Clin Orthop Surg.  2017 Sep;9(3):270-279. 10.4055/cios.2017.9.3.270.

Comparison of Poly-L-Lactic Acid and Poly-L-Lactic Acid/Hydroxyapatite Bioabsorbable Screws for Tibial Fixation in ACL Reconstruction: Clinical and Magnetic Resonance Imaging Results

• Lee DW
• Lee JW
• Kim SB
• Park JH
• Chung KS
• Ha JK
• Kim JG
• Kim WJ

• KMID: 2412262
• DOI: http://doi.org/10.4055/cios.2017.9.3.270

Abstract

BACKGROUND
The purpose of this study was to compare the clinical and radiological results of 2 different tibial fixations performed using bioabsorbable screws with added hydroxyapatite (HA) and pure poly-L-lactic acid (PLLA) screws in anterior cruciate ligament (ACL) reconstruction.
METHODS
A total of 394 patients who underwent arthroscopic ACL reconstruction between March 2009 and June 2012 were retrospectively reviewed. Of those, 172 patients who took the radiological and clinical evaluations at more than 2 years after surgery were enrolled and divided into 2 groups: PLLA group (n = 86) and PLLA-HA group (n = 86). Both groups were assessed by means of the Lysholm score, International Knee Documentation Committee (IKDC) subjective knee score, and Tegner activity score. Stability was evaluated using the KT-2000 arthrometer. Magnetic resonance imaging was performed to evaluate tibial tunnel widening, screw resorption, osteoingeration, and foreign body reactions.
RESULTS
The PLLA-HA group showed significant reduction in the extent of tibial tunnel widening and foreign body reactions and significant increase in screw resorption compared to the pure PLLA group (p < 0.001 for both). In contrast, postoperative Lysholm score, Tegner activity score, IKDC score, and side-to-side difference on the KT-2000 arthrometer showed no significant differences between groups (p = 0.478, p = 0.906, p = 0.362, and p = 0.078, respectively). The PLLA group showed more significant widening in the proximal tibial tunnel than the PLLA-HA group (p = 0.001). In the correlation analysis, proximal tibial tunnel widening revealed a positive correlation with knee laxity (r = 0.866) and a negative correlation with Lysholm score (r = −0.753) (p < 0.01 for both).
CONCLUSIONS
The HA added PLLA screws would be advantageous for tibial graft fixation by reducing tibial tunnel widening, improving osteointegration, and lowering foreign body reactions. Even though no clinically significant differences were noted between the pure PLLA group and PLLA-HA group, widening of the proximal area of the tibial tunnel showed a tendency to increase knee laxity measured using the KT-2000 arthrometer.

Keyword

Anterior cruciate ligament; Tunnel enlargement; Tunnel widening; Bioabsorbable interference screw; Hydroxyapatite

MeSH Terms

*Absorbable Implants
Adult
Anterior Cruciate Ligament/diagnostic imaging/surgery
Anterior Cruciate Ligament Injuries/diagnostic imaging/surgery
Anterior Cruciate Ligament Reconstruction/instrumentation/*methods
*Bone Screws
Durapatite/*therapeutic use
Female
Humans
Magnetic Resonance Imaging
Male
Polyesters/*therapeutic use
Retrospective Studies
Tibia/diagnostic imaging/*surgery
Polyesters
Durapatite

Figure

• 

  Fig. 1 Flowchart of inclusion and exclusion of participants. PLLA: poly-L-lactic acid, HA: hydroxyapatite, MRI: magnetic resonance imaging.

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  Fig. 2 Tibial bone tunnel maximum cross-sectional area was measured automatically by picture archiving and communication system (Maroview ver. 5.4; MAROTECH Inc.).

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  Fig. 3 The signal quality of the bone tunnel-screw-graft system was evaluated to estimate the degree of osteointegration of the screw (arrow) on the coronal view of T2-weighted magnetic resonance imaging and classified as good (A), partial (B), some (C), and little (D).

• 

  Fig. 4 Foreign body reactions (arrow) were classified as no reaction (A), edema (B), or cyst formation (C) on the coronal view of T2-weighted magnetic resonance imaging.

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  Fig. 5 Coronal (A) and sagittal (B) views of magnetic resonance imaging after anterior cruciate ligament reconstruction using the poly-L-lactic acid screw showed significant widening in the proximal area of the tibial tunnel (arrow).

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