The unpredictable material properties of bioabsorbable PLC interference screws and their adverse effects in ACL reconstruction surgery

Abstract Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

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Lateral Meniscus Height and ACL Reconstruction Failure: A Nested Case–Control Study

The Journal of Knee Surgery ◽

10.1055/s-0040-1722323 ◽

2021 ◽

Author(s):

Iskandar Tamimi ◽

David Bautista Enrique ◽

Motaz Alaqueel ◽

Jimmy Tat ◽

Almudena Pérez Lara ◽

...

Keyword(s):

Acl Reconstruction ◽

Tibial Plateau ◽

Case Control Study ◽

Lateral Meniscus ◽

Case Control ◽

Lateral Tibial Plateau ◽

Reconstruction Surgery ◽

Meniscus Height ◽

Nested Case Control ◽

Control Study

AbstractPrevious work has shown that the morphology of the knee joint is associated with the risk of primary anterior cruciate ligament (ACL) injury. The objective of this study is to analyze the effect of the meniscal height, anteroposterior distance of the lateral tibial plateau, and other morphological features of the knee joint on risk of ACL reconstruction failure. A nested case–control study was conducted on patients who underwent an ACL reconstruction surgery during the period between 2008 and 2015. Cases were individuals who failed surgery during the study period. Controls were patients who underwent primary ACL reconstruction surgery successfully during the study period. They were matched by age (±2 years), gender, surgeon, and follow-up time (±1 year). A morphological analysis of the knees was then performed using the preoperative magnetic resonance imaging scans. The anteroposterior distance of the medial and lateral tibial plateaus was measured on the T2 axial cuts. The nonweightbearing maximum height of the posterior horn of both menisci was measured on the T1 sagittal scans. Measurements of the medial and lateral tibial slope and meniscal slope were then taken from the sagittal T1 scans passing through the center of the medial and lateral tibial plateau. A binary logistic regression analysis was done to calculate crude and adjusted odds ratios (ORs) estimates. Thirty-four cases who underwent ACL revision surgery were selected and were matched with 68 controls. Cases had a lower lateral meniscal height (6.39 ± 1.2 vs. 7.02 ± 0.9, p = 0.008, power = 84.4%). No differences were found between the two groups regarding the bone slope of the lateral compartment (6.19 ± 4.8 vs. 6.92 ± 5.8, p = 0.552), the lateral meniscal slope (–0.28 ± 5.8 vs. –1.03 ± 4.7, p = 0.509), and the anteroposterior distance of the lateral tibial plateau (37.1 ± 5.4 vs. 35.6 ± 4, p = 0.165). In addition, no differences were found in the medial meniscus height between cases and controls (5.58 ± 1.2 vs. 5.81 ± 1.2, respectively, p = 0.394). There were also no differences between cases and controls involving the medial bone slope, medial meniscal slope, or anterior posterior distance of the medial tibial plateau. Female patients had a higher medial (4.8 degrees ± 3.2 vs. 3.3 ± 4.1, p = 0.047) and lateral (8.1 degrees ± 5.1 vs. 5.6 degrees ± 5.6, p = 0.031) tibial bone slope, and a lower medial (5.3 mm ± 1.0 vs. 6.1 mm ± 1.2, p = 0.001) and lateral (6.6 ± 1.0 vs. 7.0 ± 1.2, p = 0.035) meniscus height, and medial (4.3 ± 0.4 vs. 4.8 ± 0.4, p =0.000) and lateral (3.3 ± 0.3 vs. 3.9 ± 0.4, p = 0.000) anteroposterior distance than males, respectively.The adjusted OR of suffering an ACL reconstruction failure compared to controls was 5.1 (95% confidence interval [CI]: 1.7–14.9, p = 0.003) for patients who had a lateral meniscus height under 6.0 mm. The adjusted OR of suffering an ACL reconstruction failure was 2.4 (95% CI: 1.0–7.7, p = 0.01) for patients who had an anteroposterior distance above 35.0 mm. Patients with a lateral meniscal height under 6.0 mm have a 5.1-fold risk of suffering an ACL reconstruction failure compared to individuals who have a lateral meniscal height above 6.0 mm. Patients with a higher anteroposterior distance of the lateral tibial plateau also have a higher risk of ACL reconstruction failure.

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Effects of Distally Fixated Versus Nondistally Fixated Leg Extensor Resistance Training on Knee Pain in the Early Period After Anterior Cruciate Ligament Reconstruction

Physical Therapy ◽

10.1093/ptj/82.1.35 ◽

2002 ◽

Vol 82 (1) ◽

pp. 35-43 ◽

Cited By ~ 37

Author(s):

Matthew C Morrissey ◽

Wendy I Drechsler ◽

Dylan Morrissey ◽

Philippa R Knight ◽

Paul W Armstrong ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Resistance Training ◽

Acl Reconstruction ◽

Knee Pain ◽

Cruciate Ligament ◽

Early Period ◽

Kinetic Chain ◽

Reconstruction Surgery ◽

Open Kinetic Chain ◽

Anterior Cruciate

Abstract Background and Purpose. Nondistally fixated (ie, what is often referred to as “open kinetic chain” [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called “closed kinetic chain” [CKC]) leg extensor training were compared for their effects on knee pain. Subjects. Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16–54). Methods. Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy. Results. No differences in knee pain were found between the treatment groups. Discussion and Conclusion. Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

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Low Rates of Return to Preinjury Sport After Bilateral Anterior Cruciate Ligament Reconstruction

The American Journal of Sports Medicine ◽

10.1177/0363546518813901 ◽

2018 ◽

Vol 47 (2) ◽

pp. 334-338 ◽

Cited By ~ 4

Author(s):

Kate E. Webster ◽

Julian A. Feller ◽

Alexander J. Kimp ◽

Timothy S. Whitehead

Keyword(s):

Quality Of Life ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Return To Sport ◽

Rates Of Return ◽

Acl Injuries ◽

Reconstruction Surgery ◽

Anterior Cruciate

Background: Patients with bilateral anterior cruciate ligament (ACL) injuries tend to report worse results in terms of knee function and quality of life as compared with those with unilateral injury. There are limited data regarding return to preinjury sport in this group. Purpose: To report return-to-sport rates for patients who had bilateral ACL reconstruction and to compare outcomes according to age and sex. Study Design: Case series; Level of evidence, 4. Methods: A total of 107 patients (62 male, 45 female) who underwent primary ACL reconstruction surgery to both knees completed a detailed sports activity survey at a mean 5-year follow-up (range, 2.5-10 years). Follow-up also included the International Knee Documentation Committee subjective form, Marx Activity Scale, and Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale. Rates of return to preinjury levels of sport were calculated for the whole cohort, and for further analysis, the group was divided according to age (<25 vs ≥25 years), sex, and time between the reconstruction procedures (<3 vs ≥3 years). Results: The rate of return to preinjury sport after bilateral ACL reconstruction was 40% (95% CI, 31%-50%), as compared with an 83% (95% CI, 74%-88%) return rate after the first reconstruction procedure. Although not statistically significant, return rates were higher for male versus female patients (47% vs 31%) and older versus younger patients (45% vs 31%). Of those who returned to their preinjury levels of sport after the second reconstruction, 72% thought that they could perform as well as before their ACL injuries. In contrast, only 20% thought that they could perform as well if they returned to a lower level. Fear of reinjury was the most common reason cited for failure to return to sport after the second reconstruction. Patient-reported outcome scores were higher for those who returned to their preinjury levels of sport but did not differ for sex and age. Conclusion: Return-to-sport rates drop markedly after a second (contralateral) ACL reconstruction, with less than half of the investigated cohort returning to its preinjury level of sport. Return-to-sport outcomes are less than ideal for patients who have ACL reconstruction surgery to both knees.

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Whether Sutures Reduce the Graft Laceration Caused by Interference Screw in Anterior Cruciate Ligament Reconstruction a Biomechanical Study in Vitro

10.21203/rs.3.rs-143941/v1 ◽

2021 ◽

Author(s):

Yuanjun Teng ◽

Lijun Da ◽

Xiaohui Zhang ◽

Hong Wang ◽

Hua Han ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Interference Screw ◽

Biomechanical Study ◽

Protective Effects ◽

Mineral Density ◽

Interference Screws ◽

Anterior Cruciate

Abstract Background: Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction However, previous studies h a d reported that the insertion of interference screws significantly caused graft laceration . The purpose of this study was to determine whether sutures reduce d the graft laceration from the insertion of interference screws in ACL reconstruction. Methods: Porcine tibias and bovine extensor tendons were used for establishing a knee model of ACL reconstruction in vitro . The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra high molecular weight polyethylene (UHMWPE) sutures Poly ether ether ketone (PEEK) interference screw s w ere used fortibial fixation Biomechanical tests were performed to investigate the protective effects of different sutures on grafts Results : All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre tension of the tendons, tibial bone mineral density) among all groups ( P 0.05). The biomechanical test s demonstrated that PEEK interference screw s significantly caused the graft laceration P 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction P 0.05). Conclusions : PEEK interference screw s significantly weakened the biomechanical properties of grafts during tibial fixation in ACL reconstruction. Absorbable Ethibond and UHMWPE sutures did not provide protective effects on grafts during ACL reconstruction.

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A Randomized Controlled Trial of PEEK Versus Titanium Interference Screws for Anterior Cruciate Ligament Reconstruction With 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546519861530 ◽

2019 ◽

Vol 47 (10) ◽

pp. 2386-2393 ◽

Cited By ~ 5

Author(s):

Sarah Shumborski ◽

Emma Heath ◽

Lucy J. Salmon ◽

Justin P. Roe ◽

James P. Linklater ◽

...

Keyword(s):

Acl Reconstruction ◽

Clinical Performance ◽

Controlled Trial ◽

Cruciate Ligament ◽

Cyst Formation ◽

Metal Artifact ◽

Interference Screws ◽

Novel Technique ◽

Randomized Controlled ◽

Anterior Cruciate

Background: Graft fixation with interference screws for anterior cruciate ligament (ACL) reconstruction is a highly successful technique. Polyether ether ketone (PEEK) is a novel thermoplastic polymer with high biocompatibility and mechanical properties that mimic native bone, and it can be imaged on computed tomography or magnetic resonance imaging (MRI) without signal flare. Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. Results: There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P = .03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. Conclusion: Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction.

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