasm [3,6], developmental defect [5], or reactive process [14].…”

“…Use of bioabsorbable screws for fixation of graft in ACL reconstruction is effective in terms of fixation strength [7,21] and safe with overall low complication rates [2]; however, we need to be aware of potential complications, early recognition of which may prevent associated morbidity. …”

“…They have similar or superior fixation strength in comparison to metallic interference screws [11,21]. However, they have complications such as cyst and abscess formation [4,7,19,20], breakage, and intraarticular migration [2,18]. Although no fibroxanthoma as a complication of biodegradable screws has been reported in the English literature, a literature search shows sarcoma [9] and malignant fibrous histiocytoma [1,8] in response to other orthopaedic implants.…”

Graft tendon slippage with metallic and bioabsorbable interference screws under cyclic load: a biomechanical study in a porcine model

“…The material may induce an exacerbated inflammatory response (Ghalayini and Banks, 2008;Shafer and Simonian, 2002). The migration of the screw in the joint space has also been occasionally reported (Baums et al, 2006). Given the advantages and drawbacks of each type of screw, no clear best option is evident.…”