Soft-Tissue Interference Fixation: Bioabsorbable Screw Versus Metal Screw

doi:10.1016/j.arthro.2005.05.009

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 21, Issue 8, August 2005, Pages 911-916

https://doi.org/10.1016/j.arthro.2005.05.009 Get rights and content

Purpose: To compare the biomechanical properties of eccentrically positioned bioabsorbable and titanium interference screws for quadrupled hamstring tendon graft (QHTG) fixation. Type of Study: In vitro, biomechanical study. Methods: In 10 paired cadaveric tibiae and femurs (mean age, 66.5 years; range, 53 to 81 years), QHTG fixation was performed in tunnels sized to within 0.5 mm of QHTG diameter using either a titanium (RCI; Smith & Nephew Donjoy, Carlsbad, CA) or a bioabsorbable (BioScrew; Linvatec, Largo, FL) screw of equal size. Constructs then underwent biomechanical load-to-failure testing on a servo-hydraulic device at 20 mm/min. Results: Load at failure was greater for femoral-side QHTG fixation using the bioabsorbable screw than the titanium screw (486 ± 223.7 N v 246 ± 99.1 N, P = .006); however, displacement did not differ (P = .81). There were no statistically significant differences between groups for tibial side load at failure (P = .54), stiffness (P = .44), or displacement (P = .50). Screw thread-induced graft laceration was more frequently observed in the titanium screw group (9 of 10 grafts during femoral-side testing, 0 of 10 grafts during tibial-side testing) than in the bioabsorbable screw group (0 of 10 grafts during femoral-side testing, 1 of 10 grafts during tibial-side testing). Conclusions: BioScrew interference screw fixation was comparable or superior to RCI titanium interference screw fixation. BioScrew interference screw fixation also produced less screw thread-induced laceration of the QHTG during load-to-failure testing. Clinical Relevance: Use of a biodegradable interference screw positioned directly against a soft-tisse graft provides fixation properties similar to those of a metal interference screw.

Section snippets

Methods

Ten paired cadaveric femurs and tibiae (mean donor age, 66.5 years; range, 53 to 81 years) were used in this study. After removal of all knee specimen soft tissues, individual tibia and femur specimens were placed in a saline bath. After this, dual-energy x-ray absorptiometry (DEXA) scanning of the metaphyseal and diaphyseal regions of interest for ACL reconstruction was performed using an x-ray fan beam scanning system (Hologic QDR-1000 Whole Body X-Ray Bone Densitometer; Hologic Inc, Waltham,

Results

Our use of paired femur and tibia specimens helped to attain comparable femur (Table 1) and tibia (Table 2) BMD between groups. The mean femur specimen BMD (.76 g/cm²) was significantly higher than the mean tibia specimen BMD (.56 g/cm²) (P = .04).

BioScrew fixation of a QHTG in a femoral tunnel showed superior load at failure and stiffness to QHTG-femoral tunnel fixation using an RCI titanium interference screw (Table 1). Significant differences were not observed for QHTG-tibial tunnel fixation

Discussion

Mean tibia (.57 g/cm²) and femur (.76 g/cm²) specimen BMD was considerably less than that reported in young active female subjects using a similar DEXA scanning technique (tibia metaphysis BMD approximately = 1.1 ± .12 g/cm², femoral metaphysis BMD approximately = 1.27 ± .14 g/cm²). ¹³ The lower BMD of the elderly cadaver bone used in our study limits the generalizability of our findings. Young cadaveric bone would be the ideal substrate for biomechanical testing, but this type of tissue is

Acknowledgment

The authors thank Linvatec for providing materials for this research and Ray Neef and Robert Morgan who initiated this research.

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Citation Excerpt :
We observed a preference for bioabsorbable interference screws for tibial fixation. Some authors40–42 reported that metal screws, compared with bioabsorbable screws, had higher rates of graft laceration in hamstring ACL reconstruction. A meta-analysis that compared ACL reconstruction outcomes between bioabsorbable and metallic screws found no significant differences in functional outcomes or stability.43
The Magellan Society is composed of > 150 high-volume fellowship-trained sports surgeons from four continents. These surgeons represent their regional sports organisations in travelling fellowships and are considered to be opinion leaders in their respective organisations. Prior to the 2014 Magellan Meeting in Arima, Japan, a survey was conducted to understand how Magellan members perform anterior cruciate ligament (ACL) reconstruction. This study aims to better understand how ACL reconstruction is performed by sports surgeons worldwide and to determine differences in surgical practice.
A survey was conducted prior to the Magellan Meeting in Arima, Japan. Information on ACL graft of choice for primary surgery and revision surgery, preferred surgical techniques, and femoral and tibial graft fixation methods was collected. The incidence of meniscal tears and the management of injuries in ACL surgery were also studied. The results of the survey are discussed in this article.
A response rate of 51% (72 member respondents) was achieved for this survey. Hamstring autograft (58%) was the graft of choice for primary ACL reconstruction. The next most common autograft used was bone patella tendon bone autograft (28%). Allograft was the graft of choice in only 4% of respondents. The region of origin of surgeons and the age of surgeons were factors in the ACL graft of choice. Seventy-five percent of surgeons practised single-bundle ACL reconstructions only, 22% performed both single-bundle and double-bundle ACL reconstructions, and 3% performed double-bundle ACL reconstructions exclusively. Sixty-two percent of the respondents drilled femoral tunnels using the anteromedial portal technique. Meniscus repairs were performed in 25% of ACL reconstructions, on average.
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: Supported in part by Linvatec Inc, Largo, Florida.

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Original articleSoft-Tissue Interference Fixation: Bioabsorbable Screw Versus Metal Screw

Section snippets

Methods

Results

Discussion

Acknowledgment

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Hamstring tendon grafts for reconstruction of the anterior cruciate ligamentBiomechanical evaluation of the use of multiple strands and tensioning techniques

J Bone Joint Surg Am

Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation

J Bone Joint Surg Am

Original article
Soft-Tissue Interference Fixation: Bioabsorbable Screw Versus Metal Screw