Abstract
ABSTRACTObjectiveTo compare the widening of bone tunnels between poly-etheretherketone (PEEK), absorbable polylactic acid DL (PLDL) and tricalcium phosphate (TCP) interference screws in anterior cruciate ligament (ACL) reconstruction.MethodsThree groups of patients undergoing ACL reconstruction with at least 1 year of follow-up using the out-in drilling technique and hamstring as a graft were assessed. The patients were divided according to the type of interference screw used (PEEK, PLDL and TCP). Computed tomography (CT) was performed to measure the greatest femoral and tibial tunnel widening regarding to the initial tunnel, and then it was compared between groups.ResultsMean widening in group 1 (PEEK) was 39.56% (SD 16%) in the femoral tunnel and 33.65% (SD 20%) in the tibia. In group 2 (PLDL) mean widening was 48.43% in the femoral tunnel (SD 18%) and 35.24% (SD 13%) in the tibial tunnel. In group 3 (TCP) mean widening was 44.51% in the femur (SD 14%) and 36.83% in the tibia (SD 14%). The comparison between groups (PLDL-PEEK, PLDL-TCP, PEEK-TCP) shows no statistically significant difference.ConclusionBone tunnel enlargement values after ACL reconstruction with the use of different types of materials (bioinert and biomaterials) of interference screws (PEEK, PLDL and TCP) were similar. Level of Evidence III, Comparative retrospective study.
Highlights
Anterior cruciate ligament (ACL) reconstruction is performed for professional and recreational athletes and in cases of daily life instability
The inclusion criteria consisted of patients aged between 18 and 55 years who presented with an anterior cruciate ligament (ACL) injury, confirmed by magnetic resonance imaging (MRI), with complaints of instability for physical activity or in daily life, with a positive Lachman and/or Pivot Shift test, and were submitted to ACL reconstruction, by drilling technique of tunnels from outside in (OUT-IN), with the hamstring as a graft by the same surgeon
The three non-randomized groups evaluated in our study were: Group 1: 20 patients (80% male) in which poly- etheretherketone (PEEK) (Masterteck-BIOTECK) interference screws with mean age 34.85 years, group 2: 20 (85% male) with polylactic acid (PLDL) absorbable screws (Sinfix-SINTEGRA) with a mean age of 37.05, and group 3: 10 patients (90% male) with polylactic acid DL (PLDL) absorbable screws with tricalcium phosphate (TCP) (Sinfix-SINTEGRA) and with a mean age of 36.2 years
Summary
Anterior cruciate ligament (ACL) reconstruction is performed for professional and recreational athletes and in cases of daily life instability. The ligament reconstruction techniques, with the anatomical positioning of the graft, leads to good results with the use of different methods and fixation devices.[1] The interference screw is still the most widely used fixation,[2] and is made from many different types of materials, such as titanium, bioinert materials such as polyether-ethyl ketone (PEEK), and bioabsorbable materials, such as poly-lactic acid (PLDL) that may be associated with biocomposites, such as hydroxyapatite (HA), and tricalcium phosphate (TCP), each with their advantages and disadvantages.[3,4,5] Metal (titanium) interference screws, widely used due to their lower cost, have some disadvantages such as the difficulty of being removed in a revision surgery[3,4] and the presence of. The objective of this study is to compare the enlargement of bone tunnels one year after ACL reconstruction, with computed tomography (CT), among three types of interference screws: pure poly-lactic acid (PLDL), absorbable poly-lactic acid with tricalcium-phosphate (TCP), and polyether-ethylketone (PEEK). We hypothesize that the enlargement of the bone tunnels among the raw materials of interference screws is similar, which would be a safety factor for the use of biomaterials
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