Editorial Commentary: The Acrid Bioscrew in Anterior Cruciate Ligament Reconstruction of the Knee

Pinczewski, Leo A.; Salmon, Lucy J.

doi:10.1016/j.arthro.2017.08.229

Cited by 7 publications

(4 citation statements)

References 24 publications

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“…21 Karikis et al 22 reported that 83% of patients 5 years after hamstring ACL reconstructions secured with selfreinforced SR-PL (96)/D (4) LA/b-TCP biocomposite interference screws had decreased tibial tunnel widths compared with the early postoperative period. As Pinczewski and Salmon 23 noted, biocomposite material reabsorption also may be influenced by the environment into which it is implanted, with the potential for different performance in different locations.…”

Section: Discussionmentioning

confidence: 99%

Biocomposite Interference Screws in Anterior Cruciate Ligament Reconstruction: Osteoconductivity and Degradation

Barber

Dockery

2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To evaluate the long-term in vivo degradation of an amorphous stereoisomer combined with micro b-tricalcium phosphate poly levo (96%)/dextro (4%) lactide beta-tricalcium phosphate biocomposite interference screw. Methods: A study approved by the institutional review board of in vivo biologic behavior of the screw was initiated in 2011 using an anterior cruciate ligament (ACL) reconstruction model. Twenty patients undergoing boneepatellar tendonebone ACL reconstruction fixed at the femur and tibia with these biocomposite screws followed at least 36 months were evaluated by physical, radiographic, and computed tomography (CT) evaluations. Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee scores were obtained. CT Hounsfield unit (HU) data were obtained at the femoral and tibial screw and other bone sites. An ossification quality score (range 1-4) was used to determine osteoconductivity at the screw sites. Results: In total, 11 male and 9 female patients evaluated by CT scan and radiographs a mean of 41 months postsurgery (range, 37-51) showed bone plug healing to the tunnel wall and the screw replaced with calcified and nontrabecular material. Osteoconductivity was present in 34 of 40 tunnels (85%) and nearly complete or complete (type 3 or 4 ossification) in 10 of 40 (25%). Mean screw-site densities (femoral 239 HU; tibial 290 HU) were consistent with cancellous bone density. One positive pivot-shift test was found. Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee activity scores improved from 46.9, 43.5, 1.9, and 1.7 preoperatively to 92, 90.2, 6.0, and 3.2 at follow-up, respectively. The average postoperative Single Assessment Numeric Evaluation score was 86 and mean KT-1000 arthrometer difference was 0.32 mm. Conclusions: The micro b-tricalcium phosphate poly levo (96%)/dextro (4%) lactide beta-tricalcium phosphate interference screw was replaced by calcified, nontrabecular material a mean of 42 months after implantation in a boneepatellar tendonebone ACL reconstruction model. Osteoconductivity was confirmed. Level of Evidence: Level IV (therapeutic case series).

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Section: Discussionmentioning

confidence: 99%

Biocomposite Interference Screws in Anterior Cruciate Ligament Reconstruction: Osteoconductivity and Degradation

Barber

Dockery

2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…У відповіді на публікацію в журналі Arthroscopy редактори висловили власне розчарування імплантатами, що піддаються біодеградації, які, на їх думку, не виправдали покладених на них очікувань та не підтвердили позитивних результатів експериментальних досліджень на тваринах, і висловилися на користь більш перспективного розвитку PEEK імплантатів, як більш біологічно інертних, що не викликають реактивного запального процесу [38].…”

Section: матеріали і методиunclassified

Differential Diagnosis of Reactive and Infectious Arthritis after Anterior Cruciate Ligament Reconstruction

Kostrub

Котюк²,

Лютко

et al. 2020

HOTP

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Summary. Relevance. Negative results of the anterior cruciate ligament (ACL) reconstruction occur in 10-20% of cases. The incidence of infectious arthritis can reach up to 1.7% and even up to 7.1%, according to the literature. However, ACL reconstruction can be complicated not only by infectious but also by reactive arthritis. Differential diagnosis between infectious and reactive arthritis is often hard to be done, but it is necessary for effective treatment. Objective: to determine the possible causes of the development of reactive and infectious arthritis after ACL reconstruction, peculiarities of their diagnostics and differential diagnostics. Materials and Methods. The literature data regarding the frequency of reactive and infectious arthritis after various methods of surgical treatment of ACL injury and the use of different types of implants, as well as laboratory indicators of the activity of the inflammatory process in the postoperative period and such indicators in reactive and infectious arthritis, were analyzed. We also analyzed literature data on the sensitivity and specificity of various methods of microbiological studies in patients with infectious synovitis or arthritis. Results. Numerous probable causes of a higher incidence of infectious arthritis in ACL reconstruction are suspected. Synthetic implants may be the cause of the development of reactive arthritis, according to a number of studies. Our experience in using different biodegradable fixators from various manufacturers suggest that the percentage of complications depends not only on the fact of the biodegradability of the implant, but on its composition, and even on the percentage of tricalcium phosphate or the manufacturer. Therefore, it is impossible to unambiguously state that biodegradable fixators are worse or better then metallic or non-biodegradable polymeric ones. However, on average, if we consider all existing fixators from various manufacturers, the number of complications when using biodegradable implants is higher. Diagnosis of reactive arthritis is often based on negative bacteriological findings. Given the not always high sensitivity of bacteriological inoculation of synovial fluid and the duration of the investigation, we cannot rely only on its results. Conclusions. The most difficult for differential diagnosis between infectious and reactive arthritis (synovitis) is acute synovitis after ACL reconstruction with normal results of bacteriological studies, but high biochemical parameters of inflammation. We suggest to suspect infectious arthritis after ACL reconstruction in the following hemogram values: 1) CRP >40-50 mg/l, 2) ESR >30-50 mm/h, 3) fibrinogen >800 mg/ml, 4) procalcitonin in blood plasma >0.5 ng/ml, 5) leukocytosis and left shift of the leukocyte formula, with the following synovial fluid test parameters: a) CRP >40-50 mg/l, b) leukocytosis with an increase in the percentage of polymorphonuclear leukocytes >75%.

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“…Although bioresorbable screws have been associated with good clinical outcomes and do not cause MRI signal flare, resorption has proven unreliable and complete replacement by bone rare 5 . This is largely due to the acidic nature of the materials and the hydrolytic pathway for their dissolution resulting in bony destruction and cyst formation 3,20 .…”

Section: Introductionmentioning

confidence: 99%

“…5 This is largely due to the acidic nature of the materials and the hydrolytic pathway for their dissolution, resulting in bony destruction and cyst formation. 3,19 Another option is polyether ether ketone (PEEK), a thermoplastic polymer that is widely used in spinal and maxillofacial surgery and is becoming increasingly popular in orthopaedic surgery. PEEK is chemically inert and insoluble, has a modulus of elasticity closer to human cortical bone, is compatible with MRI, and, for sterilization purposes, has high resistance to radiation.…”

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confidence: 99%

A Randomized Controlled Trial of PEEK Versus Titanium Interference Screws for Anterior Cruciate Ligament Reconstruction With 2-Year Follow-up

et al. 2019

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Background: Graft fixation with interference screws for anterior cruciate ligament (ACL) reconstruction is a highly successful technique. Polyether ether ketone (PEEK) is a novel thermoplastic polymer with high biocompatibility and mechanical properties that mimic native bone, and it can be imaged on computed tomography or magnetic resonance imaging (MRI) without signal flare. Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. Results: There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P = .03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. Conclusion: Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction.

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Editorial Commentary: The Acrid Bioscrew in Anterior Cruciate Ligament Reconstruction of the Knee

Cited by 7 publications

References 24 publications

Biocomposite Interference Screws in Anterior Cruciate Ligament Reconstruction: Osteoconductivity and Degradation

Biocomposite Interference Screws in Anterior Cruciate Ligament Reconstruction: Osteoconductivity and Degradation

Differential Diagnosis of Reactive and Infectious Arthritis after Anterior Cruciate Ligament Reconstruction

A Randomized Controlled Trial of PEEK Versus Titanium Interference Screws for Anterior Cruciate Ligament Reconstruction With 2-Year Follow-up

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