Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 200, Rome, Italy.
Br Med Bull. 2014;109:19-29. doi: 10.1093/bmb/ldt038. Epub 2013 Dec 18.
Approximately 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the USA each year. Interference screw fixation is considered the standard for rigid fixation of the graft and provides higher fixation strength compared with other devices such as staples or buttons. The present study summarizes the latest evidence comparing the effectiveness of the available classes of interference screws for fixation of ACL grafts.
A comprehensive search of the CINAHL, PubMed, Google Scholar, Embase Biomedical databases and the Cochrane Central Registry of Controlled Trials was performed in March 2013. Twelve studies met our inclusion criteria.
Most studies showed no intergroup difference in terms of outcomes measured with validated clinical scores such as IKDC (International Knee Documentation Committee), Lysholm score and Tegner activity level. There was no significant difference regarding range of motion. Knee stability as evaluated with pivot shift and KT arthrometer showed a significant difference only in one study, favouring metallic interference screws. Tunnel widening is much more evident and marked patients who underwent ACL reconstruction with bioabsorbable screws, with no influence on the final clinical results achieved. Complication rates between the two screw classes were similar. The average modified Coleman methodology score was 74.67. AREAS OF UNCERTAINTY/RESEARCH NEED: The data comparing the outcomes achieved by two different materials for fixation, bioabsorbable and metallic, to be used during single-bundle ACL reconstruction, showed no significant difference in the final patient outcomes, in terms of clinical scores, clinical evaluation and imaging.
美国每年大约进行 10 万例前交叉韧带（ACL）重建手术。干扰螺钉固定被认为是移植刚性固定的标准，与其他装置（如钉书钉或纽扣）相比，它提供更高的固定强度。本研究总结了比较目前可用的各种干扰螺钉类固定 ACL 移植物的有效性的最新证据。
2013 年 3 月，对 CINAHL、PubMed、Google Scholar、Embase 生物医学数据库和 Cochrane 对照试验中心注册进行了全面检索。有 12 项研究符合我们的纳入标准。
大多数研究表明，在使用经过验证的临床评分（如 IKDC（国际膝关节文献委员会）、Lysholm 评分和 Tegner 活动水平）测量的结果方面，各研究组之间没有差异。在运动范围方面没有显著差异。只有一项研究表明，用 pivot shift 和 KT 关节测径仪评估的膝关节稳定性存在显著差异，金属干扰螺钉更有利。隧道增宽在接受 ACL 重建的患者中更为明显，这些患者使用可吸收螺钉，对最终获得的临床结果没有影响。两种螺钉类的并发症发生率相似。平均改良 Coleman 方法评分为 74.67。
不确定性/研究需求领域：比较两种不同材料（可吸收和金属）用于固定单束 ACL 重建的结果的数据显示，在最终患者结果方面，即临床评分、临床评估和影像学方面，没有显著差异。
