Bone ingrowth into open architecture PEEK interference screw after ACL reconstruction

Martin Lind,Stacy Leake-Gardner,Peter Faunø,Bjarne Mygind-Klavsen,Torsten Nielsen,Ole Gade Sørensen

doi:10.1186/s40634-020-00285-z

Martin Lind, Stacy Leake-Gardner + Show 4 more

Open Access

https://doi.org/10.1186/s40634-020-00285-z

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Abstract

PurposeOpen or fenestrated interference screw design that allow bone ingrowth is a concept for improved bone healing to softtissue graft and bone filling in bone tunnels after anterior cruciate ligament reconstruction (ACLR) The aim of the current study was to assess CT scanning evaluated bone ingrowth into an open architecture interference screws in the tibial tunnel of patients undergoing ACL with soft tissue grafts. It was hypothesized that open architecture interference screws would stimulate bone ingrowth into the screw cavities.MethodsTwelve patients requiring ACLR were included. They underwent arthroscopic ACLR with semitendinosus−/gracilis tendon graft and an open architecture polyetheretherketone (PEEK) interference screw. The patients were scanned with a multi-slice CT scanner two weeks, six and twelve months postoperatively. On CT reconstruction slices bone ingrowth into the screw was measured. Subjective and objective clinical outcome international knee documentation committee score and instrumented knee laxity determination were collected.ResultsAt six months no implants demonstrated more than 10% bone ingrowth. At twelve months 42% (5/12) implants had more than 10% bone ingrowth (p = 0.009). The average bone filling into the screws was 7.7%. There was no tunnel widening or cyst formation seen in relation to any of the implants. Subjective IKDC score improved significantly from 50.6 baseline to 80.1 at 24 month follow-up. Preoperative side-to-side knee laxity improved from 3.7 (2.1) to 1.4 (1.2) mm at twelve months. There were no serious adverse events in relation to the new open architecture thread PEEK interference screw during or after hamstring ACL reconstruction.ConclusionThe present study demonstrated that open architecture thread PEEK interference screw can stimulate bone ingrowth into the screws after soft tissue ACL reconstruction with at 12 months with an average bone filling into screws was 7.7%. Knee stability, functional, subjective and objective outcomes were similar to large volume ACL outcome studies.Trial registrationThe study was registered at ClinicalTrials # NCT02382341. 12-09-2014.Level of evidenceIV.

Highlights

Advances in Anterior Cruciate Ligament Reconstruction (ACLR) techniques over the last three decades have resulted in 80–100% of patients reporting normal to nearly normal outcome scores following ACLR [16]
CT scanning bone ingrowth outcome At 6 months no implant demonstrated more than 10% bone ingrowth
At twelve months 42% (5/12) implants had more than 10% bone ingrowth (p = 0.009) compared to no ingrowth

Summary

Introduction

Advances in Anterior Cruciate Ligament Reconstruction (ACLR) techniques over the last three decades have resulted in 80–100% of patients reporting normal to nearly normal outcome scores following ACLR [16]. Despite these advances, it has been reported that 3–10% of ACL reconstructions fail [14]. The decreased stability of hamstring reconstructions compared to BTB could result from differences in graft properties that adversely affect the ability of the soft tissue graft to heal inside bone tunnels [15, 21]

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