Results of anterior cruciate ligament reconstruction and the use of absorbable interference screws (minimum 2.5-year follow-up)

Abstract

The purpose of this study was to assess the effects of biodegradable interference screw use in ACL reconstruction beyond the usual clinical historical and physical findings. The use of this material for interference screws has potential benefits if the problems of inflammation are minimal and the fixation properties are sufficient. There is no need for a second operation for removal and no complicating factor if revision surgery is necessary. A prospective study was initiated in May, 1993 to evaluate the use of biodegradable interference screws (Instrument Makar). Our patients were evaluated with the aid of the common OAK-score. The overall evaluation showed 89.5% excellent and good results, 7% fair results and 3.5% poor results. The average score was 90.7 points (63-100 points). The measurement with the arthrometer (KT 1000) showed a difference of up to 3 mm as compared to the knee joint not operated on in 24 (93%) of the patients. Four patients showed a 3 to 6 mm difference. A tibia translation of more than 4 mm was not measured in any case. The biodegradable interference screw is a safe and effective interference screw for fixation of the bone blocks for ACL reconstruction.

Anterior Cruciate Ligament Reconstruction with Bioabsorbable Polyglycolic Acid Interference Screws: MR Imaging Follow-up

“…No clinical inflammatory reaction has been observed in most studies performed after ACL reconstruction with bioabsorbable interference screws (2,5,6,8,24,25,27,35).…”

Poly-L-lactic acid — hydroxyapatite (PLLA-HA) bioabsorbable interference screws for tibial graft fixation in anterior cruciate ligament (ACL) reconstruction surgery: MR evaluation of osteointegration and degradation features

“…Such screws are not, however, free of limitations. These are related to surgical technique, excessive hydrolysation of the screw, decreased pH, biocompatibility problems and incomplete osteointegration with resulting loss of torsional strength and graft instability [4][5][6]. This has led to the introduction of screws composed of materials having biomechanical properties that are both more reliable and closer to those of metallic implants, that is, materials that are not only bioabsorbable and biocompatible but also osteoinductive: polymer-ceramic composite materials made up of PLLA and hydroxyapatite (HA) granules.…”

“…Negli ultimi anni le applicazioni cliniche hanno rivolto particolare interesse a viti composte da polimeri di acidi polilattici (PLLA), che sono dotate di resistente fissazione del neo-legamento, paragonabile a quella dei mezzi di sintesi metallici, possibilità di revisione chirurgica, scarsa risposta infiammatoria, bassa incidenza a reazioni avverse, facilità di incorporazione biologica dell'innesto nel tunnel osseo [3]. Tali viti tuttavia non sono scevre da limiti che sono in parte legati alla tecnica operatoria, in parte dovuti alla eccessiva idrolisi che subisce la vite, alla diminuizione del pH e a problemi di biocompatibilità, e in parte dovuti alla non completa integrazione ossea con conseguente perdita della forza torsionale dell'innesto e conseguente instabilità [4][5][6]. Pertanto si è pensato all'introduzione di viti costituite da materiali dotati di caratteristiche biomeccaniche più affidabili e più vicine a quelle dei mezzi di sintesi metallici, ovvero a composti che oltre che dotati di caratteristiche di bioriassorbibilità e biocompatibilità posseggono altresì la peculiarità di essere osteoinducenti; si tratta di composti polimerici-ceramici costituiti da acidi polilattici (PLLA) e granuli di idrossiapatite (HA).…”