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

Abstract

Background: Bioabsorbable interference screws and metallic interference screws are both widely used for graft fixation, but it remains unclear which screw type is superior. Purpose: To compare clinical outcomes and complications between bioabsorbable and metallic interference screws for anterior cruciate ligament reconstruction (ACLR). Study Design: Systematic review; Level of evidence, 1. Methods: The literature was searched for relevant randomized controlled trials published between 1966 and 2020. Two investigators independently assessed risk of bias in the included studies, and data were pooled to calculate mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, together with 95% CIs. Meta-analysis was performed using a random- or fixed-effects model, depending on the heterogeneity in the data. Results: Included were 14 randomized controlled trials involving 1032 patients who underwent ACLR: 528 patients with bioabsorbable screws and 504 patients with metallic screws. The 2 groups did not differ significantly in International Knee Documentation Committee score (RR, 1.04; 95% CI, 0.97 to 1.11), Lysholm score (MD, 0.59; 95% CI, –0.46 to 1.63), range of motion deficit (RR, 0.95; 95% CI, 0.67 to 1.34), positive pivot-shift test (RR, 0.87; 95% CI, 0.61 to 1.24), positive Lachman test (RR, 0.82; 95% CI, 0.48 to 1.39), or KT-1000 arthrometer value (MD, 0.01; 95% CI, –0.16 to 0.18). However, bioabsorbable screws were associated with a significantly higher risk of complications (RR, 1.70; 95% CI, 1.16 to 2.50), such as graft rupture, joint effusion, and infection. Conclusion: The results of this review showed that there was no difference between metallic and bioabsorbable screws for ACLR in terms of subjective knee function or knee laxity, but metallic interference screws had fewer complications.

Iliotibial band reconstruction with allograft fasciae latae tissue: Imaging aspects of a novel surgical technique

“…Anchoring the reconstructed graft to the bone may be achieved by different devices such as screws, buttons, cross pins and screw posts or a combination of these on the femoral side [20] . Bioabsorbable and metallic screws are both frequently used for femoral or tibial fixation in ALC reconstructions and a recent meta-analysis showed that although there is no difference between them in terms of subjective knee function or knee laxity, bioabsorbable screws may show more complications [21] .…”

Strategies to promote tendon-bone healing after anterior cruciate ligament reconstruction: Present and future

“…As a downside, it interferes with magnetic resonance imaging (MRI) and has to be removed during revision surgery ( Emond et al, 2011 ). With the development of biomaterials, bioabsorbable interference screws have been introduced to the clinic, with some patients preferring the clinical outcome of the screw disappearing ( Xu et al, 2021 ). Most current metal interference screws are composed of titanium, but bioabsorbable interference screws are composed of a variety of biodegradable biomaterials that are non-toxic, non-responsive to tissue, and degrade over time ( Xu et al, 2021 ).…”

“…With the development of biomaterials, bioabsorbable interference screws have been introduced to the clinic, with some patients preferring the clinical outcome of the screw disappearing ( Xu et al, 2021 ). Most current metal interference screws are composed of titanium, but bioabsorbable interference screws are composed of a variety of biodegradable biomaterials that are non-toxic, non-responsive to tissue, and degrade over time ( Xu et al, 2021 ). However, there have been some clinical reports of adverse reactions related to bioabsorbable interference screws, such as the risk of synovitis, excessive inflammation, and tunnel widening ( Xu et al, 2021 ).…”

“…Most current metal interference screws are composed of titanium, but bioabsorbable interference screws are composed of a variety of biodegradable biomaterials that are non-toxic, non-responsive to tissue, and degrade over time ( Xu et al, 2021 ). However, there have been some clinical reports of adverse reactions related to bioabsorbable interference screws, such as the risk of synovitis, excessive inflammation, and tunnel widening ( Xu et al, 2021 ). In a study comparing bioabsorptive interference screws with metal ones, Debieux et al (2016) demonstrated no differences in patients’ self-reported knee function or postoperative activity.…”

The safety and effectiveness comparison of Delta Medical's PEEK interface screw and Endobutton and that of Smith & Nephew's in arthroscopic anterior cruciate ligament reconstruction: A multicenter prospective double-blind randomized controlled clinical trial

“…The other is suspensory fixation like EndoButton ® (Smith & Nephew, Inc. Andover, MA, USA). Metallic interference screws (MISs) were the first applied interference screw that have reached a reliably positive clinical outcome ( 8 ). MISs can promote early bone integration with high initial fixation strength but a relatively high failure load which is very difficult to remove during revision surgery ( 9 , 10 ).…”