Bioabsorbable Versus Titanium Interference Screws With Hamstring Autograft in Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Trial With 2-Year Follow-up (original) (raw)
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Journal of Chitwan Medical College
Background: Arthroscopic anterior cruciate ligament reconstruction can be performed both with titanium and bioabsorbable interference screws. The purpose of this study was to compare functional outcomes after reconstruction using these different implants. Methods: This was a retrospective study. Patients who underwent ACL reconstruction with hamstring autograft at Bheri hospital over the designed period were observed. Each group (titanium and bioabsorbable screws) consisting of 20 patients were compared using Lyshlom knee scores at 3, 6 and 12 months postoperatively. Statistical analysis was done using SPSS version 24. Chi square test was applied for comparing functional outcomes. Confidence interval of 95%, p value less than 0.05 was taken as significant. Results: Mean Lyshlom scores at 3, 6 and 12 months were 61.70, 69.60 & 85.90 for titanium group and 62.65, 70.95 & 84.65 for bioabsorbable screw group. The differences were not statistically significant. Conclusions: Functional ...
The American journal of sports medicine
To date, there has been no publication of clinical follow-up data on patients who have undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable screw fixation. To report the results of quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation. Retrospective review. Sixty-five patients (66 knees) were retrospectively identified by chart review as having undergone quadrupled hamstring tendon autograft anterior cruciate ligament reconstruction with bioabsorbable interference screw fixation with a minimum 2-year follow-up. Data were collected on 48 knees in 47 patients (73%) at an average 30.2 months (range, 24 to 43) after surgery. Thirty-six patients (37 knees) returned for clinical evaluation (56% return) and subjective follow-up only was obtained in 11 patients (17%). The mean Lysolm knee score was 91 (range, 45 to 98), with a mean of 97 for the uninvolved knee. T...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
To compare the Phantom bioabsorbable polymer interference screw (DePuy, Warsaw, IN) with a titanium metal interference screw when used in fixation of femoral and tibial bone blocks in central third bone-patellar tendon-bone autograft anterior cruciate ligament (ACL) reconstructions. Type of Study: Multicentered prospective randomized study. Methods: Two surgeons performed primary ACL reconstructions at different locations. Preoperatively, the patients were randomly assigned. One group received a titanium cannulated interference screw. The second group received the cannulated poly-L-lactic bioabsorbable Phantom screw. Data included subjective evaluation of activity level and International Knee Documentation Committee scores. Objective measures were made using the KT-1000 arthrometer (MedMetric, San Diego, CA), range of motion, presence of effusions, and complications intraoperatively or postoperatively. Measurements were made at 1 year and 2 years. Radiographic evaluation was carried out at least 2 years from the initial surgical date and interpreted by 2 independent orthopaedic surgeons. Results: At the 1-year follow-up (N ϭ 97), pain was reported more during moderate activity in the Phantom screw group (6) compared with the titanium screw group (0) (P ϭ .03). No statistical difference between range of motion (P ϭ .45), activity level (P ϭ .83), swelling with activity (P ϭ .95), partial (P ϭ .13) or full (P ϭ .31) giving way, knee effusions (P ϭ .33), or KT-1000 side-to-side difference (P ϭ .53) were found. At the 2-year follow-up (N ϭ 65), more subjects (18) in the Phantom interference screw group reported activity levels in the strenuous category compared with those in the titanium interference screws (7) group (P ϭ .02). No differences were reported with respect to pain (P ϭ .97), effusion (P ϭ .17), partial (P ϭ .28) or full (P ϭ .27) giving way, swelling with activity (P ϭ .21), range of motion (P ϭ .64), or KT-1000 side-to-side difference (P ϭ .96). Radiographic inspection showed no change in bone plug position, osteolysis, adverse effect, or complication caused by the bioabsorbable material. Some evidence of tunnel widening was seen in both groups. Conclusions: Use of a poly-L-lactic bioabsorbable interference screw can provide clinical results equal to that of a metal interference screw for fixation of a central third bone-patellar tendon-bone graft in ACL reconstruction. Level of Evidence: Level II, therapeutic.
The American Journal of Sports Medicine, 2007
Background Conventional anterior cruciate ligament reconstruction techniques have focused on restoration of the anterome-dial bundle only, which, however, may be insufficient in restoring the rotational stability of the knee. Hypothesis Rotational stability of the knee is better when using a double-bundle technique instead of a single-bundle technique for anterior cruciate ligament reconstruction. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Seventy-seven patients were randomized into 3 different groups for anterior cruciate ligament reconstruction with hamstring tendons: double-bundle with bioabsorbable screw fixation (n = 25), single-bundle with bioabsorbable screw fixation (n = 27), and single-bundle with metallic screw fixation (n = 25). The evaluation methods were clinical examination, KT-1000 arthrometric measurement, and the International Knee Documentation Committee and Lysholm knee scores. Results There were no differences between the stu...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2006
Tibial fixation is the key to success in anterior cruciate ligament (ACL) surgery using the hamstring tendon technique. Interference screws are popular intratunnel fixation devices not exceeding 35 mm in length. A mismatch between the lengths of the tibial tunnel and the interference screw can cause protrusion of the screw inside the knee or outside the anterior tibia, with a poor postoperative outcome. Our objective was to evaluate the safety length that exists with the use of a 35-mm screw in the tibial tunnel. For this purpose, 27 patients with ACL reconstruction were included. All measurements were performed directly during surgery. The lengths were recorded along with the patients' data. Our study group included 16 male and 11 female patients with an average age of 30.9 years. The average tibial tunnel length was 43.4 mm (range, 40 to 48 mm). This means that for a tibial tunnel drilled at a 55°angle, its length will be at least 5 mm longer than the 35-mm screw. In the same way, the distance between the graft fixation and the articular surface will not exceed 13 mm if the screw is completely inside the tunnel.
Knee Surgery, Sports Traumatology, Arthroscopy, 1997
Disruption of the anterior cruciate ligament (ACL) is a relatively common knee injury which may result in functional disability [11, 15, 28, 31]. Surgical reconstruction of the ligament may be indicated to reduce the morbidity associated with this injury [23, 29, 40]. Endoscopic reconstruction has become the preferred method because of reduced postoperative pain, less fibrosis, accurate alignment of the osseous tunnels, improved cosmesis, shorter rehabilitation and hospital stay [22, 36].
The American Journal of Sports Medicine, 2009
Background New devices for graft fixation in anterior cruciate ligament reconstruction are released to clinical use without clinical follow-up data. Hypothesis There is similar clinical outcome after either cross-pin or absorbable interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods A total of 120 patients were randomized into 4 different groups (30 each) for anterior cruciate ligament reconstruction with hamstring tendons: femoral Rigidfix cross-pin and Intrafix tibial expansion sheath with a tapered expansion screw; Rigidfix femoral and BioScrew interference screw tibial fixation, BioScrew femoral and Intrafix tibial fixation; or BioScrew fixation into both tunnels. The evaluation methods were clinical examination, knee scores, and instrumented laxity measurements. Results Ten patients were completely lost to follow-up and 3 revisions were done before the 2-...
Clinical Orthopaedics and Related Research®, 2011
Background Several methods are available for fixing the femoral side of a hamstring autograft in ACL reconstruction and the best method is unclear. Biomechanical studies have shown varying results with regard to fixation failure. Questions/purposes We asked whether there were any differences with regard to graft failures and functional outcome measures with differing methods of femoral fixation of hamstring autografts in ACL reconstruction. Methods We systematically reviewed the literature using PubMed, MEDLINE, Scopus, and Cochrane Controlled Trial Register databases with regard to interference screw fixation (aperture fixation) versus noninterference screw fixation (fixation away from the joint line). A meta-analysis was performed of those studies reporting on surgical failures and postoperative International Knee Documentation Committee score. Eight studies met our inclusion criteria of Level I or II evidence.
The Knee, 2008
Hamstring tendon autograft has become a popular graft choice for anterior cruciate ligament (ACL) reconstruction, but there is no consensus on the ideal technique of fixation. We performed a pilot randomized controlled study to compare the clinical and mechanical outcome of two femoral fixation techniques for anterior cruciate ligament (ACL) reconstruction using hamstrings graft. We recruited 30 patients with a chronic unilateral tear of the anterior cruciate ligament. In all patients, quadrupled hamstring graft was used for ACL reconstruction. In 15 patients, femoral graft fixation was performed using Bio-interference Screws fixation (Arthrex, Inc. Naples USA) (Group 1). In the other 15 patients, femoral graft fixation was performed using BioTransFix femur extra cortical transverse fixation (Arthrex, Inc. Naples USA) (Group 2). In both groups, tibial fixation was achieved with a Delta bio-absorbable interference screw (Arthrex). Both groups were comparable with regard to demographic data, pre-operative activity level, mechanism of injury, interval between the injury and the operation, and pre-operative knee laxity measurements. An independent observer, who was blinded with regard to the involved leg and the type of graft, performed the outcome assessment with the use of a Rolimeter® arthrometer (Aircast), and the International Knee Documentation Committee. At 13 months follow up, all patients except one had functionally normal or nearly normal IKDC objective scores. The mean IKDC subjective score was 83.38 ± 9.4 in Group 1 and 79.92 ± 11.01 in Group 2 (P N.05). The side to side laxity as measured with the Rolimeter® arthrometer was 1.5 mm± 1 (range 0-3) for Group 1, and 2 mm± 1 (range 0-3) for Group 2 (P N.05). Femoral Biotransfix fixation and Bio-interference Screws fixation provide comparable mechanical stability and clinical outcome at 13 months follow up. BiotransFix fixation is an effective alternative to other devices. Our preliminary study shows that there is no evidence to prefer femoral transfixation to the more traditional, technically less demanding, and more economical interference screw fixation. A full study requires 368 participants.